# Metastatic Hepatocellular Carcinoma Presenting as a Large Abdominal Mass and Secondary Varicocele in a Hepatitis B Patient: A Case Report

## TL;DR

A 50-year-old man with a history of hepatitis B developed aggressive liver cancer that presented as an abdominal mass and varicocele, requiring palliative surgery and systemic therapy.

## Contribution

This case report highlights an atypical presentation of hepatocellular carcinoma in a patient with minimal liver disease history.

## Key findings

- The patient presented with a rapidly enlarging epigastric mass and left-sided varicocele.
- Histopathology confirmed poorly differentiated hepatocellular carcinoma with intrahepatic metastases.
- Palliative surgical debulking and systemic therapy were recommended to manage tumor burden.

## Abstract

We report a rare and aggressive presentation of hepatocellular carcinoma in a 50-year-old man with a brief history of hepatitis B infection. The patient presented with a rapidly enlarging epigastric mass, recurrent hematemesis, and a newly developed left-sided varicocele. Imaging revealed a large exophytic hepatic mass with evidence of vascular displacement and intrahepatic metastases. Histopathological examination confirmed a diagnosis of poorly differentiated hepatocellular carcinoma. A multidisciplinary tumor board recommended palliative surgical debulking followed by systemic therapy to address tumor burden and improve quality of life. This case highlights the diagnostic and management challenges associated with atypical presentations of hepatocellular carcinoma in patients with minimal liver disease history.