S5489 A Rare Occurrence of Hepatocellular Carcinoma in a Younger Woman Patient

Introduction: Hepatocellular carcinomas (HCCs) are malignant tumors arising from mutations within normal hepatocytes. Over 80% of cases present in patients greater than or equal to 55 years of age with the incidence rates significantly dropping in younger patients.1 Additionally, cases often present with abnormal alpha-fetoprotein levels. We present a case of a large, well differentiated, hepatocellular carcinoma presenting in a younger woman patient with normal liver test values. Case Description/Methods: A 25-year-old woman presents with a history of several years of progressive abdominal pain, nausea with vomiting, easy fatigability, loss of appetite, and dyspnea upon exertion. The patient had a 10-year history of oral contraceptive (OCP) use. Computed tomography and MRI of the abdomen showed a complex mass measuring 9.1 × 7.2 × 7.2 cm within the right medial lobe of the liver. Aspartate aminotransferase, alanine aminotransferase and alpha fetoprotein levels were normal. OCPs were discontinued after the discovery of the mass, and the patient underwent portal vein embolization prior to a right partial hepatectomy. Upon histological analysis of the removed mass, reticulin stain was lost, supporting a final diagnosis of hepatocellular carcinoma. Additionally, glypican-3 was absent and Ki-87 was not increased. Discussion: Although incidence of hepatocellular carcinoma is highest in patients 55 and older 1, it can present in younger patients without history of liver disease. Indications may begin with generalized symptoms, such as abdominal pain or weight loss, and can worsen over time. Additionally, patients with HCCs often show elevated alpha fetoprotein, however, liver function tests can return with normal values. Therefore, although rare, hepatocellular carcinoma should be included in the differential diagnosis of liver mass cases, even in younger patients with normal liver panels. Reference 1. Abboud Y, Ismail M, Khan H, et al. Hepatocellular carcinoma incidence and mortality in the usa by sex, age, and race: A nationwide analysis of two decades. J Clin Transl Hepatol. 2024;12(2):172-181.