A 40-year-old patient attended the outpatient department of the Digestive Service for a study of elevated transaminases in a routine blood test. In the abdominal ultrasound study, a LOE was detected in segments 2 and 3 of the liver with a maximum size of 4 cm, with solid characteristics compatible with the diagnosis of hepatoma. The abdominal multislice computed axial tomography (CT) scan showed a focal lesion with lobulated borders measuring 4 cm in diameter in segments 2 and 3, with intense enhancement after injection of intravenous contrast in the arterial phase; and with washout in the portal phase, findings compatible with the diagnosis of hepatocarcinoma. There was no evidence of other focal lesions. The intrahepatic bile duct was not dilated and the gallbladder showed no lithiasic images.

Fine needle aspiration puncture (FNA) of the lesion was performed under ultrasound control with negative results for malignant cells and with a positive CD 34 in the immunohistochemical study.

Systematic blood tests were normal, as were liver function, immunoglobulins, antibodies and tumour markers. Viral markers were also negative.
Given the diagnosis of probable hepatoma on non-cirrhotic liver, surgical resection was decided. Segments 2 and 3 were resected laparoscopically, using two No. 12 ports, periumbilical and in the right hypochondrium, and a gel port in the left hypochondrium. The intraoperative histological study diagnosed hepatocellular proliferation with no histological signs of malignancy, the lesion being 2 cm from the edge of the surgical resection. In the anatomopathological study, the nodular formation showed liver tissue with a compact trabecular pattern of up to 3 cell layers, with proliferation of the large muscular arteries surrounded by a dense connective stroma, where no preserved portal spaces were identified. The pathological diagnosis was focal nodular hyperplasia. The postoperative course was uneventful and he was discharged on the fourth postoperative day.