Infiltrative and multifocal hepatocellular carcinoma with malignant portal vein thrombosis in a cirrhotic liver
Diagnosis almost certain
Presentation
Cirrhotic patient with jaundice, abdominal pain and significantly elevated alpha feto-protein.
Patient Data
Age: 50 years
Gender: Male
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- The liver shows cirrhotic configuration with irregular nodular outline and hypertrophied left and caudate lobes.
- The left liver lobe segments II and III shows a large ill-defined infiltrative mass lesion having irregular outline and mixed signals with areas of breaking down within. This lesion roughly measures 16 X 11.5 X 12 cm in its maximal axial cross sectional & craniocaudal dimensions and causing contour bulge. It elicits hypointense T1, intermediate to high T2 as well as restricted diffusion. The lesion shows intense post-contrast enhancement in the arterial phase with washout in the portal-venous and delayed phases.
- A few smaller lesions of similar signal and enhancement pattern are seen scattered in the right lobe, the largest is at segment VIII (hepatic dome as well as juxta-caval) as well as segment VI and segment V. They show arterial enhancement with washout in the portal-venous and delayed phases with coronal / capsular enhancement.
- Multiple innumerable regenerative / dysplastic small hypervascular and arterially enhancing nodules are seen scattered in both liver lobes.
- Malignant thrombosis of the left portal vein with similar malignant enhancement criteria.
- No evident intra-hepatic or extra-hepatic biliary tree dilatation.
- The spleen is enlarged, with no definite focal lesion.
- The right kidney shows a 4.5 X 3.3 cm cortical cyst, otherwise, normal both kidneys.
- Normal pancreas.
- Mild to moderate ascites is noted, mainly peri-hepatic.
- Multiple enlarged para-aortic, celiac and porta hepatis lymph nodes are noted, the largest is 3.5 X 2.5 cm.
Case Discussion
Liver cirrhosis with a large infiltrative and extensive left liver lobe malignant hepatic focal lesion consistent with infiltrative hepatocellular carcinoma (HCC), with malignant left portal vein thrombosis, as well as two right liver lobe smaller hepatocellular carcinomas, abdominal lymphadenopathy, ascites and splenomegaly.
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