Macrotrabecular-Massive Hepatocellular Carcinoma: A Case Report

Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) is a rare and aggressive molecular subtype of hepatocellular carcinoma (HCC) associated with a poor prognosis. Unlike typical HCC, which commonly arises in the context of cirrhosis, MTM-HCC can develop in non-cirrhotic livers, presenting unique diagnostic and therapeutic challenges. This case report describes a 35-year-old male who presented with persistent epigastric pain, fatigue, and loss of appetite. Clinical examination revealed hepatomegaly, prompting advanced imaging and laboratory investigations. Imaging studies identified a large hepatic mass with portal vein thrombosis and metastatic lesions, while histopathological analysis confirmed the diagnosis of MTM-HCC. The patient initiated treatment with a combination of immune checkpoint inhibitors and anti-angiogenic agents, which represent the current standard for advanced HCC. Despite initial adherence, disease progression was observed after four cycles of therapy. The patient passed away less than two months after his last consultation. This clinical course highlights the aggressive nature of MTM-HCC and its limited responsiveness to existing therapeutic protocols. MTM-HCC is characterized by distinctive histological and molecular features that differentiate it from other HCC subtypes. These include specific genetic mutations and protein expression patterns that contribute to its aggressive behavior and poor prognosis. Advanced imaging modalities combined with histopathological analysis remain crucial for accurate diagnosis and classification. This case emphasizes the critical need for heightened clinical vigilance, particularly in younger patients with atypical presentations of liver disease. It also underscores the importance of developing more effective, tailored therapeutic strategies for MTM-HCC. Further research into its molecular characteristics and inclusion in clinical trials is essential to improving outcomes for patients with this challenging and understudied subtype of liver cancer.