Case 오O 수 M/56 adm C.C) known hepatic mass

Presentation on theme: "Case 오O 수 M/56 adm C.C) known hepatic mass"— Presentation transcript:

1 Case 1 12177750 오O 수 M/56 adm.2011.3.22 C.C) known hepatic mass
P.I) 특이병력 없는 자로 매일 소주 2병씩 마시는 heavy alcoholics로 충북대 병원에서 ALC진단( )받고 CT상 r/o HCC소견으로 ~ 동안 입원하여 evaluation진행했던 자로 자세한 F/E위해 재입원함. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/-) OPHx) (-) PHx) alcohol(+) : 소주 2병/ daily smoking(+) : 30 py FHx) none

2 Lab Findings CBC/DC WBC (mm3) 7310 Hb (g/dl) 12.6 PLT 87K PT (sec)
19.5 INR 1.66 Viral markers HBs Ag (-) Anti HBs Ab Anti- HCV Ab LC & Stage Child-Pugh B(9) MELD score 13.48 EV (+), F1, RC(-) Ascites (+) Encephalopathy (-) Chemistry TB (mg/dL) 3.55 AST/ALT (IU/L) 41/28 ALP 134 Prot/Alb (g/dL) 6.5/3.0 BUN/Cr 12/0.7 CRP 0.57 Tumor markers AFP (ng/mL) 15.89 CA 19-9 (ng/mL) 19.02 Performance status Grade

3 Clinical Course AFP ng/mL AFP ng/mL ALC r/o HCC Liver MR TACE #1 Adm 충북대 병원 LIVER MR( ) - Focal ductal dilatation with/without cystic lesion in the posterior segment of the liver 1. Mucin producing tumor communicating to the IHD 2. Hemobilia --> R/O HCC with ductal invasion TACE #1( ) 특별히 hyperstaining을 보이는 lesion은 없으나 liver MR와 correlation하여 right anterior and posterior segment에 chemoembolization시행 LIVER CT( ) LIVER MR( ) SONOGRAPHY( )

4 Case 2 11323760 이O 섭 M/62 adm.2011.3.10 C.C) for evaluation of HCC
P.I) 1997년 hepatitis B 진단받은 자로 이후 본원 IG f/u 하면서 LC 진단받았던 자로 최근 외래 f/u 시 시행한 검사상 AFP 상승되어 있고 abd CT상 HCC 의심소견으로 F/E 위해 내원함. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/+) OPHx) (+) appendectomy PHx) alcohol(-) , smoking(-) FHx) none

5 Lab Findings Viral markers HBeAg (+) Anti HBe Ab (-) Anti- HCV Ab
Antiviral agents (+) Adefovir CBC/DC WBC (mm3) 7470 Hb (g/dl) 15.6 PLT 180K PT (sec) 13.7 INR 1.04 LC & Stage Child-Pugh A(5) MELD score 3.05 LCSGJ Stage II(T2N0M0) JIS 1 EV (-) ascites Chemistry TB/DB (mg/dL) 0.64/0.23 AST/ALT (IU/L) 21/21 ALP/rGT 62/27 Prot/Alb (g/dL) 7.4/4.5 BUN/Cr 11/0.8 CRP <0.3 Tumor markers AFP (ng/mL) 33.83 CEA (ng/mL) 0.910 CA 19-9 (ng/mL) 2.00 Performance status Grade

6 Clinical Course 33.83 ng/mL AFP 3.02 ng/mL 1997~ ~ ~ B-viral LC HCC Dx Adm ABD SONO( ) -Liver cirrhosis Right hepatic cysts LIVER CT ( ) A nodular lesion in segment 6 suggestive of HCC Liver MR LIVER MR( ) -HCC in segment 5-6 -Lap. 5 & 6 segmentectomy PATHOLOGIC FINDINGS Hepatocellular carcinoma Tumor size: 3 cm x 2.5 cm x 2.4 cm Extent of tumor: solitary tumor with vascular invasion (pT2) Hepatic capsular penetration: not identified Margins of resection: no tumor Vascular invasion: present Lymphatic invasion: not identified

7 Case 3 12050455 이O 숙 F/47 adm.2011.3.23 C.C) known hepatic mass
P.I) 09년 6월 외부병원에서 B-viral LC, esophageal varix 진단받은 자로 이후 본원 방문하여 HCC 진단받고 TACE #3 시행 받은 자로 f/u liver CT상 recurrent HCC소견으로 F/E 및 mx위해 입원함. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/-) OPHx) (+) 04년 cholecystectomy PHx) alcohol(-), smoking(-) FHx) 둘째 오빠 HCC로 사망함. 첫째 오빠 및 남동생 HBV carrier

