FCCT Blog Post #21

KCMC-FCCT Tumor Board

A 57-year-old woman presented with right upper quadrant pain, nausea, night sweats and a 8cm liver mass.  She was from a remote area of Tanzania and provided history that she has been aware of a liver mass for 20 years. The details of this prior diagnosis were not available, however.   Her son had recently accepted a job in Arusha and facilitated a trip to Moshi to visit the cancer center at KCMC.  A CT scan identified a heterogenous right lobe of liver mass with central necrosis and calcifications. There was no clinical or laboratory evidence of cirrhosis. Hepatitis serologies were negative. The alpha-fetoprotein was minimally elevated.  An ultrasound guided biopsy revealed well-differentiated glandular appearing cells with a mild degree of fibrosis.  The differential diagnosis, histologically, included a well-differentiated hepatocellular carcinoma or cholangiocarcinoma or possibly benign disease.  A battery of immunohistochemical stains, currently unavailable at KCMC would have helped to better classify the pathology.  Hepatocellular carcinoma is the third leading cause of cancer deaths in Tanzania (Lyimo eta all, Cancer mortality patterns in Tanzania, J Global Oncol 2020 https://ascopubs.org/doi/10.1200/JGO.19.00270.  It typically has a very aggressive course with a median survival measured in months.  If the 20-year history of a liver mass is correct, perhaps the lesion represents a large, benign,  bile duct adenoma.  There have been case reports of such entities in the literature. Koga F, et al World Journal of Clin Oncol 2012 https://www.wjgnet.com/2218-4333/full/v3/i4/WJCO-3-63-g001.htm

The ultimate plan was to refer her to Muhimbili National Hospital in Dar Es Salaam for partial liver resection.  KCMC and Muhimbili also perform regular tumor conferences to review patients being sent for further management; resection is planned for June 2026.

Randy Hurley MD

Medical Oncologist (Retired)

Health Partners—Park Nicollet