A Rare Case of Suspected Extrahepatic Manifestation of Primary Hcc [Conference Winner Abstract]

Introduction Hepatocellular carcinoma (HCC) ranks as the sixth most common malignancy and as the third-leading cause of cancer-related mortality globally [1]. Both computed tomography (CT) and magnetic resonance imaging (MRI) are essential imaging techniques for diagnosing HCC [2]. Moreover, in the case of non-cirrhotic liver, a biopsy is required for such a diagnosis [3]. However, HCC manifesting extrahepatically without known intrahepatic findings is extremely rare [4]. Case Presentation A 53-year-old male was diagnosed with hepatitis C virus (HCV) and liver cirrhosis. The HCV infection was successfully treated with glecaprevir/pibrentasvir. 6 months later at the follow-up visit alpha-fetoprotein value of 118099 was detected and abdominal ultrasound revealed a 2,5 cm mass in the hilum of the liver with no visible focal lesions in the liver parenchyma. Abdominal and chest CT revealed no intrahepatic lesions, but there were conglomerated lymph nodes around the portal vein, multiple pathologic lymph nodes in the liver hilum and foci in the lungs. After the CT, lymphoproliferative disorder was suspected, and it was decided to perform a biopsy of the mass in the liver hilum. The histopathological findings revealed cancerous tissue with HEP-positive and CK7- negative markers. The patient was diagnosed with HCC and started receiving systemic treatment of atezolizumab and bevacizumab. Discussion HCV infection frequently causes advanced liver fibrosis and cirrhosis and markedly increases the likelihood of developing HCC [5]. HCC is usually diagnosed when liver lesions larger than 1 cm exhibit arterial phase enhancement and washout of contrast media on dynamic CT or MRI [6]. HCC has previously been reported as ileal, vertebral, subphrenic, and pancreatic masses with occult hepatic HCC lesions [7–9]. Histology prevails as the gold standard for diagnosing HCC [10]. In this clinical case, MRI was not performed since it was not obligatory to determine the treatment for the patient. We recognize that the absence of MRI undermines the evidence for extrahepatic HCC with occult intrahepatic lesions thus this case has its limitations. Conclusions This case describes a rare incidence of primary HCC with occult liver lesions, manifesting mainly in the extrahepatic lymph nodes and lungs. Despite its rarity, physicians should have knowledge about the occurrence of such instances.