HCC

Case Presentation 56 F, White HCV HCC?

History of Present Illness 56 y/o white female Hx of Blood transfusion in ‘73 Cirrhosis secondary to HCV infection, post failed IFN Rx Elevated AFP since 09/2004

Past Medical History Histerectomy ’73 with transfusion Breast cancer, resected in ’89 Rt.breast reconstruction Osteoporosis, refractory to Fosamax Hip, wrist, elbow fracture Parotid tumor (benign), resected in ’91 Hernia repair in ’95, ’97

Familial and Social History Mother: Breast Cancer (died at 54 y/o) Father: Heart Disease (died at 74 y/o) No smoking, no drinking

Medications Inderal Vit. C, E, multi Vit. Calcium Imitrex Forteo

Physical Examination Generally alert and oriented, no apparent distress No jaundice Palmar erythema Splenomegaly, no ascites Mild lower extremity edema

Lab Data 2/9/05 WBC 2.3 AST 139 T. Bil 1.7 HGB 13.0 ALT 102 D. Bil 1.0 HCT 38.3 ALP 99 ALB 3.4 PLT 60 GGTP 87 BUN 13 PT 12.9 CRE 0.7 INR 1.16 HCV genotype 1A RNA 2980K IU/ML MELD 11

AFP 33 (Mar 2004) 1315 (Sept 04)

US 11/09/04 S2 S5

CT 10/1/04 S2 arterial portal delayed

CT 10/1/04 S5 (1) arterial portal delayed

CT 10/1/04 S5 (2) arterial portal delayed

MRI 1/4/05 S2 T1 T2 Gd

MRI 1/4/05 S5 (1) T1 T2 Gd

MRI 1/4/05 S5 (2) T1 T2 Gd

Nodules in the Liver S5 2.0*1.2cm S2 3.5*2.8cm S5 1.1*0.8cm

AFP

AFP Forteo Stop Start Imaging study

CT 12/17/98 S5 S5 S2

AFP Trend Pseudo positive because of Forteo? Occult HCC?

Explanted Liver ? ? ? Patients is on the list with MELD 11