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We report on a 62-year-old man from Ethiopia with a large solitary primary hepatocellular carcinoma. In spite of using modern imaging techniques (ultrasound, computed tomography, magnetic resonance imaging, hepatobiliary function scintigraphy) it was not possible to distinguish between hepatocellular carcinoma, focal nodular hyperplasia and adenoma. Surgery with histological examination was necessary to obtain the diagnosis of a hepatocellular carcinoma.

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