Challenges in the Diagnosis of Hepatocellular Carcinoma in a 32-Year-Old Male With Hepatitis B and Alcohol Use.

Hepatitis B induced hepatocellular carcinoma (HCC) is an important cause of morbidity and mortality in sub-Saharan Africa and particularly in Zambia presenting at a younger age compared to other regions globally and with poorer prognosis. Early diagnosis remains a challenge in low resource settings where advanced imaging, supportive serological testing, and histopathology services are limited, resulting in most cases of HCC being diagnosed late, usually clinically with more advanced disease and with limited treatment options. A 32-year-old male with chronic hepatitis B infection, anemic, and a 12-year history of excessive alcohol use was referred from a district hospital for evaluation of HCC based on a positive hepatitis B surface antigen, an elevated alpha fetoprotein, and an abdominal ultrasound showing multiple hepatic masses. The atypical enhancement pattern of the steatotic variant of HCC in this patient failed to meet standard non-invasive diagnostic criteria, precluding oncology referral under local protocols and necessitating tissue confirmation. Ultrasound-guided biopsy was however definitive in the diagnosis. Significant challenges exist in the evaluation and confirmation of HCC in Zambia, contributing to delay in commencing the available treatment options. Additionally, unhealthy consumption of alcohol in chronic hepatitis B necessitates vigilant surveillance to detect hepatocellular carcinoma.