Case 206:   Hepatocellular Carcinoma (HCC)

Diagnostic Category:

Clinical Presentation:

40 year old woman with a palpable right flank lump.

MR: Giant, with central necrosis and pseudocapsule

Imaging Findings:

MR shows large hypervascular mass in the right hepatic lobe with mosaic architecture on arterial phase (i.e. hypervascular and hypovascular compartments in a random order) and washout and pseudocapsule on equilibrium phase, characteristic for HCC.  No enhancement of the central area, but marked hyperintensity on T2, representing a small portion of necrosis, mimicking a scar on imaging given its small size in relation to the large mass. 

Patient was treated with several cycles of TACE before she underwent extended right hemihepatectomy for tumor resection (see CT after TACE). Resection specimen one year following first TACE demonstrated moderately-differentiated hepatocellular carcinoma with central necrosis, which metastasized two years after surgery intra- and extrahepatically (not shown). Note necrotic (yellow) tumor portions peripherally as a result of TACE, as well as centrally, mimicking a scar on imaging. No cirrhosis. 

Pathology specimen photo courtesy of Matthew M. Yeh, MD, PhD, Department of Pathology, University of Washington, Seattle, WA.