RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT

Abstract

Hepatocellular carcinoma can mimic benign lesions like liver haemangioma with atypical image findings and can manifest in an acute emergency where a diagnostic dilemma is encountered that can alter the phase of management. We hereby present a case of a 70-year-old male patient with multiple medical comorbidities who presented to us initially in June 2021 with a history of blunt trauma abdomen. Ultrasound abdomen imaging was suggestive of bleeding from liver hemangioma. The patient underwent emergency exploratory laparotomy and hemostasis was achieved. After being clinically better he underwent angioembolisation of the bleeding vessels; unfortunately, he presented one year later with bleeding per rectum. On re-evaluation, imaging features were again consistent with giant liver hemangioma infiltrating ascending and transverse colon. Tumour markers were negative. Being nonamenable to angioembolisation at this setting he underwent exploratory laparotomy unblock right hemicolectomy + non-anatomical liver resection (segment 6, part of 5,7) on October 2022 based on intraoperative findings. Surprisingly the histopathology report was that of hepatocellular carcinoma (HCC). Detailed searching made us able to find these sorts of discordant presentations of HCC with negative tumor markers and atypical imaging findings. The patient was referred to our medical oncology department for expert management. The incidence of direct invasion of HCC to the gastrointestinal tract is approximately 0.5–2%. Colonic metastasis is uncommon in patients with HCC. The diagnosis of HCC is generally made by radiologic hallmarks of dynamic contrast imaging. Sometimes large HCCs may have atypical radiological contrast enhancement patterns thus mimicking hemangioma.