Medullary-like hepatocellular carcinoma.

Area of Science:

• Hepatology
• Oncology
• Pathology

Background:

• Hepatocellular carcinoma (HCC) is the most common primary liver cancer.
• Pathological variants influence HCC behavior and prognosis.
• Medullary-like HCC is an extremely rare subtype, with only two previous reports.

Observation:

• A 72-year-old man with non-cirrhotic liver disease due to hepatitis C virus presented with two HCC lesions.
• One lesion was classic HCC, treated with chemoembolization.
• The second lesion was a PET/CT-positive carcinoma with a metastatic coeliac lymph node, surgically resected.

Findings:

• Histopathology confirmed the second lesion as medullary-like HCC.
• The coeliac lymph node was confirmed as metastatic.
• An incidental B-cell lymphoma was found in the hepatic pedicle lymph nodes.

Implications:

• This is the third reported case of medullary-like HCC globally.
• It is the first reported case of medullary-like HCC co-occurring with typical HCC.
• This case expands the understanding of rare HCC variants and their presentation.