Massive HCC Case Study-1

CASE STUDY-1

Massive Hepatocellular Carcinoma (HCC)

Ultrasound • Liver Oncology • Educational Case

Ultrasonography demonstrates a large heterogeneous mass lesion occupying a significant portion of the liver, showing mixed echogenicity with areas of necrosis. The lesion has irregular margins and causes distortion of normal hepatic architecture, findings highly suggestive of massive hepatocellular carcinoma.

Fig-1

Fig. 1—Ultrasound image showing a massive heterogeneous hepatic mass with mixed echogenicity and internal necrotic areas (arrows).

Findings: A large lobulated lesion involving the right lobe of the liver, predominantly heterogeneous with hypoechoic and hyperechoic components. Internal vascularity may be seen on Doppler. Adjacent liver parenchyma appears coarse, suggesting underlying chronic liver disease.

Impression: Imaging features are suggestive of massive hepatocellular carcinoma. Correlation with AFP levels and contrast-enhanced CT/MRI is advised.

Patient Symptoms

Patients commonly present with right upper quadrant abdominal pain, abdominal distension, weight loss, anorexia, and features of chronic liver disease. Jaundice may be present in advanced cases.

Ultrasound Technique

Abdominal ultrasound is performed using a low-frequency curvilinear transducer. The liver is evaluated in multiple planes with assessment of lesion size, echotexture, vascularity, and involvement of adjacent structures.

Doppler Evaluation

Color and spectral Doppler may demonstrate internal arterial vascularity, tumoral vessels, or portal vein invasion, which supports malignant etiology.

Key Ultrasound Features of Massive HCC

• Large heterogeneous hepatic mass
• Irregular or lobulated margins
• Areas of necrosis or hemorrhage
• Internal vascularity on Doppler
• Possible portal vein thrombosis

Differential Diagnosis

Differential considerations include hepatic metastasis, intrahepatic cholangiocarcinoma, hepatic abscess, and large hemangioma. Clinical correlation and multiphasic imaging help establish diagnosis.

Recommended Further Evaluation

Contrast-enhanced CT or MRI liver protocol, serum alpha-fetoprotein (AFP) levels, and histopathological confirmation when required.

Abnormal Condition / Findings

PRIMARY HEPATIC MALIGNANCY
📄 Hepatocellular carcinoma (HCC)
📄 Fibrolamellar HCC
VASCULAR INVOLVEMENT
📄 Portal vein thrombosis
📄 Hepatic vein invasion

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Declaration

This case is presented solely for educational and academic purposes. Patient identity and clinical details have been anonymized.