Metastatic Hepatocellular Carcinoma in a Non-Cirrhotic Liver without Viral Hepatitis: A Case Report and Literature Review

Background: Hepatocellular carcinoma (HCC) usually develops in the setting of cirrhosis or chronic liver disease. Its occurrence in a non-cirrhotic liver and in the absence of viral hepatitis is rare and represents a diagnostic challenge due to the lack of risk factors and routine surveillance. Case Presentation: We report the case of a 45-year-old patient with no history of chronic liver disease and no infection with hepatitis B or C viruses, who presented with right upper quadrant pain and deterioration of general condition. Laboratory investigations showed preserved liver function and normal alpha-fetoprotein levels. Liver imaging revealed a hepatic mass in a liver with normal morphology, showing arterial enhancement with portal washout, associated with multiple pulmonary lesions, confirming the metastatic nature of the disease. A liver biopsy confirmed the diagnosis of metastatic hepatocellular carcinoma. The patient was treated with sorafenib, with a favorable clinical and radiological response. Conclusion: This case illustrates a rare presentation of HCC arising in a non-cirrhotic liver, metastatic at diagnosis, in the absence of viral hepatitis, and occurring in a relatively young patient. It highlights the importance of considering this diagnosis even in the absence of classical risk factors and underscores the role of systemic therapies in medical oncology.