Unusual hepatocellular carcinoma with macroscopic biliary tumor thrombus accompanied by rim calcification and no arterial-phase enhancement

We encountered a case of hepatocellular carcinoma (HCC) with macroscopic biliary tumor thrombus, which was a rare manifestation of HCC that simultaneously showed rim calcification and no arterial-phase enhancement. A 67-year-old woman was admitted with back pain. Enhanced computed tomography revealed a hypodense hepatic tumor surrounded by rim calcification, and a dilated left hepatic duct containing dense material indicating tumor thrombi. Magnetic resonance imaging showed fat deposition in the main part of the tumor. Malignancy was strongly suspected because of the tumor thrombus and elevated PIVKA II, left hepatic lobectomy was performed. Subsequent