B B 398 The Korean Journal of Hepatology Vol. 16. No. 4, December 2010 A A Figure 1. CT scans performed at the initial diagnosis of HCC. (A) The hepatic mass was a 1.7 cm-sized mass with arterial enhancement (arrow) mass in hepatic segment VI, with a patent portal vein and no metastatic lesion evident on CT scans. (B) A tiny subcapsular arterial enhancement (arrow) without early washout was noted in segment IV. Figure 2. Endoscopy image and CT scan of metastatic HCC. (A) Endoscopy revealed a bulging contoured mass at 20 cm from the anal verge without a mucosal defect or diverticulum. (B) The CT scan revealed a 4×3.5 cm eccentric mass (arrow) abutting the sigmoid colon without lymph node enlargement. aminotransferase: ALT 50 IU/L) and a mild decrease in platelet 3 count (113,000/mm ). All other values including white blood with abdominal pain around the left lower quadrant. Physical examination was unremarkable and all laboratory findings cell, hemoglobin, protein, albumin, bilirubin, and prothrombin including an AFP level were within normal limits except a mild time were within normal limits. HBV surface antigen (HBsAg) elevation of liver enzymes: AST 46 IU/L and ALT 68 IU/L. On and HBV e antigen (HBeAg) were positive but anti-hepatitis C colonoscopy, a bulging contoured hard mass was noted in the virus antibody was negative. The alpha-fetoprotein (AFP) level sigmoid colon but the overlying mucosa was intact (Fig. 2A). was 365 ng/mL. A percutaneous needle biopsy was performed on The CT scan revealed a 4×3.5 cm sized, eccentric mass abutting the the mass in segment VI and the pathologic diagnosis of HCC, sigmoid colon without any lymph node enlargement (Fig. 2B). Edmonson-Steiner grade 3, was made. The patient underwent However, the scan did not show any evidence of recurrence in transcatheter arterial angiography and chemoembolization (TACE) the liver and the portal tract. The patient underwent anterior to treat the HCC and differentiate the tiny enhancing nodule from resection and a well-defined subserosal mass, measuring another HCC. On angiography, the enhancing nodule was identi- 5.2×4×3.7 cm, was identified. The cut surface of the mass was fied as an AP shunt. After TACE, there had been no evidence of grayish white, solid, and granular with hemorrhage and necrosis tumor recurrence on follow-up CT scans and AFP levels for one (Fig. 3A). The mass extended to the proper muscle layer, how- and a half years. In one and a half years, the patient presented ever, the overlying mucosa was intact. Histologic examination