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00133446

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RADIOLOGY: HEPATOBILIARY: Case# 32853: CIRRHOSIS, MULTIFOCAL HCC. This is a 60 year old white male with alcoholic cirrhosis who now presents with worsening intractable pruritis, jaundice and hepatic failure. The liver has a cirrhotic morphology along with a large, heterogeneous low attenuating mass lesion involving predominantly the left hepatic lobe and measuring approximately 12.5 cm x 20 cm in its maximum anteroposterior and transverse dimensions. The mass has scattered areas of hypodensity and is displacing the adjacent vascular structures. The vessels within the mass are attenuated. A large number of abnormal blood vessels are seen supplying this tumor mass. The splenoportal axis is visualized up to the level of the confluence of the splenic vein and superior mesenteric vein. The portal vein itself is not visualized indicating prior occlusion. Extensive collateral circulation is noted involving the gastrohepatic, splenogastric, paraesophageal and paraumbilical collaterals in the anterior abdominal wall. A moderate amount of ascites is noted. The spleen itself is not significantly enlarged and no focal lesions are identified in it. Also noted is a small filling defect in the suprahepatic portion of the IVC. Multiple gallstones are noted. Although uncommon in the United States, hepatocellular carcinoma is an important cause of death in parts of Africa and Asia because of the hepatotrophic viruses. In the United States, eighty percent of hepatocellular carcinomas arise in cirrhotic livers. Three patterns of tumor growth are seen: 50% present as a solitary tumor, 30% as a diffuse infiltrative tumor, and 20% as a multinodular tumor. The tumor usually appears as a hypodense or isodense lesion on nonenhanced images and enhances prominently during the arterial phase on dynamic contrast injection. Areas of tumor necrosis and calcification are common. Tumor invasion of hepatic and portal veins occurs frequently.

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Peter Anderson
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