Surveillance for Hepatocellular Carcinoma in Patients With Cirrhosis

Abstract

Clinical Scenario A man was referred to liver transplantation clinic for the evaluation of enlarging abdominal girth and welling of feet during the preceding 2 months. The patient was Cambodian native who immigrated to the United States 5 ears ago. The patient was first diagnosed with chronic hepatitis virus (HBV) infection shortly after his entry into the United tates. However, he was not further evaluated, treated, or folowed. He had no personal or family history of liver disease or iver cancer. Physical examination of the abdomen showed mild epatosplenomegaly with positive shifting dullness from a oderate amount of ascites. There was no abdominal tenderess. Laboratory results included platelet count, 95,000/ L; spartate aminotransferase, 100 U/L; alanine aminotransferase, 5 U/L; and Model for End-Stage Liver Disease score, 13. Viral erology showed hepatitis B surface antigen–positive and entigen–positive and HBV DNA of 5 million IU/mL. Serum lpha-fetoprotein (AFP) was normal at 4 ng/mL. An abdominal ltrasound (US) showed cirrhotic liver contour and evidence of ortal hypertension. An esophagogastroduodenoscopy showed arge esophageal varices. The patient was started on the followng medications: spironolactone and furosemide for the ascites, ropranolol for the varices, and entecavir for HBV. Patient was urther assessed and then listed for liver transplantation. During the ensuing 12 months, the patient had substantial linical improvement including resolution of ascites as well as epatitis B e seroconversion. He also underwent abdominal US nd serum AFP measurement on a 6-month interval. An abominal US performed 18 months after his presentation howed a new 2.1-cm hyperechoic nodule in the right lobe of he liver along with mild elevation of serum AFP at 22 ng/mL. subsequent triphasic abdominal computed tomography (CT) can showed a 2.2-cm well-circumscribed vascular mass that ad arterial enhancement and venous washout, thus meeting he radiographic diagnosis criteria for hepatocellular carcinoma HCC) of the American Association for the Study of Liver isease (AASLD). The patient underwent transarterial chemombolization and subsequently received a liver transplant. Four ears later, the patient is doing well with satisfactory liver unction with no evidence of recurrent HBV or HCC.