Atypical case of hepatoma recurrence two years post-transplant

Hepatocellular carcinoma ranks third most common cancer worldwide. Chronic hepatitis B and C are most common cause of HCC. Liver transplantation is only curative treatment for HCC. However, recurrence post transplantation is most dreadful complication. In this case report, we presented the case of a 48-year-old South Asian patient with a history of chronic hepatitis C infection and subsequent hepatocellular carcinoma (HCC) leading to liver cirrhosis and liver failure signs and symptoms. The patient underwent liver transplantation with a right lobe graft with middle hepatic vein in 2020 which significantly improved in his condition. Two years’ post-transplant, he presented with complaints of abdominal pain radiating and shortness of breath. Radiological investigations including triphasic CT scan and ultrasonography revealed an exophytic growth from the liver and an enhancing lesion in the pre and para-vertebral area, consistent with HCC recurrence and hematoma development. The patient was managed with transarterial chemoembolization (TACE), resulting in a favorable outcome.