Background : Primary Hepatic Tuberculosis is a rare disease entity which comprises less than 1% of total patients with tuberculosis. The liver has a low oxygen environment as compared to the lung and this environment is unfavorable for mycobacterium growth. It has a non-specific clinical presentation and may even be asymptomatic hence diagnosis would pose as a challenge and could easily be misdiagnosed and may have delay on treatment.

Methods : Case of a 46 year old male, with incidental Computed Tomography Scan finding of hepatic lesion at segment II with consideration of Focal Nodular Hyperplasia with slightly elevated CEA and normal AFP, PIVKA II, and CA 19-9. Colonoscopy showed no pathology. MRI with primovist was done one year after which showed an increase in the size of the mass but still with consideration of FNH. A repeat MRI was done after 3 months now showing worrisome features of hepatocellular carcinoma. Patient then underwent laparoscopic left lateral sectionectomy.

Results : Histopathologic studies revealed chronic granulomatous inflammation with caseation necrosis and langhan's type giant cells consistent with a tuberculous process.

Conclusions : We described a case of an incidentally found hepatic mass which initially had benign radiologic features that became suspicious for malignancy over a period of 1 year. These findings led to the decision of a surgical approach for better tissue diagnosis and aid in further management.