Multifocal hepatocellular carcinoma
Chronic liver disease with rising AFP and focal lesion in ultrasound
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Multiple well defined round lesions are seen within the liver the larger ones being subcapsular, showing late arterial phase enhancement and equilibrium phase washout, typical of hepatocellular carcinoma. Liver shows morphological features of cirrhosis in the form of nodular surface and parenchyma. Enlarged spleen. No ascites. Patent dilated portal vein and its branches.
Hepatocellular carcinoma is notorious for its arterial blood supply becoming conspicuous in late arterial phase and washing out in venous / equilibrium phase. The multifocal nature of malignancy is well demonstrated in this case in the background of chronic liver disease with portal hypertension.