Case history
Case history #1
A 60-year-old Asian man with a longstanding history of chronic hepatitis B virus infection complicated by cirrhosis presents to his primary care physician with abdominal distension, yellow eyes, right upper quadrant (RUQ) abdominal pain, decreased appetite, weight loss, and change in his sleep pattern for several weeks. Physical examination reveals a cachectic man with jaundice, palmar erythema, ascites, a palpable mass in RUQ, and asterixis.
Case history #2
A 55-year-old black man with a history of intravenous drug and heavy alcohol use, and chronic hepatitis C virus infection with cirrhosis is referred to a liver specialist. He has an elevated serum alpha fetoprotein of 200 nanograms/mL and a 2 cm liver mass on screening ultrasound of the abdomen. Physical examination reveals palmar erythema, bilateral lower extremity edema, and ascites.
Other presentations
A significant number of patients may be asymptomatic and may have well-compensated liver cirrhosis. HCC can also present in patients without any known chronic liver disease. In these patients it usually presents with right upper quadrant abdominal pain.
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