1. HCC

2. Case Presentation
56 F, White
HCV
HCC?

3. 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

4. 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

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

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

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

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

9. AFP
33 (Mar 2004)
1315 (Sept 04)

10. US /09/04 S2 S5

11. CT /1/04 S2
arterial
portal
delayed

12. CT /1/04
S5 (1)
arterial
portal
delayed

13. CT /1/04
S5 (2)
arterial
portal
delayed

14. MRI 1/4/05 S2 T1 T2 Gd

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

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

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

18. AFP

19. AFP
Forteo
Stop
Start
Imaging study

20. CT /17/98 S5 S5 S2

21. AFP Trend
Pseudo positive because of Forteo?
Occult HCC?

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