A 70-year-old man presented to our hospital complaining of back pain. CT revealed an intra-abdominal tumor under the left diaphragm, located next to the spleen and lateral segment of the liver. The tumor showed a remarkably high fat density, with a peripheral enhancement effect. MRI also showed the fat-rich character of the tumor. Based on the findings, the tumor was suspected as a hepatocellular carcinoma (HCC) or angiomyolipoma. Laparoscopic partial resection of the liver was performed.

The resected specimen showed a yellow tumor, 5.0 cm in diameter. Histopathologically, the tumor was diagnosed as moderately differentiated HCC with marked fatty change.

This case serves as an important reminder to consider hepatocellular carcinoma in the investigation of possible causes of liver tumor with marked fatty change.