患者女,34岁,右侧腹部隐痛史半年。1980年5月16日以慢性阑尾炎急性发作行阑尾切除时,经探查发现腹内出血500ml以上。阑尾正常。肝右前叶下部和右后叶下段有9×10×9cm的巨型癌块,呈结节状凹凸不平,表面溃烂坏死,破裂出血,沿结肠旁沟流向右下腹。鉴于病人全身情况良好,肝左叶及其它脏器无明显癌灶,于是做了不规则性急诊肝部分切除术。切除标本重350g。病理诊断为肝细胞性肝癌(曾经天津市肿瘤研究所病理室会诊)。术后随访7年11个月,健在并能参加工作。讨论1.已明确为原发性肝癌患者伴自发性破裂出血的诊断并无困难。但对部分患者,肝癌破裂前未能明确诊断,常易误诊。本例原发性肝癌误诊 The female patient, 34 years old, has a half-year history of pain in the right abdomen. On May 16, 1980, when appendicectomy was performed with acute exacerbation of chronic appendicitis, an intraabdominal bleeding of more than 500 ml was detected. The appendix is ​​normal. The lower part of the right anterior lobe of the liver and the lower segment of the right posterior segment were giant 9×10×9 cm tumor masses, with nodular irregularities, surface ulceration and necrosis, and ruptured hemorrhage, and flowed along the side of the colon to the right lower quadrant. In view of the good body condition of the patient, there were no obvious lesions in the left lobe of the liver and other organs, so an irregular emergency partial hepatectomy was performed. The resection specimen weighed 350g. Histopathological diagnosis was hepatocellular carcinoma (formerly referred to by the Pathology Department of Tianjin Cancer Institute). After 7 years and 11 months of follow-up, he was alive and able to work. Discussion 1. There is no difficulty in identifying patients with primary liver cancer who have spontaneous rupture bleeding. However, for some patients, failure to make a diagnosis before liver cancer rupture is often misdiagnosed. Misdiagnosis of primary liver cancer in this case