Giant pedunculated liver mass: primary hepatocellular carcinoma masquerading as hepatic haemangioma

A woman in her mid-60s was referred to surgeons with a 2-week history of worsening right-sided abdominal pain. CT demonstrated a large encapsulated, pedunculated hepatic lesion with active intracapsular bleeding and free fluid but nil further lesions. Findings suggested giant hepatic haemangioma; surgical excision took place the following day. Histopathology however confirmed malignancy. Pedunculated hepatocellular carcinoma (HCC) is rare but characteristically large and encapsulated. Sporadic case reports indicate that diagnosis is typically challenging and delayed with liver metastases at presentation. This case describes a patient with no clear risk factors for HCC found to have a well-defined, encapsulated and pedunculated mass but no detected metastasis or other lesions on initial CT. In this instance, subsequent MRI did identify further lesions in the liver. Such cases are limited in the literature: much remains to be learnt regarding presentation, differential diagnoses, investigation and management.