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Published byΠτολεμαῖος Βασιλικός Modified over 6 years ago
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Successful Tace in Patient with large HCC
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History 65 y/o hispanic (Cuban) male with alcoholic + NASH-related cirrhosis diagnosed in October 03 (since abstinent) Referred for HCC (8.5 cm) management 10/06 PMH DM Asthma Cholecystectomy Obesity Alcoholic cardiomyopathy (compensated)
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Cirrhosis Hepatic encephalopathy related hospitalization
H/O grade 1–2 varices, no GI bleed No ascites/edema/jaundice Biological MELD – 12 (2006) Diagnosed with 8.5 cm HCC in 2006 on US, CT and MRI during screening AFP in June 2006 was 12,526
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Medications Digoxin Rifaximin Fluoxetine Montelukast Bumetanide
Spironolactone
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TACE with ethiodol cisplatin combination and embolisation with gelfoam
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Post TACE CT scan
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Therapy (cont’d) Adjuvant therapy Tumor size 8.5 3 cm in 4 months
Bevacizumab Octreotide Tumor size 8.5 3 cm in 4 months AFP 12,526 3.1(10/06)
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Post TACE labs Sodium 140 Hemoglobin 12.4 Potassium 3.6 HCT 37.2
BUN/Cr 14/0.9 INR 1.54 Total Bilirubin 1.3 AST 45 ALT 50 Alk. Phosphatase 124 Albumin 2.6 Biological MELD score 12 Hemoglobin 12.4 HCT 37.2 WBC 3.3 Platelets 32K
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Liver Transplant OLT on 2/1/07 with a MELD of 17 [biological]
Explant pathology Cirrhosis with mild inflammatory activity Area of 3 cm necrosis No residual viable carcinoma No vascular invasion
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Post Liver Transplantation
Patient doing well No complications No tumor recurrence
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Follow-up triple phase CT at 2 years
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