Hemorrhagic hepatocellullar carcinoma: a case report and literature review

Objective: To illustrate the CT findings of a case of hemorrhagic hepatocellular carcinoma and to review the literature of differentiation of nontraumatic hemorrhagic liver masses. Method: A case of hemorrhagic hepatocellullar carcinoma was analysed and literatures were reviewed. Results: Abdominal ultrasound revealed a well-defined heteroechonic area with liquefied foci in the right lobe of liver. Precontrast CT scan revealed a heterogeneously dense mass in the right lobe of liver. There was hyperdense and hypodense areas in the mass and irregular soft tissue in the margin of the mass. Contrast enhanced CT scan showed the margin with soft tissue density enhanced in the hepatic arterial phase, but it decreased in the portal phase and delayed phase. The hyperdense and hypodense areas had no enhancement. Histopathology showed poorly differentiated hepatocellular carcinoma invaded the capsule. Immunohistochemistry showed hepatocyte positive and AFP negative. Conclusion: Spontaneous bleeding of hepatic tumor is a rare condition. The key to distinguish is to observe the mass comprehensively and to identify the soft tissue carefully in the mass. (authors)