Case Study: An old male with Hepatocellular Carcinoma (HCC)

Background: The most common type of primary liver cancer includes Hepatocellular carcinoma (HCC). It is well established that HCC is associated with chronic liver diseases, such as cirrhosis caused by hepatitis B or hepatitis C infection. Commonly HCC is diagnosed at advanced stages making median survival rate ranging from 0.5 to 2 years.

Clinical History: A 63 years male, ultrasound report (May 18, 2020) showed liver mass then trucut-biopsy was done from the mass for histological analysis which later (June 6, 2020) suggested Hepatocellular Carcinoma (HCC). FDG PET/CT study was suggested for staging.

Our Findings: This is an abnormal baseline FDG PET/CT study.

Large hypermetabolic centrally necrotic soft tissue mass involving right hepatic lobe with multiple small lesions in other segments are seen.

Hypermetabolic lymph nodes are seen in right posterior mediastinum, bilateral retrocrural and retroperitoneum.

Hypermetabolic soft tissue masses are seen in bilateral suprarenal region.

Extensive hypermetabolic bilateral pulmonary metastasis.

Evidence of right-sided mild pleural effusion with FDG contamination and pelvic ascites.

Urinary bladder shows two hypermetabolic soft tissue nodules over posterior wall.

Hypermetabolic soft tissue masses are seen in left parasternal, left distal sternal and right upper chest wall with destruction of underlying right ribs.

Hypermetabolic bony metastasis involving both femur, iliac bones, left mandible & few vertebrae.

Hypermetabolic muscular deposits seen in right tricep, left gluteal & bilateral paraspinal muscles.