Yesterday, I performed a rather special liver surgery, which further strengthened my opinion of “active surgical resection of solid hepatic masses with unclear diagnosis”. The patient was a woman in her 60s. Ultrasound examination revealed the presence of 2 masses in the liver (there were no masses at the time of ultrasound examination 1 year ago), and MRI examination was performed in the hospital, suggesting an abnormal mass in the S6 segment of the liver, measuring 2.8×3.4 cm with clear borders and mixed signals. In the arterial phase of the scan, the edge of the lesion was strengthened, the center of the lesion was separated and strengthened, and the degree of strengthening in the portal vein phase was increased. The imaging physician considered an abnormal signal mass in the S6 segment of the right lobe of the liver, which was considered a benign tumor, without excluding the possibility of vascular origin. An abnormal signal nodule in the S8 segment of the right lobe of the liver was considered a benign lesion with a possible inflammatory pseudotumor. Various tumor markers, including methemoglobin, were normal on laboratory tests. Pengji Gao, Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing, China Despite the imaging considerations of benign possibility and low tumor markers, and the patient’s lack of background of liver disease, our treatment team considered the liver mass to be solid and could not exclude malignant tumor. After full communication with the family, a right posterior lobe resection of the liver was performed. Intraoperative exploration of the 6-segment mass was hard and highly suspicious of malignancy, and intraoperative pathology also confirmed that it was a malignant tumor with a high possibility of hepatocellular carcinoma; intraoperative ultrasound imaging considered that the 8-segment mass was also a high possibility of malignancy, and ablation therapy was performed because the mass was located deep in the liver parenchyma. Based on the summary of the above cases, we believe that: for solid liver lesions without a background of liver disease, with negative tumor markers and atypical imaging presentation, active surgery should be performed to avoid delaying the treatment.