Hypervascular Lesion in a Cirrhotic Liver: A Case Report

Hepatocellular carcinoma (HCC) is the leading cause of death among patients with cirrhosis. Therefore, a focal hepatic lesion in a patient with cirrhosis must always be investigated for its high risk of cancer. However, when hepatic lesions in an imaging exam do not present the typical characteristics of a malignant or a benignant tumor, diagnosis may be a challenge. The biopsy can be used in these circumstances, but, as shown by this case, even that can be misleading. A 54-year-old male patient with cirrhosis presented with abdominal pain, jaundice, nausea and vomits. He performed a biopsy at another service, with the result being focal nodular hyperplasia (FNH). He presented adequate hepatic function, and alpha-fetoprotein level was 6.4. Upon first consultation, we required the slides to be brought to our service and reviewed. Our revision also showed no signs of malignancy. Magnetic resonance imaging showed a large hepatic tumor in segments V and VI, predominantly exofitic, with a central scar. The tumor was surgically removed, and its dimensions were 14 × 10 × 9 cm. Microscopic examination revealed an HCC. Even though histological diagnosis was not necessary to indicate surgery, due to its exofitic nature and adequate hepatic function, we discuss the diagnostic characteristics of both HCC and FNH that could help other medical groups in cases where the position of a liver tumor could make the decision to operate more difficult.