[A case of massive hepatocellular carcinoma producing various imaging patterns after long-term follow-up]

A 62-year-old man had been previously diagnosed as having a 7-cm liver tumor in segment 4 at another hospital, but did not pursue treatment. Twenty-nine months later, he was referred to our hospital suffering from jaundice. Abdominal computed tomography( CT) revealed a 13.5-cm tumor in the liver( S4) with early staining and isodensity in the portal and equilibrium phases. Because magnetic resonance imaging (MRI) of this tumor showed central scarring in T2WI and uptake of EOB in the hepatocyte phase, focal nodular hyperplasia (FNH) was included as a differential diagnosis. Alternatively, the signal decreased out of phase, suggesting a possibility of hepatocellular carcinoma( HCC). We performed extended left lobe resection because of tumor growth and exclusion of the bile duct. Histopathological examination revealed well and moderately differentiated hepatocellular carcinoma with various types of pathological patterns, including necrosis, fat, and scarring. The patient remains well at 12 months after this surgery with no signs of recurrence.