Amyloidosis is a diverse entity that poses both diagnostic and treatment challenges. Whether systemic or local, amyloidosis has varied manifestations including occasional hepatic involvement. Hepatic amyloidosis, although rare, should be on the differential for those with unexplained hepatomegaly, cholestasis, alkaline phosphatase elevations, other associated organomegaly, and those with certain epidemiologic risks. In this study, we report a case of a man with systemic amyloid light chain amyloidosis with multiorgan involvement, acute liver injury, cholestasis, nephrotic syndrome, cardiomegaly, and bleeding diathesis.

Figure 1. Haematoxylin and eosin stain showing poorly differentiated polygonal cells containing eccentrically located nuclei and abundant eosinophilic cytoplasm with cells arranged in solid nests. 2. Hep-par stain positivity suggestive of hepatocellular carcinoma. 3. Cytokeratin-7 stain diffusely positive favoring lung as the primary tumor site.