Liver mass!

Chief Complaint A 52-year-old female complains of diffuse abdominal pain, which was relieved on analgesia. She complained of obstructed defecation for the past 3 months. History No nausea, vomiting, loss of appetite or weight loss. No other past medical history. Examination Physical examination is within normal limits. No splenomegaly or palpable liver noted. Investigations Hb: 12.5 g/dl and a CRP: 6.5 mg/dl (reference range <0.5 mg/dl). Carcinoembryonic antigen level was also check which shows normal limits <0.2 ng/ml; (reference range 0–5ng/ml). X-ray wnl. USG of the abdomen shows a 15 × 16 cm semisolid tumor mass in the right lobe of liver. CT shows a tumor mass with necrosis. Diagnosis What is your opinion? What next should be done?

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Large tumor mass in liver The very fact that carcinoembryonic antigen level is done, the physician is thinking of malignancy No doubt, malignancy is first differential diagnosis ? Hepatocellular carcinoma ? Intrahepatic cholangiocarcinoma Adv Alfa feto protein Biopsy Histopathology Treatment based on reports

Hepato - cellular carcinoma is the most likely Diagnosis. An urgent Alfa - feto protein estimation is indicated A PET scan is indicated to confirm the diagnosis and look for any distant metastasis A CT guided biopsy is indicated before starting any treatment but Correct PTI before biopsy. If no distant metastasis are evident - a right hepatectomy is indicated

NEED'S.. TO.. DO.. HISTOPATHOLOGICAL STUDY..BIOPSY.. CT GUIDED..STUDY.. TO. R/O ..MALIGNANCY.. EXPERTS OPINION..

Suggest Alfa fetoprotein estimation PETCT to check metabolic activity and metastasis. CT guided biopsy of the liver mass. Partial heoatectomy

Thank you ,Dr Amith Gupta
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Surgical resection

A colonoscopy also if the primary is in the colon

Hepatoma, requires partial hepatectomy

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