Description

Abstract: Hepatocellular carcinoma (HCC) is one of the most common sequelae of liver
disease, and it is the fourth leading cause of cancer worldwide. This disease often arises from
cirrhosis and chronic liver disease such as fatty liver disease or autoimmune hepatitis. HCC
has particular prevalence in developed countries where metabolic issues such as diabetes and
obesity are common. Males and elderly patients are predominantly affected compared to
females and young people, respectively. Lastly, patient presentations of HCC can vary
depending on staging, cirrhosis state, and current symptoms.
Diagnosis of HCC is uniquely defined with ultrasound, CT, and MRI. HCC demonstrates a
distinctive arterial phase hyperenhancement and portal venous washout on contrast CT,
which differentiates it from other liver masses and allows for accurate diagnosis without
invasive biopsy. Additionally, an AFP level above 400 ng/mL can assist with HCC screening
and diagnosis. The management of HCC involves many avenues of care involving tumor
characterization, liver function and compensation, and patient symptoms and preferences.
Depending on patient status and disease progression, treatments may include surgical
resection, liver transplantation, and systemic therapies.
In this case report, we have a 77-year-old female without a history of cirrhosis developing
advanced HCC. After presenting to the ED with jaundice and altered consciousness, she was
diagnosed with HCC via contrast-enhanced CT. This is a case with an atypical presentation
of HCC in a previously non-cirrhotic liver. Therefore, the role of CT in diagnosing HCC is
pivotal for timely management, averting the need to wait for biopsy results. This patient
presented with a profile of HCC that precluded traditional therapeutic interventions such as
surgical resection, liver transplant, or chemotherapy, suggesting the consideration for
palliative care. Furthermore, this case highlights age as a significant risk factor and highlights
the importance of comprehensive screening in at-risk populations to improve early detection
and patient outcomes.

Keywords: hepatocellular carcinoma, liver disease, cirrhosis, old age hepatocellular
carcinoma