Controversy in the Treatment of Localized Hepatocellular Carcinoma

A 75-year-old man was found to have a solitary liver mass concerning for hepatocellular carcinoma (HCC). His medical history was notable for obesity, type 2 diabetes, and nonalcoholic fatty liver disease. A computed tomography scan of the abdomen was performed for abdominal pain and showed a 4.5 cm mass in the liver. Laboratory evaluation revealed total bilirubin 1.1 mg/dL, albumin 4.5 g/dL, prothrombin time 12.5 seconds, creatinine 1.2 mg/dL, platelets 199, and alpha fetoprotein 36 ng/mL. Magnetic resonance imaging of the abdomen showed a 4.5 cm mass in segment 6/7 of the liver demonstrating early arterial enhancement with delayed washout and a pseudocapsule, meeting imaging criteria for HCC (Fig. 1).

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