A Mosaic of Malignancy: Multicentric Hepatocellular Carcinoma in Medicolegal Autopsy

Abstract

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver and is strongly associated with chronic liver disease and cirrhosis. Multicentric HCC is characterized by the presence of multiple primary tumor nodules arising independently within the liver and is commonly observed in chronically diseased hepatic tissue. We report the case of a 46-year-old man who underwent medicolegal autopsy following sudden deterioration and death. External examination revealed no evidence of trauma. The liver was enlarged and had a nodular external surface. On cut section, multiple tumor nodules of varying sizes were distributed throughout both hepatic lobes, with areas of hemorrhage and necrosis. Histopathological examination demonstrated HCC, with malignant hepatocytes arranged predominantly in trabecular and pseudoglandular patterns, together with cirrhosis and steatohepatitis in the surrounding liver parenchyma. Metastatic deposits of HCC were identified in the mesentery and omentum. No evidence of poisoning or external injury was identified. The cause of death was attributed to complications of advanced multicentric HCC. This case highlights the diagnostic and medicolegal importance of comprehensive postmortem examination in patients with previously undiagnosed hepatic malignancy, particularly when death occurs suddenly or without an established cause.