1. HCC Developing in Non-Cirrhotic with History of HBV

2. 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

3. 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

4. 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

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

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

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

15. 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