Giant Multinodular Liver Hepatocellular Carcinoma: Case Report

Introduction:Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, accounting for up to 85% cases with major risk factor of liver cirrhosis. The aim of this study is to present a rare case of an unusually large multinodular HCC with duodenal invasion in a non-cirrhotic patient, treated with extensive surgical tumor resection followed by systemic therapy. Case report: 68-year-old male presented with generalized weakness, cachexia and enlargement of the abdomen with no liver disease or risk factors. Advanced stage HCC was diagnosed with preserved liver function. Computer tomography revealed multiple liver lesions, the largest measuring 22x16x25cm. Based on these findings, debulking surgery was recommended. Before the surgery, patient presented with symptoms of gastrointestinal bleeding, thus tumor invasion of the duodenum was diagnosed. During the surgery, left hepatectomy was performed with duodenal wall resection. Duodenum defect required extended pyloroplasty. The resected specimen weighted 5,6kg. Histopathological examination revealed HCC, surrounded by reactive hepatitis and focal steatosis, with no evidence of cirrhosis. Postoperative period was uneventful. At 2-month follow-up, the patient reported gained weight and overall well-being, and liver function remained preserved. However, computed tomography revealed disease progression. Given the patient’s good performance status and disease progression, systemic immunotherapy was initiated. Conclusions:This case illustrates the challenges associated with unusually large multinodular HCC occurring in the absence of identifiable risk factors. As a result, optimal treatment selection requires multidisciplinary decision-making and an individualized approach to patient care.