HCC Developing in Non-Cirrhotic with History of HBV

Background A 48 y/o Japanese American Woman chronic hepatitis B for 25 years Antiviral therapy: Lamivudine Lamivudine/Entecavir Entecavir Good response with negative HBV DNA and normal ALT/AST for 2 years

Background Hepatitis B serology: Liver biopsy (2001): Grade 1 Stage 0 Positive HBs Ag/Anti-HBc Ab/Anti-HBe Ab Negative HBs Ab and HBe Ag Liver biopsy (2001): Grade 1 Stage 0 No complication related to the liver disease

2/4/2003 5/21/03 7/16/03 8/13/03 7/23/04 9/23/04 3/2/05 HBV DNA HBs Ag   2/4/2003 5/21/03 7/16/03 8/13/03 7/23/04 9/23/04 3/2/05 HBV DNA <200 <300 HBs Ag Positive Anti-HBc ANTI-HBs Negative HBe Ag ANTI-HBe

HPI In October 2005 she developed right sided chest pain and evaluated in the ER A CT scan/ CT angiography

Discharged from ER, with diagnosis of: Pleuritic chest pain Hepatic hemangioma

Re-evaluated by a hepatologist AFP level is 147 MRI with and without gadolinium Laparoscopy

Management Follow up Patient underwent right hepatectomy The pathology revealed 4.5 cm poorly differentiated HCC with focal vascular invasion Follow up Post operative patient did well with normalization of AFP Follow up CT was negative for liver masses Remains negative for 6 years