Hepatocellular Carcinoma

This was a 54 year-old man from Vietnam (immigrated to USA 20 years ago) with no past medical history, presenting with a week of epigastric pain. He also endorsed a 10-lb. weight loss  over the past year, and had a significant smoking and alcohol abuse history, though stopped 1 year ago. He had remotely used IV cocaine in the past.

Physical exam was notable for mild scleral icterus, multiple tattoos, diffuse abdominal tenderness and mild hepatomegaly, but no other signs of liver failure (e.g. gynecomastia, palmar erythema, spider angiomata, or caput medusae).

Labs were notable for a leukocytosis of 13.5, platelets of 90, a relatively unremarkable chemistry panel, and and a cholestatic pattern of liver tests. INR and albumin were normal.

Abdominal ultrasound revealed a 7.5×7.5 cm mass in the right lobe of the liver, AFP was 3400, and a diagnosis of hepatocellular carcinoma was made.

Teaching points:

-List the risk factors for hepatitis infection and hepatocellular carcinoma

-Understand the diagnostic criteria for hepatocellular carcinoma (Often, no tissue is necessary for diagnosis)

-Understand the management of portal vein thrombosis

Click on these links for more information regarding the diagnosis and prognosis of hepatocellular carcinoma.