Suspected case of HCC Chief Complaints A 42 yr old male attended Mopd with diffuse pain abdomen with few episodes of vomiting following intake of food since 1 month. No associated Yellowish discolouration of urine,wt loss ,fever,night sweats,pruritus,stool discolouration,Chest pain,SOB,Loose stool,Headache,Dysuria ,Bloody vomitus etc. Past H/O Jaundice 1 yrs back for which pt took Treatment from Quack. No H/O HTN,DM,Thyroid disorder or substance abuse. No H/O Blood Transfusion,High risk behaviour,IV drug abuse etc. O/E General Examination normal. P/A - left lobe of liver palpable,Mild tender,Hard,Mobile,round border with smooth surface. Rest Systemic Examination normal. Routine Blood IX along with USG-W/A was advised. Next day pt attended Mopd with reports showing- Normal LFT Albumin +++ in urine HbSAG positive Anti HCV Negative HRCT Thorax Normal Rest Ix normal. USG W/A - Liver appears enlarged measuring 16.2 cm and shows coarsened echotexture. A 11.8x10.6x11.9 cm sized ill-defined heterogeneously hypochoic lesion with few anechoie areas within is noted in left lobe of liver. The lesion shows internal vascularity. Suspected of Liver SOL. CECT Abdomen ( Triple phase CT not possible at our hospital ) was advised along with AFP,HbEAg and Quantitative HBV DNA level. CECT Abdomen reports show - Liver measures 12.2cm, shows a large approximately 11.6 x15.1x 11.7cm sized solitary; non-capsulated mass lesion with pre contrast HU: 25-30 HU and post-contrast HU:50-85HU of shows heterogeneous enhancement in arterial phase & wash out in delayed phase noted in segment I & III of left lobe of liver & shows few areas of necrosis within. A 2cm sized defect seen in right inguinal region from which bowel loops & omentum seems to herniate s/o right inguinal hernia. CECT Abdomen is suggestive of HCC. Rest reports are awaited. Surgery opinion was taken and pt is referred to oncologist. UGI Endoscopy was done there showing Large Esophageal Varix with mild PHG. Some battery of test are still required before labelling it as HCC. Waiting for reports.

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Pt requires Liver biopsy & Se. Alpha fetus protein to confirm diagnosis. The lesion is large enough to be operable upfront. So the appropriate approach will be TACE/TARE ( Transarterial chemo or radio embolisation) followed by assessment. If inoperable, pt can be put on targeted therapy like Sorafenib/ Sunitinib & assessed for response. The prognosis is guarded in view of HbsAg positivity.

Thank u sir..

AFP and Core biopsy liver sol

Intresting case Pt had an episode of hepatitisB in past and neglected not received any antivirals for the same hence still hbsAg is+ve still We know hepatitisB is precursor for cirrhosis and liver malignancy Present hypoechoic solitary lesion in Lt lobe is said to be HEPATO CELLULAR CARCINOMA Still pt has a chance of lobectomy followed by radiation and chemotherapy

Thanx dr Anjali K

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