Case 박O석 M/56 adm C.C) for DM control

Presentation on theme: "Case 박O석 M/56 adm C.C) for DM control"— Presentation transcript:

1 Case 1 12200349 박O석 M/56 adm. 2011.05.25 C.C) for DM control
P.I) M/56. HBV carrier 로 그 외 특이 병력 없이 지내던 자로 2개월 전부터 다음, 다뇨, 다갈 있으며 40일 동안 5kg 의 체중 감소 있어 동네 의원에서 진료 후 큰 병원 권해 본원 내분비 내과 입원함. 입원하여 시행한 Abd sono, Liver CT 상 HCC 진단되어 소화기 내과로 전과됨. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/+) OPHx) (-) PHx) alcohol(+) : 소주 1.5병/주 4회, smoking(+) : 30py FHx) 아버지, 형제 : CHB

2 Lab Findings Viral markers Anti HBc Ab (+) HBeAg (-) Anti HBe Ab
Anti- HCV Ab Antiviral agents CBC/DC WBC (mm3) 5630 Hb (g/dl) 13.8 PLT 171K PT (sec) 13.6 INR 1.08 Chemistry TB/DB (mg/dL) 0.62/0.31 AST/ALT (IU/L) 219/254 ALP/rGT 314/480 Prot/Alb (g/dL) 7.3/3.4 BUN/Cr 9/0.6 LC & Stage Child-Pugh A (6) MELD score 7 EV (-) ascites encephalopathy Performance status Grade Tumor markers AFP (ng/mL) 3.53

3 Clinical Course 2011.05.26 05.27 06.01 06.02 *Liver CT (2011.05.27) :
AFP 3.53 ng/mL HBV carrier A-P sono Liver CT Chest CT PET CT *Liver CT ( ) : Hepatocellular carcinomas at right lobe. Left hepatic cyst. A GB stone. LK cyst. Right lung metastases.

4 Case 2 11725981 황O익 M/72 C.C) recurrent HCC
P.I) M/ 년 고대병원에서 CHB 진단받았으며 2007년부터 본원 소화기 내과 f/u 중인 환자로 2010년 12월 시행한 Liver MR 상 Rt lobe 에 2 HCC 소견 보여 TACE #1( ) 시행함. 이후 시행한 f/u Liver MR 상 segment 6 에 HCC 로 의심되는 병변 관찰됨. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/+) OPHx) (-) PHx) alcohol(-), smoking(-) : ex-smoker 30PY FHx) (-)

5 Lab Findings Viral markers Anti HBc Ab (+) HBeAg Anti HBe Ab (-)
Anti- HCV Ab Antiviral agents CBC/DC WBC (mm3) 3140 Hb (g/dl) 12.8 PLT 88K PT (sec) 15.3 INR 1.20 Chemistry TB (mg/dL) 1.28 AST/ALT (IU/L) 35/33 ALP 105 Prot/Alb (g/dL) 7.2/3.9 BUN/Cr 18/0.9 LC & Stage Child-Pugh A (6) MELD score 9 EV (+), F2, RC(+) ascites (+) encephalopathy (-) Performance status Grade Tumor markers AFP (ng/mL) 2.93

6 Clinical Course AFP 7.25 ng/mL AFP 1.99 ng/mL AFP 2.74 ng/mL AFP 2.93 ng/mL CHB B-viral LC Liver MR TACE #1 Liver CT Liver MR *Liver MR ( ) : Suggestive of a HCC at segment 6. Slightly improved mild dilatation of the right anterior segment bile duct. R/O bile duct injury. Equivocal change of thrombosis at left unbilical segment, main portal vein and SMV. Increased amount of ascites. Liver cirrhosis with multiple dysplastic nodules and splenomegaly. Both hepatic cysts. A small benign cystic lesion in pancreas body. Edematous wall thickening in cecum and ascending colon and pericholecystic fatty infiltration. Calcification at spleen.

7 Case 3 11864818 김O안 M/63 C.C) elevated AFP
P.I) M/63. 20년간 매일 소주 2병씩 마셔온 chronic alcoholics로 2001년 CHB 진단받고 본원 소화기 내과 f/u 중 2007년 B-viral LC 진단받았으며 2008년 5월 시행한 Liver CT 상 HCC 진단되어 TACE #1 ( ), TACE #2( ), RFA #1 ( ), TACE #3 ( ) 시행 함. 이 후 외래 f/u 하던 자로 liver MR 상 HCC recurrence 소견 없으나 AFP 257.4로 증가한 소견 보임. PMHx) DM / HTN / pul.TB / hepatitis (-/-/+/+) OPHx) (-) PHx) alcohol(-): 현재 금주, smoking(-) : ex- smoker 10py FHx) (-)

8 Lab Findings Viral markers Anti HBc Ab (+) HBeAg Anti HBe Ab (-)
Anti- HCV Ab Antiviral agents CBC/DC WBC (mm3) 6850 Hb (g/dl) 13.6 PLT 71K PT (sec) 14.8 INR 1.15 Chemistry TB (mg/dL) 1.17 AST/ALT (IU/L) 49/20 ALP/rGT 104 Prot/Alb (g/dL) 7.1/3.7 BUN/Cr 17/0.7 LC & Stage Child-Pugh A (5) MELD score 9 EV (+), F1, RC(-) ascites (-) encephalopathy Performance status Grade Tumor markers AFP (ng/mL) 257.4

9 Clinical Course AFP 278.5 ng/mL AFP 257.4 ng/mL AFP 107.1 ng/mL AFP 106.0 ng/mL AFP 50.44 ng/mL AFP 3.26 ng/mL B-viral LC HCC TACE #1 TACE #2 RFA #1 TACE #3 Liver MR *Liver MR ( ) : A lipiodolized nodule in segment 6 without viable tumor. A hepatic cyst in segment 8. No definite new HCC in liver on MR. Liver cirrhosis with splenomegaly. Right renal cyst.

