Hepatocellular Carcinoma in Non-cirrhotic Portal Fibrosis/Idiopathic Portal Hypertension: An Under-recognized Complication-A Case Report and Literature Review.

Vascular liver diseases are recognized risk factors for the development of hepatocellular carcinoma (HCC) in non-cirrhotic livers. While the association is well established in conditions like Budd-Chiari syndrome, which have defined surveillance strategies, data regarding HCC in non-cirrhotic portal fibrosis/idiopathic portal hypertension (NCPF/IPH) remain limited. We report a case of incidentally detected HCC in a 52-year-old woman with NCPF/IPH and preserved liver function. She initially presented with portal hypertension without hepatic decompensation and was diagnosed with NCPF/IPH based on histology and clinical criteria. Sixty-four months after her diagnosis, imaging revealed a large well-defined hepatic mass lesion, which showed arterial-phase hyperenhancement and porto-venous-phase washout with markedly elevated alpha-fetoprotein levels, consistent with HCC. Notably, the tumor developed in the absence of any prior hepatic decompensation and was detected incidentally during evaluation for portal vein thrombosis. This case highlights that HCC can occur in NCPF/IPH despite preserved liver function, the absence of severe portal hypertension, and prior nodules; it may also remain clinically silent. To our knowledge, this represents the first reported case of HCC in NCPF/IPH from India.