Clear Cell Hepatocellular Carcinoma with Associated Tuberculosis-A Case Report

Clear cell hepatocellular carcinoma (CCHCC) is a rare variant of classical hepatocellular carcinoma (CHCC). Most of these cases pose a histological diagnostic dilemma with broad range of differentials of tumor with clear cell morphology. Use of immunostains or presence of classical hepatocellular carcinoma morphology focally aids in accurate diagnosis of these lesions. We report a case of a 62-year-old male who presented with loss of appetite and altered bowel habits for last 3 months. On investigation he was found to be HCV positive with genotype 1a and viral load of 3853865 IU/ml. His CECT revealed a well-defined hyper dense lesion of size 38 x 34 mm in segment V with a thin hypo dense rim. Contrast studies were suggestive of hepatocellular carcinoma with chronic liver disease. His PET CT revealed an FDG avid lesion in lung, biopsy from which showed caseating epithelioid granulomas. He underwent living donor related liver transplant. Explant liver tissue examined showed CCHCC with cirrhosis and several epithelioid granulomas. Occurrence of CCHCC with tuberculosis is a rare with no similar case has been reported in indexed English literature till date. We herein report the first case of CCHCC with coincidental Tuberculosis in an elderly male.