Abstract
Introduction: A 49 years old female woman, presented with a 2-months history of mild upper abdominal pain . Investigation revealed AFP 55 ng/ml, and hepatitis B DNA positive. Ultrasound showed a heterogenous mass between the liver and stomach. Computed Tomography (CT) showed a large exogenous heterogenous enhancing mass arising from the spiegelian lobe, and lymph node enlargement of group VIII/IX/XII. Method: The diagnosis was hepatocellular carcinoma with lymph node metastasis, the liver function was Child-Pugh grade A, the Barcelona Clinic Liver Cancer (BCLC) advanced stage ( stage C ), and she should receive sorafenib therapy only. According to the APASL (the Asian-Pacific association of the society of liver ) guideline 2017, the patient also can only receive systemic therapy. Due to the young age and good function, the patients received surgery because it was felt that this is the best chance of cure for her. The tumor was removed and radical lymph node dissection was done. Result: The patient recovered fast and AFP decreased to 18 ng/ml 2 weeks after the operation, and she is now still free form relapse with normal AFP and having an active life nearly 1 year after the surgery. Conclusion: This case revealed that personalized treatment not in accord with guideline recommendation may get better results in some carefully chosen patients.
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