• 67 year old male presented with Right upper quadrant pain for 2 months, weight gain of 2 kilos and abdominal distension
  • Past medical history- Diabetes type 2 for 20 years, hypertension
  • Blood profile –
  • Hb – 9.7gm/dl, Platelets – 81,000/cmm
  • Total Bilirubin- 3.2gm/dl, ALT- 121, AST- 167, ALP-155, GGT- 212
  • Hepatitis B and C- Non reactive, ANA – Negative, S.Ferritin- 145 ug/dl
  • AFP – 1245 IU/ml
  • INR 2.5,S. Albumin- 2.4
  • cirrhotic liver, large 9×8 cm lesion in the left lobe if liver with arterial enhancement
  • PV thrombosis, Moderate ascites
  • CT Abdomen and Pelvis –


  • 20 % of HCC have normal AFP so one must not rely on it
  • In a cirrhotic liver arterially enhancing lesion with venous washout is virtually diagnostic of HCC
  • <1cm focal liver lesion can be observed with serial MRI / CT imaging


  • NASH is the likely etiology of this cirrhosis and decompensate liver disease is often secondary to development of HCC.
  • Decompensate liver disease and Child Pugh stage B, C is a contraindication to definitive surgery.
  • TACE/RFA ablation may not be feasible in view of portal vein thrombosis, size and patient condition

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