Case 1 11967365 윤O현 M/63 adm. 2010.09.27 C.C) for TACE P.I) 63/M. B-viral LC환자로 HCC(‘09/4월) HCC로 진단받아 TACE 시행했던 자로 2010/09까지 HCC recur 보여 TACE #4 시행함. ’11/05월 외래에서 시행한 liver CT 에서 r/o recurred HCC at segment 4 소견 보여 liver MR(11/07월) 촬영 함. PMHx) DM / HTN / pul.TB / hepatitis (+/-/-/+) OPHx) (+) 2003 cholecystectomy d.t GB stone PHx) alcohol(-), smoking(+) : ex-smoker 20py FHx) none

Lab Findings (2011.05) Viral markers Anti HBc Ab (-) HBeAg (+) Anti HBe Ab Anti- HCV Ab Antiviral agents CBC/DC WBC (mm3) 3140 Hb (g/dl) 13.6 PLT 87K PT (sec) 14.4 INR 1.16 Chemistry TB/DB (mg/dL) 0.84/0.34 AST/ALT (IU/L) 57/61 ALP/rGT 93/48 Prot/Alb (g/dL) 7.5/3.8 BUN/Cr 15/1.1 LC & Stage Child-Pugh A (5) MELD score 8.35 EV (+), F1, RC(-) ascites (-) encephalopathy Performance status Grade 1 Tumor markers AFP (ng/mL) 17.92

Clinical Course AFP 39.46 ng/mL AFP 34.79ng/mL AFP 32.55 ng/mL AFP 24.5 ng/mL AFP 17.92 ng/mL AFP 14.3 ng/mL 2009.04 2009.05 2009.08 2010.04 2010.09 2011.05 B-viral LC HCC TACE #1 TACE #2 TACE #3 TACE #4 Liver CT *Liver MR (2011.07.06) : Suggested recurred HCC around lipiodolized HCC in S5. Two overt nodular HCCs in S4 and S5. Two larger lesions appearing faint arterial enhancement with delayed wash out on S8 and lateral segment --> Early HCC or DN Several DNs on S5/6 Rec) TACE

Case 2 11924990 홍O표 M/71 adm. 2011.04.19 C.C) for HCC evlauation P.I) M/71 15년전 HBV 진단 받고 toxic hepatitis 로 입원치료 받은 과거력 있는자로 2007 년 LC 진단 받은 상채로 2010.03 시행한 liver sono에서 hepatic mass 소견 보여 시행한 liver CT 에서 HCC 의심되어 내원함. PMHx) DM / HTN / pul.TB / hepatitis (-/+/-/+) : 15년전 진단 OPHx) (-) PHx) alcohol(-), smoking(-) FHx) none

Lab Findings CBC/DC WBC (mm3) 5910 Hb (g/dl) 13.6 PLT 202K PT (sec) INR 1.08 Viral markers HBsAg (+) Anti HBsAg (-) HBeAg Anti HBe Ab Anti HCV LC & Stage Child-Pugh A(5) MELD score 3.78 EV (-) ascites encephalopathy Chemistry TB/DB (mg/dL) 0.55/0.44 AST/ALT (IU/L) 32/27 ALP/rGT 86/46 Prot/Alb (g/dL) 7.1/4.2 BUN/Cr 19/0.7 Tumor markers AFP (ng/mL) 32.5 PIVKA II 41 Performance status Grade 1

Clinical Course AFP 705 ng/mL AFP 32.5 ng/mL 2007 2011.04 2011.04 2011.05 2011.06 2011.07 B-viral LC HCC TACE #1 Liver CT Liver CT *Liver CT (2011.06.20) : Increased size of hypovascular HCC on segment 8. a/w tumor thrombi at anterosuperior branch of portal vein. Lipiodolized mass on segment 6 without viable tumor. A small hepatic cyst in segment 6. Underlying liver cirrhosis. Slightly decreased size of cystic lesion at pancreatic body, suggesting serous cystadenoma, R/O IPMN(branch duct type).

Case 3 12074161 김O미 F/45 adm. 2010.09.27 C.C) for TACE #3 P.I) F/45 2009.10 B-viral LC 진단 받고 liver MR 상 S7 의 HCC 진단 받고 TACE #1(2010.11.24) 시행후 f/u liver MR 에서 S8의 새로운 HCC 발견되어 2011.05 TACE #2 시행하였음. 2011.05.16 liver CT 상 S7 lipiodolized 된 부위에 HCC recur 소견 보여 TACE #3 위해 입원 PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/+): 1992년 HBV 감염확인 OPHx) (-) PHx) alcohol(-) , smoking(-) FHx) none

Lab Findings Viral markers Anti HBc Ab (-) HBeAg (+) Anti HBe Ab Antiviral agents CBC/DC WBC (mm3) 4570 Hb (g/dl) 11.7 PLT 116K PT (sec) 12 INR 0.92 Chemistry TB (mg/dL) 0.35 AST/ALT (IU/L) 36/25 ALP/rGT 84/31 Prot/Alb (g/dL) 8.0/4.2 BUN/Cr 13/0.6 LC & Stage Child-Pugh A (5) MELD score -3.36 EV (-) ascites encephalopathy Performance status Grade 1 Tumor markers AFP (ng/mL) 7.0

Clinical Course AFP 542ng/mL AFP 6.3ng/mL AFP 8.5 ng/mL 2009.10 2010.11 2011.03 2011.04 2011.06 2011.07 Liver MR B-viral LC TACE#1 Liver CT TACE#2 TACE#3 Liver MR (2011.06.27) : Equivocal change of a hypovascular HCC in S8, hepatic dome. Recurred HCC in subcapsular portion of S7 with lipiodolized state. New tumor thrombus in right anterosuperior segmental branch of portal vein. AP shunt in S5. Liver cirrhosis with splenomegaly.