Background: Hepatocellular carcinoma (HCC) is a very common malignancy in Asia and Africa. In these areas, most patients with HCC suffer from chronic hepatitis B virus (HBV) or hepatitis C virus
(HCV) infection, and HCC not related to either HBV or HCV is very rare.Case Report: We report here a case of HCC that developed in a normal liver without persistent HBV or HCV infection. A 74 year-old man without a history of alcohol abuse was admitted to our hospital to evaluate a liver mass. His laboratory data demonstrated normal liver function and he had no evidence of past persistent HBV or HCV infection. Serum levels of ?-fetoprotein and PIVKA-II were 2211 ng/ml and 340 AU/ml, respectively. The tumor was about 40 mm in diameter and was located in the middle segment of the liver. Histological examination of theresected section revealed that the mass was a poorly differentiated HCC, and that the nontumorous area surrounding the HCC was normal in terms of pathological findings. HBV DNA was not detected by real time polymerase chain reaction in the HCC or non-HCC tissues.Conclusions: We must consider HCC when we encounter a mass in a normal liver with no evidence of HBV or HCV infection, especially when accompanied by high levels of AFP and/or PIVKA II.

Keywords: Hepatocellular carcinoma (HCC), Normal liver, No evidence of HBV or HCV, alpha-fetoprotein (AFP), PIVKA II, Poorly differentiated HCC