1. AFP > 9000 without demonstrable HCC

2. History
A 51 y/o white male, who was diagnosed with hereditary hemochromatosis in 1996
There is a history of diabetes, loss of libido, and a bronze hyperpigmentation
There was a history of excessive alcohol usage

3. History Initially, he was treated with weekly phlebotomy.
In 3/01, routine screening test with serum AFP revealed a value of 600 ng/ml.
Extensive work-up was performed, which included: 1) Abdominal MRI 2) PET scan 3) Testicular ultrasound.

4. History
Repeat serum AFP levels obtained at three month intervals revealed: 1) 1,800 ng/ml 2) 9,030 ng/ml.
Subsequently, he was referred for further evaluation.

5. Physical Examination HEENT: Sclera anicteric Neck: No JVD
CVS: Regular rhythm, normal S1.S2, No murmurs appreciated
ABD: Hepatomegaly of 18 cm, No shifting dullness
EXT: No edema of lower extremities
Skin: Bronze pigmentation

6. Laboratory data
WBC /ul Albumin 4.0 g/dl. Hb g/dl. AST 64 U/L. Platelets /ul ALT 47 U/L. Creatinine g/dl INR MELD 5

7. Figure – 1 (CT scan of 10/11/01)

8. Chest CT scan and a bone scan were negative for metastatic lesions.

9. Figure – 2 (laparoscopy was performed in November 2001)

10. Figure –3 (Liver biopsy of 11/5/01)

11. Due to the elevated serum level of AFP and the abnormal appearing abdominal CT scan, the decision was made to list the patient for transplantation with a back-up

12. He underwent cadaveric liver transplantation on 6/11/02
Gross examination of the liver and abdomen did not reveal evidence of hepatocellular carcinoma

13. Figure – 4 (Explant 6/11/02).

14. Repeat serum AFP level in 7/02 was 3.3 ng/ml
After nine month follow-up, the patient is doing well. Serial abdominal imaging with serial serum AFP levels have been negative for hepatocellular carcinoma