Hepatocellular Carcinoma & hepatic Cystic echinococcosis presenting as Synchronous single lesion

Background and Aim: Hepatocellular carcinoma (HCC) constitutes more than 90% of the primary tumor liver; approximately 85% in Cirrhotic background. Significant risk factors for HCC include viral hepatitis, alcoholic liver disease, NAFLD/NASH. Its very rare cystic echinococcosis (CE) to co-exist. Studies have shown that E. granulosus infection promotes proliferation cells by immunomodulation. A preoperative diagnosis may be challenging, when imaging features are atypical if CE present as a single lesion. Case Report: 35 yr old female, presented us (at Department Gastroenterology, BHU with complaints gradual onset RUQ pain abdomen*2 months abdominal distension low-grade fever*2 weeks. Ascitic fluid analysis showed low SAAG, presence free hooklet & protoscolex. TPCT abdomen s/o large heterogenous, hypoattenuating mass (12*8.5*13.5cm) right lobe, on contrast adminstration, peripheral rim multiple linear enhancements seen at sites nonenhancing central necrotic area thrombus Portal vein. was Non-cirrhotic. Positive biochemical results were Hb (9gm/dl), increased ALP (800IU/ml), Low Albumin (2.8mg/dl). Tumour markers (AFP=2.8ng/ml, PIVKA II=21mAU/ml) within normal limits. Viral hepatitis negative. Antiechinococcal Ig-G found positive. In view diagnostic dillema, she underwent USG guided biopsy which revealed histology well differentiated IHC HepPar-1, Arginase, Glypican-3, INSM-1 TTF-1 positivity. She finally diagnsed HCC(BCLC-C) combined hepatic hydatid disease probable rupture into peritoneal cavity. adminstered long term oral Albendazole TACE cycles. Conclusion: cyst synchronous prsence is scenario clinical practice, especially non-cirrhotic background both lesion poses great challange diagnosis. Awareness such associtaion will help clinicians formulating proper managment.