Published online Nov 26, 2023. doi: 10.12998/wjcc.v11.i33.8078
Peer-review started: October 4, 2023
First decision: October 24, 2023
Revised: November 2, 2023
Accepted: November 17, 2023
Article in press: November 17, 2023
Published online: November 26, 2023
Hepatocellular carcinoma (HCC) is difficult to treat and has a high mortality rate, emphasizing the importance of early diagnosis and treatment. If characteristic radiologic findings and underlying liver disease are present, a diagnosis can be made without a biopsy. However, when HCC is accompanied by a liver abscess, diagnosis might be delayed by atypical radiologic findings. This case report aims to assist in the diagnosis of HCC, which can manifest in various forms.
A 75-year-old male presented to the Emergency Department with worsening fever and mental changes. He was diagnosed with liver cirrhosis six months earlier. Abdominal computed tomography (CT) raised our suspicion of an organized liver abscess. A follow-up CT scan after four weeks of antibiotic treatment showed a decrease in the liver lesion size. However, high fever recurred, and C-reactive protein increased to 14 mg/L. Aspiration of the liver lesion was performed, but no bacteria were identified. Blood culture revealed the presence of fungi. The patient received an additional four weeks of antibiotics and antifungal agents before being discharged. Approximately 10 mo later, a CT scan showed an increase in the lesion size, and biopsy was performed. The biopsy revealed an organized abscess with focal carcinomatous changes, for which surgery was performed. Postoperative histopathological examination revealed HCC, clear-cell variant. The nontumor liver tissue showed cirrhosis and an organized abscess.
Even if a liver abscess is suspected in a patient with cirrhosis, the possibility of HCC should be considered.
Core Tip: Hepatocellular carcinoma (HCC) is more difficult to treat and has a higher mortality rate than other carcinomas, emphasizing the importance of early diagnosis. Radiologic examination is crucial for diagnosing HCC. If characteristic findings and underlying liver disease are present, a diagnosis can be made, but when HCC is accompanied by a liver abscess, diagnosis may be delayed by atypical radiologic findings. The present patient was hospitalized for an organized liver abscess with calcification but was subsequently diagnosed with HCC. This case report aims to assist in the diagnosis of HCC, which can manifest in various forms.