1. Comorbidity NASH/HCV and HCC

2. 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

3. 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

4. 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

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

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

7. 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

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

9. Images: Liver
                                                         

10. Images: Lesion
                                                         

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