Test yourself case study: hepatic mass

Case study:

A 53-year-old man with hepatitis C and cirrhosis comes for a follow-up office visit. He feels fatigued but has no other new signs or symptoms. The patient has a history of alcohol abuse but has been abstinent for 8 months following a treatment program. He now attends weekly Alcoholics Anonymous meetings. Complications of the hepatitis C and cirrhosis have included ascites and encephalopathy, both of which are controlled by medications.

Physical examination discloses mild jaundice, spider angiomata, splenomegaly and mild peripheral edema.

Laboratory studies

Hemoglobin 13.3 g/dL (133 g/L)
Platelet count 84,000/?L (84 × 109/L)
Serum aspartate aminotransferase 73 U/L
Serum alanine aminotransferase 64 U/L
Serum alkaline phosphatase 119 U/L
Serum total bilirubin 3.2 mg/dL (54.72 ?mol/L)
Serum albumin 3.6 g/dL (36 g/L)
INR 1.4
Serum α-fetoprotein Normal

Abdominal ultrasonography discloses a coarse echotexture of the liver, mild ascites, and a 2.2-cm hyperechoic hepatic mass that was not seen on previous imaging studies. A CT scan of the liver shows vascular enhancement of the mass.

Which of the following is the most likely diagnosis?

A. Metastatic cancer
B. Focal nodular hyperplasia
C. Hepatocellular carcinoma
D. Cavernous hemangioma
E. Regenerative nodule

The correct answer is C. Hepatocellular carcinoma. The complete MKSAP syllabus and critique on this topic is available to subscribers as item 4 in the Gastroenterology & Hepatology module.