Case 장 O 순 F/74 adm C.C) known hepatic mass P.I) F/74. CHB, HTN, CRF d/t GN 으로 본원 IN prof. 정경환 f/u 하고 있으 며 B-viral LC c ascites 진단받고 entecavir 복용 중인 자로 외 래에서 시행한 liver sono 상 2 hepatic mass 소견 및 AFP 로 상승 소견 보여 F/E 및 Mx 위해 내원함. PMHx) DM / HTN / pul.TB / hepatitis (-/+/-/+) OPHx) (-) PHx) alcohol(-) smoking(-) FHx) 큰 딸 : HCC, 나머지 자녀들 : HBV carrier

2 CBC/DC WBC(mm 3 )5580 Hb(g/dl)8.7 PLT(mm 3 )254K PT(sec)13.3 INR1.05 Lab Findings Performance status Grade0 Viral markers HBs Ag(+) Anti HBs Ab(-) Anti- HCV Ab(+) Tumor markers AFP (ng/mL)119.2 CA 19-9 (U/mL)55.88 CEA (ng/mL)4.00 Chemistry TB(mg/dL)0.15 AST/ALT(IU/L)18/13 ALP(IU/L)107 Prot/Alb(g/dL)6.3/3.6 BUN/Cr(mg/dL)46/3.1 CRP(mg/dL)<0.3 LC & Stage Child-PughA(5) MELD score18 EV(-) Ascites(-) Encephalopathy(-)

Clinical Course Liver CT Liver sono Gastroscopy PET CT AFP 5.21 ng/mL Liver CT ( ) - Two hepatocellular carcinomas in segment 4. Suggested dysplastic nodule in segment 8. No change of several simple hepatic cysts. Suggested subepithelial lesion in the GB --> focal adenomyomatosis rather than subepithelial tumor of the GB. Underlying liver cirrhosis. Hyperfunctioning of both kidneys with small size. AFP ng/mL RFA Liver CT RFA Liver CT Bone scan

Case 조 O 갑 M/73 adm C.C) melena P.I) M/73. ALC 로 본원 IG f/u 중이며 월 EVL 시행하고 HCC 진단 받은 Hx 있는 자로 내원 5 일전 복수차고 dyspnea 발생하여 당진병원 에서 입원 치료 중 내원 당일 melena, hematemesis 발생하여 응급실 경유하여 입원 PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/-) OPHx) (+) : Modified Sugiura’s procedure(2002 년 ) PHx) alcohol(+) : daily 소주 2 병, 50 년 smoking(+) : 25 갑년 FHx) none

5 CBC/DC WBC(mm 3 )8760 Hb(g/dl)8.8 PLT(mm 3 )478K PT(sec)12.4 INR0.96 Lab Findings Performance status Grade0 Viral markers HBs Ag(-) Anti HBs Ab(-) Anti- HCV Ab(-) Tumor markers AFP (ng/mL)1805 CEA (ng/mL)5.72 Chemistry TB(mg/dL)1.89 AST/ALT(IU/L)142/152 ALP(IU/L)229 Prot/Alb(g/dL)6.4/2.9 BUN/Cr(mg/dL)20/1.0 CRP(mg/dL)4.24 LC & Stage Child-PughB(8) MELD score9 EV(+), F3, RC(++) Ascites(+) Encephalopathy(-)

Clinical Course Sagiura’s procedure Sagiura’s procedure TIPS Liver CT TIPS Revision : failed Liver CT TIPS Revision : failed AFP ng/mL Liver CT ( ) - Aggravation of HCCs. No change of thrombosis within TIPS. Increased amount of ascites. R/O right scrotal metastasis. Otherwise no change. Hyperfunctioning of both kidneys with small size. AFP 1805 ng/mL HCC TACE HCC TACE TIPS Liver CT

Case 허 O 옥 F/56 adm C.C) for op risk evaluation P.I) F/ 년 HCC, CHB 진단후 HCC s/p TACE #9(2009 년 6 월, 강 동경희대병원 ) 시행하였던 자로 Lt subtroch femur Fx(pathologic Fx d/t HCC) 로 OS(pf. 한정수 ) 에서 8 차례 op 한 Hx 있음. 수술 부위 지속적 인 discharge 로 OS 에서 5 월 11 일 수술 예정으로 HCC 에 대한 op risk evaluation 위해 입원. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/+) OPHx) (+) : Lt subtroch femur Fx op 8 회 PHx) alcohol(-) smoking(-) FHx) none

8 CBC/DC WBC(mm 3 )3610 Hb(g/dl)11.0 PLT(mm 3 )184K PT(sec)14.2 INR1.09 Lab Findings Performance status Grade0 Viral markers HBs Ag(+) Anti HBs Ab(-) Anti- HCV Ab(-) Tumor markers AFP (ng/mL)285.1 Chemistry TB(mg/dL)0.46 AST/ALT(IU/L)57/32 ALP(IU/L)228 Prot/Alb(g/dL)8.1/3.3 BUN/Cr(mg/dL)15/0.6 CRP(mg/dL)3.15 LC & Stage Child-PughA(6) MELD score7 EV(-) Ascites(-) Encephalopathy(-)

Clinical Course Os op # TACE #9 Liver CT AFP 3.68 ng/mL Liver MR ( ) - Suggested small viable portion at the posteromedial aspect of smaller HCC adjacent to the larger HCC in right lobe. Relatively compactly lipiodolized HCCs in right hepatic lobe. Multiple simple hepatic cysts. Hyperfunctioning of both kidneys with small size. AFP 1.26 ng/mL Liver MR PET CT Liver MR PET CT Bone scan HCC TACE #1 HCC TACE #1 Chest CT Os op #9 AFP ng/mL

Case 배 O 남 M/66 adm C.C) abdominal pain o/s) 1 month ago P.I) 2004 년 D-colon cancer 로 left hemicolectomym, chemoTx (FL) 후 CR 상태로 지내던 자로 한달전부터 RUQ pain 있어 성모병원 내원하 여 시행한 CT 에서 liver mets, GB stone 소견보여 f/e 위해 본원 내원 함. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/-) OPHx) (+) : left hemicolectomy (2004/05/03) PHx) alcohol(-) smoking(-) : 40 py, 5 년전 stop FHx) none

11 CBC/DC WBC(mm 3 )11250 Hb(g/dl)8.8 PLT(mm 3 )224K PT(sec)15.5 INR1.28 Lab Findings Performance status Grade0 Viral markers HBs Ag(-) Anti HBs Ab(-) Anti- HCV Ab(-) Tumor markers AFP (ng/mL)0.660 CA 19-9 (U/mL)33.63 CEA (ng/mL)97.28 Chemistry TB(mg/dL)0.78 AST/ALT(IU/L)59/79 ALP(IU/L)398 Prot/Alb(g/dL)7.4/3.4 BUN/Cr(mg/dL)31/1.2 CRP(mg/dL)24.27

Clinical Course Liver CT HRCT Sono Bx Liver CT HRCT Sono Bx abd CT Bone scan PCD insertion PCD insertion LIVER CT( ) -A large mass with calcifications at right lobe of liver suggest metastasis from GI tract. A small nodule in left lateral segment do not exclude metastasis. Direct spread of mass to right free portal space Portocaval adenopathies Small calcific GB stones A small accessory spleen and mild splenomegaly AP sono tubogram