Cirrhotic hepatomegaly with multiple bilobar hypovascular infiltrative lesions, consistent with multifocal hepatocellular carcinomas (HCCs) seen invading the left portal vein with probably tumoral/malignant thrombosis (T4).

Multiple para-aortic, aortocaval, peripancreatic and cradio-phrenic masses as described, likely metastatic lymphadenopathy. Mild ascites.

Multiple peritoneal and subcutaneous masses and bilateral basal pulmonary nodules, likely metastatic. Moderate splenomegaly with splenic hypoenhancing and hypovascular soft tissue mass lesions.

The differential diagnosis is less likely malignant lymphoproliferative disorder in a cirrhotic liver with extensive parenchymal deposits and enlarged abdominal lymphadenopathy.

According to the American Joint Commission on Cancer (AJCC) 8th edition staging system for patients with Hepatocellular Carcinoma (HCC), this case is considered T4N1M1 (stage IVB) ¹.