Steatohepatitic hepatocellular carcinoma (SH-HCC)

Case contributed by Jayanth Keshavamurthy
Diagnosis certain


Treated type 1 A HCV undergoes screening ultrasound of the liver for HCC every 6 months. AFP at diagnosis 7.0 ng/mL ( ref <6.1 ng/mL ).

Patient Data

Age: 65 years
Gender: Male

There is a new echogenic lesion in the liver concerning for a neoplasm, recommend multiphasic CT scan of the liver.

Multiphasic CT


Confirms a mass in segment IVa of the liver, not  characteristic for a hemangioma. MRI was recommended.

Multiphasic MRI


The lesion in segment IVa demonstrates rim-enhancement concerning for malignancy not necessarily HCC, biopsy recommended.

Thanks to Dr.Lakshmi Vemavarapu MD for the pathology description of the HCC.

Case Discussion

The patient was referred to a hepatologist and a hepatic surgeon for further management.

SH-HCC is a frequent variant of HCC in NAFLD patients and HCV patients. As a radiologist you will see above fatty features in CT, MRI and on sonogram. So have a low threshold for biopsy and evaluation when in doubt.

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