A 69-year-old woman with compensated HBV- and MASLD-related cirrhosis, who was a former smoker, with compensated diabetes as comorbidity together with a BMI of 29 kg/m². She has been treated with 0.5 mg of entecavir since 2012 (when she was first diagnosed with HBV infection; pre-treatment liver stiffness was 12.2 kPa). Since 2013, her transaminase levels have remained normal, and her HBV DNA has been undetectable. The patient has undergone regular monitoring with ultrasound every six months. The most recent ultrasound scan (October 2025) revealed a single hypoechoic lesion measuring 40 mm in S5 in the context of steatotic liver. An abdominal CE-CT scan confirmed the presence of a 47 mm nodule (LI-RADS 5) with concomitant neoplastic vascular invasion (Vp1) in liver segment 5. Three additional nodules measuring 22, 16 and 21 mm were detected in liver segments 2, 3 and 4, respectively (LI-RADS 5), and there was no evidence of extrahepatic localization (a chest CT scan excluded lung metastases). The patient was asymptomatic, with preserved liver function (Child–Pugh class A, MELD–Na 8, platelet count 155,000, total bilirubin 1.1 mg/dL). AFP was 122 ng/dL (previously 10 ng/dL). The last endoscopy (in 2023) showed no evidence of oesophageal varices.