Case 91:   Hepatocellular Carcinoma (HCC)

Diagnostic Category:

Clinical Presentation:

56 year old man with hepatitis B.

CT: Pseudocapsule, fibrotic, without washout, mosaic architecture, steatosis

Imaging Findings:

CT shows diffuse fatty infiltration of the liver and a hypervascular HCC in segment 8. Mass is hypervascular, but note that compared to the background liver, the mass is hyperdense on unenhanced images and iso- to hyperdense on both portal venous and equilibrium phases (no typical washout due to hypodense hepatic steatosis). Hypovascular tumor components laterally on arterial and portal venous phases (arrowheads) enhance on the equilibrium phase (arrowhead) slightly more than other tumor portions, suggesting fibrotic components. A fibrotic pseudocapsule is best seen on the unenhanced image. Note overall nodular enhancement of variable density with hyper- and hypovascular compartments, representing mosaic architecture classic for HCC.