Metastatic breast cancer mimicking hepatocellular carcinoma: differences in noninvasive guidelines

Hepatocellular carcinoma (HCC), unlike most solid tumors, can be diagnosed noninvasively. We present a case that highlights an important clinical difference between two established guidelines: National Cancer Comprehensive Network (NCCN) and Barcelona-2000 EASL Conference (European Association for the Study of the Liver). Our patient had a large liver mass extending into the right atrium with elevation of the alpha-fetoprotein to 1,130 ng/mL. The radiographic and laboratory evidence is sufficient using NCCN guidelines to initiate palliative treatment for HCC. The Barcelona-2000 EASL Conference guideline for noninvasive diagnosis is restricted to cirrhotic patients. Our patient did not have a history of chronic liver disease or active hepatitis, and a biopsy was performed that demonstrated breast cancer.