Comorbidity NASH/HCV and HCC

History of Present Illness 67 y/o female with a PMHx of DM, HTN, obesity and HCV had elevated liver function tests (LFTs) on routine laboratory examination two years ago

History of Present Illness Referred to GI for further evaluation LFTs were believed to be the result of NASH and/or HCV infection At that time, she declined a liver biopsy

History of Present Illness Remained well until 2 months ago when she experienced abdominal distention and intermittent epigastric discomfort that radiated to her back Denied weight loss, N/V/D Abdominal CT: 4.5 cm mass, Rt lobe of liver, normal ovaries

Physical Exam Abdomen: Distended, obese, tender, +rebound, +fluid, no palpable liver or spleen Extremeties: +2 pitting edema. –cyanosis, -clubbing

Laboratory Data AST: 231 Albumin: 3.2 ALT: 288 Total Protein: 7.8 ALK Phos: 110 Total Bilirubin: 2.1 Paracentesis yielded bloody ascitic fluid with cells suspicious for malignancy.

Laboratory Data Amylase 30 U/L Glucose 112 MG/DL LDH 324 U/L Total Protein 1.9G/DL Appearance BLOODY RBCs 89000/MM3 WBCs 200/MM3

Laboratory Data AFP: 7.8 ng/ml, within normal limits Serum CA 125 was markedly elevated 1221 ng/ml

Images: Liver                                                          

Images: Lesion                                                          

Biopsy Results Biopsy: HCC Referred for liver transplantation evaluation Successful orthotopic liver transplantion Repeat CA-125 was 120 two weeks after transplantation