CASE HISTORY
A 36-year-old black male was referred in January 1994 for evaluation of a symptomatic hepatic mass. For 2 years before presentation he had been treated intermittently with cimetidine for chronic abdominal pain attributed to ulcer disease. An upper gastrointestinal series performed in December 1993 revealed marked scarring and irregularity of the duodenal bulb consistent with the diagnosis of chronic duodenal ulcer. Symptoms of early satiety were observed at this time. The patient reported no weight loss, fever, anorexia, or fatigue. An abdominal computed tomography (CT) scan confirmed a 13-cm, low attenuation, irregular mass in this same region. He had no history of hepatitis or jaundice. His childhood medical history was negative. He underwent a unilateral orchiectomy at age 25 years and a vasectomy in 1992. He had no history of blood transfusion or intravenous drug use. He admitted to occasional alcohol use. He was employed as a Merchant Marine and had traveled to Africa, the Far East, and South America. His sister had a "liver problem" for which she received 2 years of unknown medical therapy.
Physical examination revealed a liver palpable in the epigastrium with a smooth edge and a span in the right mid-clavicular line of 14 cm. He had no ascites, peripheral edema, spider nevi, lymphadenopathy, jaundice, or splenomegaly. Blood tests showed a hemoglobin value of 14.4 g/dL (normal, 13 to 18 g/dL), a white cell count of 5.6 x 103/pL (normal, 4.5 to 11 X 103/pL), platelet count of 227 X 103/pL (normal, 160 to 420
x 103/pL), an albumin level of 4.6 g/dL (normal, 3.7 to 5.0 g/dL), a total globulin level of 3.1 gm/dL (normal, 0.6 to 1.8 g/dL), an aspartate aminotransferase level of 17 U/L (normal, <39), an alanine aminotransferase Abbreviations: CT, computed tomography; FNA, fine-needle aspirate; HCC, hepatocellular carcinoma; FNH, focal nodular hyperplasia; HA, hepatic adenoma; MRI, magnetic resonance imaging.