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Hepatocellular carcinoma (HCC) has a distribution that typically follows the prevalence of the hepatitis B and C viruses. As a consequence a third of cases are found in China and another third in the rest of Asia.1
In New Zealand, rates of HCC for Maori and Pacific people were 7.3 and 18.0 times that for other ethnicities.2 HCC in pregnancy is extremely rare, especially if viral hepatitis negative.
We present a case of HCC diagnosed in pregnancy in a young New Zealand Maori woman in an otherwise normal liver. This case highlights the difficulty in diagnosis preoperatively, and timing of surgery in the presence of a viable fetus.
Case report
A 33-year-old, gravida eight para four, Maori woman, had a liver mass detected on routine prenatal ultrasound scan at 20 weeks gestation. Her alpha feto protein level was 295 and hepatitis screen was negative. She had no history of oral contraceptive (OCP) use.
She underwent an MRI scan (Figure 1) which showed a large (24 cm) lobulated, heterogenous mass centred in segments IVB and V with areas of restricted diffusion, and heterogenous enhancement including areas of arterial phase enhancement which showed washout on the venous phases and areas of delayed enhancement.
Given the clinical setting and MRI appearances, the lesion was thought most likely to represent a liver cell adenoma (LCA) or HCC. Biopsy was deemed to be inappropriate as it was unlikely to yield a definite diagnosis and carried an undue risk of rupture.
The patient was admitted at 30 weeks gestation for lower segment caesarean section and simultaneous resection of the hepatic mass. Laparotomy...