# Atypical Presentation of Hepatocellular Carcinoma in a Chronic Alcoholic: Diagnostic Challenges and Therapeutic Approach

## TL;DR

This case report details the atypical presentation and diagnosis of liver cancer in a chronic alcoholic, highlighting the challenges and treatment approach.

## Contribution

The paper presents a unique case of HCC in a chronic alcoholic with atypical features and emphasizes the need for thorough diagnostic evaluation.

## Key findings

- The patient showed hepatomegaly, free fluid, and multiple liver nodules on imaging.
- One nodule displayed HCC-specific imaging features confirmed by histopathology.
- The patient was scheduled for radiofrequency tumor ablation as treatment.

## Abstract

Hepatocellular carcinoma (HCC) is a primary malignancy of the liver, often arising in the context of chronic liver disease and cirrhosis. This case report describes the clinical presentation, diagnostic evaluation, and therapeutic intervention of a 72-year-old male with a long-standing history of alcohol use who presented with right hypochondrial pain. A 72-year-old male with a 20-year history of alcohol consumption presented with a one-month history of dull, aching pain in the right hypochondrium. Diagnostic imaging, including abdominal ultrasound and contrast-enhanced computed tomography (CECT), revealed significant hepatomegaly with nodular and irregular liver margins, free fluid in the abdomen and pelvis, and multiple hypodense nodules in both liver lobes. One nodule in the right lobe exhibited characteristic imaging features of hepatocellular carcinoma, including peripheral enhancement on the arterial phase and washout on the delayed phase. Histopathological analysis of a biopsy from the suspicious nodule confirmed the diagnosis of hepatocellular carcinoma. The patient was diagnosed with hepatocellular carcinoma based on clinical, radiological, and histopathological findings. He was subsequently scheduled for radiofrequency tumor ablation. This case underscores the importance of comprehensive diagnostic imaging and histopathological evaluation in patients with liver cirrhosis and suspected HCC, particularly in those with a history of chronic alcohol use.