Multifocal hepatocelullar carcinoma

Case contributed by Dr Ian Bickle

Presentation

Asymptomatic. High liver enzymes. No alcohol consumption. No prior medical history.

Patient Data

Age: 50
Gender: Male
Ultrasound

Two solid heterogeneous lesions in the right lobe of the liver.  No cystic elements.

The background echo-texture of the liver is a little coarse.

Following the ultrasound report, the serum alpha-feta protein (AFP) was measured, which was elevated at 55.

Several lesions of variable size with avid arterial enhancement in the right lobe of the liver, with subsequent contrast washout. The largest lesion is seen in segment 4A/8, measuring 5.1cm.  Additional lesions are seen in segment 4B and two lesions measuring 1.4 cm and 2 cm at the periphery of segment 8.

Two cysts measuring 2.5cm and 1.6cm in segment 8 and segment 5/8. 

The outline of the liver is nodular in keeping with cirrhosis. 

Patent portal vein.   Normal spleen.

No upper abdomimal lymphadenopathy.

Gallstones.

Case Discussion

This patent was a previously undiagnosed hepatitis C carrier.  A group prone to cirrhosis and hepatocellular carcinoma.

The lesions in the liver demonstrate the typical features of HCC with avid arterial enhancement with rapid washout.

It is not uncommon for HCC to be multifocal at presentation.

With the typical imaging findings and a raising alpha feta protein, biopsy is often not required, not least due to the significant risk of haemorrhage with such a vascular tumour.

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Case information

rID: 55362
Case created: 31st Aug 2017
Last edited: 9th Sep 2017
Inclusion in quiz mode: Included

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