Review Question - QID 214412

A 47-year-old homeless man presents to the emergency department for fatigue. He has a history of malingering and is currently requesting a sandwich and clothes. The patient states he has diffuse abdominal discomfort and has been losing weight recently which he attributes to an inability to find food. He is a known alcoholic, intravenous drug user, and has a history of hepatitis C. His temperature is 98.0°F (36.7°C), blood pressure is 114/64 mmHg, pulse is 77/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for an ill-appearing and frail man. He has temporal wasting and a distended abdomen. His abdomen is nontender and he has mild scleral icterus. Laboratory values are ordered as seen below.

Hemoglobin: 14 g/dL
Hematocrit: 42%
Leukocyte count: 7,500/mm^3 with normal differential
Platelet count: 133,000/mm^3

Serum:
Na+: 139 mEq/L
Cl-: 102 mEq/L
K+: 3.7 mEq/L
HCO3-: 25 mEq/L
BUN: 24 mg/dL
Glucose: 66 mg/dL
Creatinine: 1.3 mg/dL
Ca2+: 10.2 mg/dL
Alpha fetoprotein: 470 ng/mL (normal < 10 ng/mL)
AST: 65 U/L
ALT: 67 U/L

A CT scan is performed as seen in Figure A. Which of the following is the most likely diagnosis?