Multifocal hepatocellular carcinoma in cirrhotic patient

Case contributed by Mohammad Taghi Niknejad
Diagnosis almost certain


Elevated liver enzymes and jaundices.

Patient Data

Age: 80 years
Gender: Male

The liver has surface and parenchymal nodularity in keeping cirrhosis.

Multiple hypervascular masses with contrast washout are seen in the liver less than 30 mm, most consistent with hepatocellular carcinoma.

Umbilical vein recanalization and several collateral vessels at perigastric and perisplenic regions suggest portal hypertension.

The spleen is enlarged, and its cephalocaudal height is measured 145 mm. 

Gallstone in the gallbladder neck.

A few nonenhanced simple cortical cysts are seen in both kidneys, with maximum diameters of 15 mm.

Case Discussion

Multifocal hypervascular masses in a cirrhotic liver are highly suggestive of hepatocellular carcinoma (HCC), the most common primary malignancy of the liver strongly associated with cirrhosis1.

It should notice that alpha-fetoprotein (AFP) levels are elevated in 50-75% of cases, and normal levels of AFP don't rule out the HCC in a cirrhotic patient with hypervascular mass2.

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