8 Lab Findings Viral markers HBeAg (+) Anti HBe Ab (-) Anti- HCV Ab
Antiviral agents (+) baraclude CBC/DC WBC (mm3) 3600 Hb (g/dl) 11.8 PLT 93K PT (sec) 15.2 INR 1.19 LC & Stage Child-Pugh A(5) MELD score 13.48 LCSGJ Stage III(T3N0M0) JIS 2 EV (+), F1, RC(-) Ascites (-) Encephalopathy Chemistry TB/DB (mg/dL) 0.77/0.33 AST/ALT (IU/L) 31/21 ALP/GGT 82/56 Prot/Alb (g/dL) 7.3/3.9 BUN/Cr 11/0.4 CRP 0.48 Tumor markers AFP (ng/mL) 490.8 PIVKA II 2 Performance status Grade

9 Clinical Course 2009.6 2009.9 2010.7.6 2011.03.23 LIVER CT(2009.06.11)
AFP ng/mL AFP 3.16 ng/mL AFP 5.13 ng/mL AFP 2.30 ng/mL B-viral LC HCC TACE #2 TACE #3 Recurrent HCC LIVER CT( ) HCC in segment 5 TACE #1( ) LIVER MR( ) HCC in segment 4, 5 TACE #2( ) LIVER CT( ) Viable tumor at S5 TACE #3( ) LIVER CT( ) -recurrent HCC at left medial segment and right anterior segment of liver

10 Case 4 10863103 김O 종 M/53 adm.2011.3.15 C.C) for RFA
P.I) 20년전 HBV 진단, B-viral LC 진단받고 본원 IG f/u중인 자로 외래 추적관찰 중 시행한 검사상 segment V에 HCC소견으로 RFA시행 위해 입원함. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/+) OPHx) (+) L5S1 HNP로 disectomy & hemilaminectomy PHx) alcohol(-) smoking(-) : ex-smoker, 15 py FHx) none

11 Lab Findings Viral markers HBeAg (-) Anti HBe Ab (+) Anti- HCV Ab
Antiviral agents CBC/DC WBC (mm3) 4770 Hb (g/dl) 14.8 PLT 166K PT (sec) 13.2 INR 0.99 LC & Stage Child-Pugh A(5) MELD score -1.12 LCSGJ Stage I (T1N0M0) JIS score EV (-) Ascites Encephalopathy Chemistry TB (mg/dL) 0.51 AST/ALT (IU/L) 17/12 ALP/GGT 73/19 Prot/Alb (g/dL) 6.7/4.4 BUN/Cr 16/0.6 Performance status Grade Tumor markers AFP (ng/mL) 7.15

12 Clinical Course AFP 7.15 ng/mL B-viral LC Abd sono Liver CT RFA LIVER SONO ( ) Small right hepatic mass LIVER CT ( ) -Newly developed suggestive of a HCC in hepatic segment V Rec) RFA with/without biopsy RFA( ) LIVER CT( ) - follow-up CT check 권유

13 Case 한O 진 M/60 adm C.C) known hepatic mass o/s) 내원 7일전 P.I) B형 간염 보균자로 3년 전 건강 검진상 LC 진단받은 자로 이후 local clinic 정기적인 f/u 하면서 추적관찰 하던 중 f/u loss되었다가 abd CT 시행하였고 HCC 의심 소견으로 F/E 및 Manage 위해 내원. PMHx) DM / HTN / pul.TB / hepatitis (-/-/-/+) OPHx) (-) PHx) alcohol(-) : 3년 전부터 금주, smoking(-) : ex-smoker 40py FHx) none

14 Lab Findings Viral markers Anti HBc Ab (+) HBeAg (-) Anti HBe Ab
Anti- HCV Ab Antiviral agents CBC/DC WBC (mm3) 5190 Hb (g/dl) 13.0 PLT 106K PT (sec) 16.4 INR 1.32 LC & Stage Child-Pugh B (7) MELD score 4.50 LCSGJ Stage II(T2N0M0) JIS 2 EV (+), F2, RC(-) ascites (+) encephalopathy (-) Chemistry TB/DB (mg/dL) 0.65/0.26 AST/ALT (IU/L) 28/14 ALP/rGT 150/62 Prot/Alb (g/dL) 7.3/3.1 BUN/Cr 11/0.7 CRP 0.71 Performance status Grade Tumor markers AFP (ng/mL) 7.28

15 Clinical Course 2009 2011.3.14 2011.3.21~ 외부 LIVER CT (2011.3.14)
AFP 7.28 ng/mL ~ B-viral LC r/o HCC Adm 외부 LIVER CT ( ) -HCC LIVER MR( ) -HCC in segment V RFA( ) LIVER CT( )