Immune checkpoint inhibitor (ICI)-based combination therapy has transformed the treatment of advanced hepatocellular carcinoma (HCC), yet immune-related adverse events (irAEs) remain a serious and potentially fatal complication. We report two cases of severe irAEs following ICIbased therapy for HCC. In Case 1, a man with multimetastatic HCC developed immune-mediated colitis with hemodynamic collapse and multi-organ failure after the second cycle of the STRIDE regimen yet achieved a near-complete oncologic response. In Case 2, a patient who had tolerated 17 cycles of adjuvant atezolizumab (ate) plus bevacizumab (bev) without irAE developed fatal immune-mediated fulminant hepatitis after a single dose of ate+bev reinitiated as first-line therapy for unresectable HCC following recurrence and TACE failure. These cases highlight the unpredictability of irAEs—even in previously tolerant patients—and underscore the importance of early recognition and prompt management.

Hepatic angiomyolipoma (HAML) is a rare mesenchymal tumor of the liver composed of varying proportions of adipose tissue, smooth muscle cells, and blood vessels. Its heterogenous composition results in diverse features that may closely mimic hepatocellular carcinoma (HCC) on imaging. Here, we report a 56-year-old woman was referred after an incidental 1.8 cm hepatic mass on computed tomography. Magnetic resonance imaging demonstrated arterial phase hyperenhancement, portal venous washout, hepatobiliary phase hypointensity, and diffusion restriction, strongly mimicking the imaging appearance of HCC. However, the absence of chronic liver disease or viral hepatitis limited a confident noninvasive diagnosis. To establish a definitive diagnosis, percutaneous tumor biopsy was performed. Histologically, the lesion consisted showed a characteristic admixture of smooth muscle cells, adipose tissue, and blood vessels, and immunohistochemistry demonstrated diffuse positivity for HMB-45, confirming the diagnosis of HAML.

Surgical resection remains the only potentially curative treatment for colorectal liver metastases (CRLM). Locoregional therapies such as transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are frequently used in patients with limited or borderline resectable liver metastases. However, radiologic response does not always indicate complete tumor eradication. A 77-year-old man with rectosigmoid junction cancer presented with synchronous liver metastases (S6, 7). Combined TACE and RFA were performed for both lesions after multidisciplinary discussion. Follow-up imaging suggested complete radiologic response, and laparoscopic low anterior resection was planned for the primary tumor. Intraoperatively, a suspicious whitish lesion was noted on the liver surface, leading to laparoscopic resection. Histopathological examination confirmed residual viable CRLM with negative margins. This case highlights the limitation of imaging-based response assessment after locoregional therapy and suggests that salvage laparoscopic hepatectomy can provide definitive oncologic management in carefully selected patients.

Newly detected hepatic lesions during surveillance in patients with a history of breast cancer are often suspected to represent metastatic disease; however, benign infectious conditions, including parasitic infections, may rarely mimic malignancy on imaging. A 48-year-old woman with a history of breast cancer who had undergone curative surgery was found to have a new hepatic lesion on routine surveillance imaging. Magnetic resonance imaging demonstrated a 1.1-cm irregular mass at the hepatic dome with peripheral enhancement, raising suspicion for metastasis. Laparoscopic wedge resection of the segment VIII lesion was performed for definitive diagnosis. Histopathologic examination revealed a necrotizing granuloma containing degenerated parasitic larvae with eosinophilic inflammatory infiltrates and no evidence of malignancy. The findings were most consistent with Capillaria hepatica infection, highlighting that parasitic necrotizing granuloma may be considered as a rare differential diagnosis in patients with prior malignancy.

Hepatocellular adenoma (HCA) is a rare benign liver tumor in the pediatric population, often associated with underlying genetic syndromes or metabolic disorders. In prepubertal children, the most common subtypes are β-catenin–mutated HCA and HNF1α-inactivated HCA (H-HCA), each with distinct clinical and prognostic implications. Differentiating HCA from malignant lesions such as hepatocellular carcinoma (HCC) is critical for appropriate management. We report a 2-year-old girl with hepatic failure, who was found to have multiple hepatic nodules. Imaging studies suggested features highly indicative of HCC. Due to multiple suspicious lesions and severe liver dysfunction, liver transplantation (LT) was performed. Histopathological examination confirmed the lesions as H-HCAs. The patient was postoperatively diagnosed with hereditary tyrosinemia type 1. This case highlights the importance of including HCA in the differential diagnosis of hepatic nodules in children with metabolic disorders. Accurate diagnosis of HCA is essential to guide clinical decision-making, optimize treatment strategies including LT.

Liver cancer is among the most prevalent and life-threatening cancers worldwide, with hepatocellular carcinoma and liver metastases contributing significantly to cancer related mortality. Accurate segmentation of liver tumors in abdominal computed tomography and magnetic resonance imaging is crucial for tumor prediction, radiation therapy, and treatment monitoring. In recent years, medical image segmentation has advanced rapidly due to deep learning (DL), particularly convolutional neural networks (CNN) and transformer-based architectures. This paper provides a comprehensive review of DL based liver tumor segmentation methods in abdominal imaging. We examine the evolution from traditional encoder decoder frameworks such as U-Net and V-Net to residual, attention based, and hybrid CNN transformer models, including vision transformers. The review also analyzes performance across publicly available benchmarks, including the Medical Segmentation Decathlon, 3D-IRCADb, CHAOS, and the Liver Tumor Segmentation Challenge, using evaluation metrics such as Dice Similarity Coefficient, Hausdorff Distance, and Intersection over Union. Furthermore, we discuss key challenges including tumor heterogeneity, class imbalance, limited annotated data, and domain adaptation across imaging protocols. Emerging directions such as foundation models, self-supervised learning, federated learning, and clinically deployable AI segmentation systems are also highlighted.

Liver transplantation (LT) is a curative therapy for selected patients with hepatocellular carcinoma (HCC) and cirrhosis, simultaneously treating tumors and underlying liver disease. This review provides an up-to-date overview of LT for HCC, focusing on key considerations for hepatobiliary surgeons. We discuss established selection criteria (Milan and University of California, San Francisco) and the evolution of expanded eligibility models incorporating tumor biology (e.g., “up-to-7” criteria, alpha-fetoprotein–based models). Outcomes of LT for HCC are excellent in appropriately selected patients, with 5-year survival >70% and low recurrence rates when within criteria. We examine strategies for downstaging advanced HCC to transplantable disease, which have enabled curative LT in patients initially beyond criteria with acceptable 10-year outcomes. We compare living donor and deceased donor LT, highlighting the role of living donor transplantation in expanding access and its comparable survival. Immunosuppression protocols are reviewed, with an emphasis on striking a balance between preventing rejection and minimizing the risk of tumor recurrence. We also address global trends and challenges, including organ shortages and ethical considerations, and survey recent innovations from clinical trials and translational research—such as machine perfusion organ preservation, novel biomarkers, and immunotherapy—for their potential impact on HCC transplant practice.