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Case Reports in Oncological Medicine
Volume 2015, Article ID 878763, 5 pages
Case Report

Diagnostic Challenges in Primary Hepatocellular Carcinoma: Case Reports and Review of the Literature

1Infectious Disease Department, Wroclaw Medical University, Wroclaw, Poland
2Infectious Disease Department, Division of Infectious Disease and Hepatology, Wroclaw Medical University, Wroclaw, Poland
3Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Wroclaw, Poland

Received 2 December 2014; Accepted 9 March 2015

Academic Editor: Raffaele Palmirotta

Copyright © 2015 Monika Pazgan-Simon et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Hepatocellular carcinoma is the fifth most common malignancy and the third leading mortality cause worldwide. It typically develops secondarily to liver cirrhosis, due to hepatitis B or C infection, alcohol abuse, metabolic disease, and so forth. According to the American Association for the Study of Liver Diseases (AASLD) guidelines, which constitute diagnostic standards, the diagnosis of primary hepatocellular carcinoma (HCC) should be based on contrast-enhanced imaging. Lesion hyperenhancement should be observed throughout the arterial phase, followed by the washout during the venous phase. The diagnosis can also be based on the histopathological evaluation of liver biopsy specimen. Although the standards are clear, we often see patients with advanced HCC in clinical practice, who cannot be offered any effective treatment. Patients with chronic liver disease, presenting with inconclusive and changeable test results, constitute a separate problem. In such cases the diagnostic process is typically long-term and delayed. In this paper we present three case reports where the diagnosis could not be made promptly and the patients died as a result of a delayed diagnostic process.