Case report reveals diagnostic challenges in differentiating benign lesions from liver cancer in chronic hepatitis B, indicating the need for careful evaluation.
We report a case of a 51-year-old man with chronic hepatitis B (CHB) in whom a small hepatic lesion was incidentally detected during routine surveillance. Dynamic computed tomography and gadoxetic acid-enhanced magnetic resonance imaging demonstrated arterial hyperenhancement with hepatobiliary phase washout, raising strong suspicion for hepatocellular carcinoma (HCC). However, serum tumor markers were within normal ranges, and there was no evidence of advanced fibrosis, although HCC can still occur in patients with CHB. Contrast-enhanced ultrasonography using Sonazoid® revealed delayed and mild washout, which is atypical for HCC and suggested a benign lesion. Given the discordance between imaging findings and clinical context, an ultrasound-guided liver biopsy was performed. Histopathological examination confirmed focal nodular hyperplasia (FNH). This case highlights a diagnostic pitfall in differentiating FNH from HCC in patients with CHB and emphasizes the importance of integrating clinical findings with imaging features to avoid misdiagnosis and unnecessary intervention.
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Ryu et al. (2026) studied this question.
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