A Case of Advanced Hepatocellular Carcinoma Without Cirrhosis History

Hepatocellular carcinoma (HCC) is one of the most common sequelae of liver disease, and it is the fourth leading cause of cancer worldwide. This disease often arises from cirrhosis and chronic liver disease such as fatty liver disease or autoimmune hepatitis. HCC has particular prevalence in developed countries where metabolic issues such as diabetes and obesity are common. Males and elderly patients are predominantly affected compared to females and young people, respectively. Lastly, patient presentations of HCC can vary depending on staging, cirrhosis state, and current symptoms. Diagnosis of HCC is uniquely defined with ultrasound, CT, and MRI. HCC demonstrates a distinctive arterial phase hyperenhancement and portal venous washout on contrast CT, which differentiates it from other liver masses and allows for accurate diagnosis without invasive biopsy. Additionally, an AFP level above $400 \mathrm{ng} / \mathrm{mL}$ can assist with HCC screening and diagnosis. The management of HCC involves many avenues of care involving tumor characterization, liver function and compensation, and patient symptoms and preferences. Depending on patient status and disease progression, treatments may include surgical resection, liver transplantation, and systemic therapies. In this case report, we have a 77-year-old female without a history of cirrhosis developing advanced HCC. After presenting to the ED with jaundice and altered consciousness, she was diagnosed with HCC via contrastenhanced CT. This is a case with an atypical presentation of HCC in a previously non-cirrhotic liver. Therefore, the role of CT in diagnosing HCC is pivotal for timely management, averting the need to wait for biopsy results. This patient presented with a profile of HCC that precluded traditional therapeutic interventions such as surgical resection, liver transplant, or chemotherapy, suggesting the consideration for palliative care. Furthermore, this case highlights age as a significant risk factor and highlights the importance of comprehensive screening in at-risk populations to improve early detection and patient outcomes.