జీర్ణకోశ & జీర్ణ వ్యవస్థ

నైరూప్య

A Focal Liver Lesion in a Patient with Chronic Hepatitis B and Cirrhosis not always Hepatocellular Carcinoma

Samuel Raimundo Fernandes, Joana Rita Carvalho,Luis Araujo Correia, Artur Silva, Cilenia Baldaia, Helena Cortez-Pinto, Jose Velosa

Chronic liver disease and cirrhosis are known risk factors for hepatocellular carcinoma (HCC). We present a 68- year old male patient with chronic hepatitis B infection and cirrhosis admitted for investigation of a 10-cm solid liver nodule detected during surveillance ultrasound. Abdominal computed tomography (CT) revealed an additional 3 cm lesion in the right liver lobe and multiple lesions in the spleen without typical features of HCC. Histopathologic examination of the liver nodule biopsy was compatible with metastasis from a neuroendocrine tumor. The patient was referred for chemotherapy but unfortunately died 2 months later from infectious complications. The present case seemed unusual considering that the background chronic liver disease would make HCC a more likely diagnosis. The multiple comorbidities presented by our patient provided an additional challenge by broadening the differential diagnosis.