Electronic Clinical Challenges and Images in GI

Question: A 65-yearold patient presented with a painful epigastric mass. It had been diagnosed as a hematoma after a blunt abdominal trauma 3 months prior. Since then, the mass remained and continued to cause the patient pain. Past medical history included chronic alcohol consumption and benign prostatic hyperplasia. Upon physical examination, e was determined to have a hard, irregular mass in the epigastric area associated with an ulcerated, 1.5 cm large nodule of the umbilicus Figure A). Laboratory tests revealed a mild anemia (10 g/dL) with a low prothrombin time (63%) and a total bilirubinemia of 26 mg/L. is serum alpha-fetoprotein concentration was 16.8 ng/mL. Thoracoabdominopelvic computed tomographic (CT) was performed. It evealed a 12 7-cm solid mass in the epigastric region associated with a hypertrophy of the left hepatic lobe (Figure B). What is your diagnosis? the GASTROENTEROLOGY web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.