Spontaneous rupture of hepatocellular carcinoma

Case contributed by Dr MT. Niknejad

Presentation

A middle-aged woman with acute abdominal pain and report of large hepatic mass and some abdominal fluid on ultrasound evaluation.

Patient Data

Age: 40 years
Gender: Female

A 111×86×103 mm well defined mass is noted at the right liver lobe. The mass is hypersignal, mainly on T2W images with areas of low signal foci. The T2W low signal areas are high signal on T1W in favor of hemorrhagic components. After contrast injection, the T2W high signal areas show inhomogeneous enhancement with centripetal extension. The low signal regions remain unenhanced. 

A heterosignal non-enhancing subcapsular collection at inferior mass proximity is noted, extended to subhepatic space.

The patient underwent laparotomy and liver mass resection. The histopathologic findings and IHC confirmed ruptured hepatocellular carcinoma.

Case Discussion

Pathology proved hepatocellular carcinoma with spontaneous rupture and subcapsular and subhepatic hematoma formation.

Spontaneous rupture and hemorrhage are rare complications of HCC. When mass protrudes out of the liver contours, it might tear more easily than in cases where the mass is surrounded by liver parenchyma. 

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