An exceptional finding in an explanted liver: a case report of cirrhotomimetic hepatocellular carcinoma

We present a case of cirrhotomimetic hepatocellular carcinoma (HCC) diagnosed on an explant following a liver transplantation (LT). The pre-LT computerized tomography (CT) scan demonstrated a nodular, cirrhotic-appearing liver; there was no evidence of lesions consistent with HCC. The level of serum alpha fetoprotein (AFP) 1 month pre LT was 4 ng/dL. Following LT, the patient underwent surveillance for HCC. Eight months post LT, he was noted to have lytic osseous lesions in his sternum and T10 vertebral body. Biopsies of these lesions demonstrated metastatic poorly differentiated carcinoma, which was concerning for progression to metastatic HCC. It is important to spread awareness of cirrhotomimetic HCC as it often evades detection by current screening methods, and if patients are inadvertently transplanted with a liver with cirrhotomimetic HCC, this can have significant consequences downstream. A multidisciplinary team approach is critical to ensure early detection of any recurrence and timely treatment.