10 Case 4 12165517 서O선 M/57 adm. 2011.05.30 C.C) for TACE #3
P.I) M/57. B-viral LC 환자로 8년 전 삼성병원 OPD f/u하다가 loss되었던 과거력 있는 자로 2010년 12월 시행한 건강 검진상 AFP 250으로 상승소견으로 본원 내원하여 HCC 진단받고 TACE #1 ( )시행 받고 퇴원함. 이후 f/u CT상에서 new HCC 소견 보여 TACE #2( ) 시행함 시행한 f/u MR 상 recurrence of HCC 소견 보여 TACE #3 위해 입원함. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/+) OPHx) (-) PHx) alcohol(-), smoking(-) : ex-smoker 15py FHx) none

11 Lab Findings Viral markers Anti HBc Ab (+) HBeAg (-) Anti HBe Ab
Anti- HCV Ab Antiviral agents CBC/DC WBC (mm3) 3680 Hb (g/dl) 14.7 PLT 81K PT (sec) 14.3 INR 1.15 Chemistry TB/DB (mg/dL) 0.91/0.27 AST/ALT (IU/L) 34/33 ALP/rGT 84/174 Prot/Alb (g/dL) 6.4/3.6 BUN/Cr 15/0.9 LC & Stage Child-Pugh A (5) MELD score 8 EV (-) ascites encephalopathy Performance status Grade Tumor markers AFP (ng/mL) 838.4

12 Clinical Course AFP 7238 ng/mL AFP 838.4 ng/mL AFP 657.5 ng/mL AFP 524.8 ng/mL B-viral LC HCC TACE #1 Liver CT Liver MR TACE #2 Liver MR TACE #3 *Liver MR ( ) : A newly develped HCC in segment VII (about 7mm in size). Viable tumor at anterior aspect of lipiodolized HCC at segment VIII. Newly lipiodolized HCC at segment V without definite viable tumor. Another multiple lipiodolized HCCs in both hepatic lobes without definite viable tumor. No change of liver cirrhosis with atrophy No change of an accessory spleen

13 Case 5 11834498 안O섭 M/65 C.C) liver mass
P.I) M/65. HTN 으로 medication 중이며 2006년 stable angina 로 본원 순환기 내과(pf.김수중) 에서 CAG 시행한 자로 2011년 5월 시행한 검사상 liver mass 발견됨. PMHx) DM / HTN / pul.TB / hepatitis (-/+/-/-) OPHx) (-) PHx) alcohol(-) , smoking(-) FHx) (-)

14 Lab Findings CBC/DC WBC (mm3) 7500 Hb (g/dl) 15.2 PLT 206K PT (sec)
11.8 INR 0.90 Viral markers HBsAg (-) Anti HBs Ab Anti- HCV Ab Anti- HIV Ab Chemistry TB (mg/dL) 0.33 AST/ALT (IU/L) 28/29 ALP/rGT 90/22 Prot/Alb (g/dL) 7.2/4.2 BUN/Cr 15/1.0 Tumor markers AFP (ng/mL) 6.27 CEA (ng/mL) 1.26 CA 19-9 (U/mL) 2.00 Performance status Grade

15 Clinical Course AFP 6.27 ng/mL A-P sono Stable angina s/p CAG Liver MR *Liver MR ( ) : Suggestive of inflammatory granuloma at segment 8. R/O eosinophilic necrosis R/O parasitic infection. R/O intrahepatic cholangiocarcinoma. Tiny both hepatic cysts. Rec> Close F/U

16 Case 6 12024069 윤O식 M/50 C.C) HCC s/p TACE #1
P.I) CHB 로 2009년부터 IG(pf.김병호) f/u 하던 자로 시행한 Liver CT 상 HCC 소견 보여 ~ 기간 동안 입원하여 TACE #1 시행 후 퇴원함. PMHx) DM / HTN / pul.TB / hepatitis (-/-/+/+) OPHx) (-) PHx) alcohol(+) : 소주 2~3병/주3회, smoking(-) : ex-smoker 10py FHx) none

17 Lab Findings Viral markers Anti HBc Ab (+) HBeAg (-) Anti HBe Ab
Anti- HCV Ab Antiviral agents CBC/DC WBC (mm3) 6810 Hb (g/dl) 14.7 PLT 172K PT (sec) 14.4 INR 1.11 Chemistry TB (mg/dL) 0.57 AST/ALT (IU/L) 35/49 ALP 66 Prot/Alb (g/dL) 6.8/3.9 BUN/Cr 10/0.7 CRP <0.3 LC & Stage Child-Pugh A (5) MELD score 8 EV (-) ascites encephalopathy Performance status Grade Tumor markers AFP (ng/mL) 17.28

18 Clinical Course 2011.3.18 2011.05.17 LIVER MR (2011.05.17) :
AFP ng/mL AFP ng/mL CHB B-viral LC HCC Liver MR TACE #1 LIVER MR ( ) : Two lipoidolized HCCs with parenchymal uptake at segment 8, and segment 7/6, without viable portion. Hepatic cysts in right lobe and segment 4. Undrelying liver cirrhosis.