Multifocal hepatocellular carcinoma in a noncirrhotic liver: A diagnostic pitfall mimicking cholangiocarcinoma and metastatic disease

Hepatocellular carcinoma (HCC) usually develops in cirrhotic livers, most often related to viral hepatitis or alcohol use. Its occurrence in noncirrhotic livers is uncommon and can mimic other hepatic malignancies. We report a 50-year-old patient presenting with abdominal discomfort, vomiting, and jaundice. Computed tomography (CT) revealed multiple heterogeneous hepatic lesions with capsular retraction but no cirrhotic features. In the absence of hepatitis or alcohol history, intrahepatic cholangiocarcinoma or metastases were initially suspected. Magnetic resonance imaging (MRI) demonstrated arterial hyperenhancement, washout, and late capsule enhancement, consistent with HCC. Tumor thrombus extended into the right hepatic vein and inferior vena cava. Ultrasound-guided biopsy confirmed HCC. This case highlights the diagnostic challenge of multifocal HCC in a noncirrhotic liver and underscores the importance of MRI and histopathology in achieving diagnostic certainty. Clinicians should maintain awareness of HCC even in the absence of cirrhosis or typical risk factors.