Virginia Via Research Day Book 2026

Medical Student Research Case Reports

50 CASE REPORT: HEPATOCELLULAR CARCINOMA IN SITUS INVERSUS TOTALIS

Indra Kapoor, OMS-II; Meghan Wilson, PhD Corresponding author: ikapoor@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

despite the absence of typical etiologies such as viral hepatitis, MASLD, or alcohol-related liver disease. Surgical intervention was not pursued due to the advanced stage of cirrhosis and cancer spread. The clinical course was managed with supportive and palliative measures. Comments: Situs inversus totalis and hepatocellular carcinoma are both conditions with a higher prevalence in males. Most reported cases describing hepatocellular carcinoma with situs inversus are in patients with established risk factors such as chronic viral hepatitis or alcohol-related liver disease. In contrast, this patient developed advanced cirrhosis and hepatocellular carcinoma in the absence of a hepatitis B or C infection, alcohol use disorder, or MASLD. This suggests a different disease course such as metabolic dysfunction and possible non-alcoholic fatty liver disease (NAFLD). Additionally, situs inversus has been commonly associated with infertility; however, this patient had multiple pregnancies, further distinguishing her clinical

history from the described patterns in the current literature. The presentations also highlighted diagnostic and management challenges due to the reversed anatomic orientation with situs inversus. This was demonstrated by the patient’s left upper quadrant tenderness, rather than right-sided pain, due to the hepatic pathology. While surgical interventions have been reported in the past, such interventions are often technically complex and are highly individualized to the patient. In this case, due to the patient’s advanced stage of cirrhosis present and the extent of metastatic spread, surgical management was not feasible. The management was therefore focused on supportive and palliative care which is consistent with the outcomes of similar cases. Diagnosis: Hepatocellular carcinoma in a patient with situs inversus totalis and advanced cirrhosis.

Context: Situs inversus totalis (SIT) is a rare congenital condition affecting approximately 1 in 10,000 individuals and occurs more frequently in men. Hepatocellular Carcinoma (HCC) is one of the most common primary liver cancers worldwide and also has a higher prevalence in men. HCC is commonly found in individuals with cirrhosis secondary to a hepatitis B or C infection, metabolic dysfunction associated steatotic liver disease (MASLD), or chronic alcohol use disorder. Report of Case: A 76-year-old woman with a known history of situs inversus totalis diagnosed at birth and type 2 diabetes mellitus presented to the emergency department with acute confusion. The physical exam revealed left upper quadrant abdominal tenderness, consistent with the location of her liver due to the reversed orientation of her organs. Laboratory evaluation demonstrated mild hepatic dysfunction. Magnetic resonance imaging (MRI) revealed a liver mass and was consistent with hepatocellular carcinoma. Further evaluation demonstrated advanced cirrhosis

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88 Edward Via College of Osteopathic Medicine (VCOM)