Case Of Hepatocellular Carcinoma Presenting Research Articles

Unusual presentation of a common tumor

Hepatocellular carcinoma(HCC) is the most common primary malignant tumour of liver. It is 5th most common malignancy in males and 8th most common tumour in females. The patients of HCC may remain clinically asymptomatic or may present with abdominal pain, weight loss, malaise, fever, jaundice or ascitis. HCC is a highly malignant tumor with frequent extrahepatic metastasis. The most frequent site of metastasis is lungs (47%), followed by lymph nodes (45%), bones (37%), and adrenal glands (12%). We present a case of 67 year old male, who presented with progressively increasing swelling in the left occipital region for 2 months. MRI brain showed large lobulated moderately enhancing T2 isointense to hyperintense and T1 hypointense mass lesion in occipital region, causing destruction of occipital bone with large intracranial extradural soft tissue component. Possibilities suggested were Meningioma or metastatic lesion. The scalp mass was excised. The histopathological examination of the excised tissue followed by elaborate immunohistochemistry suggested metastatic hepatocellular carcinoma, which was later confirmed by S.AFP and multiphase CT thorax, abdomen, pelvis which showed multiple liver lesions. Initial presentation of HCC as a subcutaneous lesion is very rare and only very few cases of HCC presenting with primary soft tissue swelling have been reported.

S2530 An Unusual Case of Hepatocellular Carcinoma Presenting as an Abscess and Enterohepatic Fistula

S2530 An Unusual Case of Hepatocellular Carcinoma Presenting as an Abscess and Enterohepatic Fistula

A case of hepatocellular carcinoma presenting with myasthenia gravis (P5.4-031)

A case of hepatocellular carcinoma presenting with myasthenia gravis (P5.4-031)

A Typical Presentation of Hepatocellular Carcinoma

Introduction: Hepatocellular carcinoma is commonly seen in chronic liver disease patients due to hepatitis B or C infection. Melena and haematemesis are the common gastrointestinal symptoms due to intraluminal haemorrhage. Surgical resection is the treatment of choice. Case presentation: We report a case of hepatocellular carcinoma presenting as gastric outlet obstruction in a 64 years male with chronic hepatitis B virus infection. Hepatocellular carcinoma was detected during evaluation for gastric outlet obstruction. Intra-operatively there was no invasion to the duodenum; rather there was extrinsic compression and adhesions around the duodenum. Patient underwent successful right posterior sectionectomy. Conclusion: Hepatocellular carcinoma presenting as gastric outlet obstruction is rare and curative surgery is possible in selected patients.

胆道出血で発症した肝細胞癌の1例

症例は54歳の男性。30歳時にC型肝炎を指摘されたが放置していた。2時間前から徐々に増強する心窩部痛を主訴に来院した。血圧88/58mmHg，脈拍57/分であった。身体診察にて，心窩部に圧痛を認めた。血液検査では肝臓逸脱酵素および胆道系酵素の上昇と軽度のビリルビン上昇を認めた。腹部単純CTでは右肝管から総胆管内の出血を，造影後は肝右葉優位に多発する濃染腫瘤を認め，肝細胞癌破裂により生じた胆道出血と診断した。内視鏡的胆道内血腫除去を行い，心窩部痛の改善を認めた。さらに入院3日目に再出血予防および肝細胞癌の治療を目的として肝動脈化学塞栓術（transcatheter arterial chemoembolization: TACE）を施行した。症状は改善し入院24日目に退院となった。2か月後，5か月後に残存腫瘍に対してTACEを行ったが，7か月後に肝不全で永眠された。胆道出血の治療方針の柱は止血と胆道閉塞解除であり，出血速度に応じていずれを優先させるかを判断する必要がある。

Intraductal Hepatocellular Carcinoma without Parenchymal Tumor: A Case Report

Obstructive jaundice due to hepatocellular carcinoma is rare. We present a case of hepatocellular carcinoma presenting as an intraductal tumor, which was clinically and radiologically diagnosed as cholangiocarcinoma. A 59-year-old male was admitted with recurrent episodes of jaundice. He was found to have a tumor in the right hepatic duct extending into intrahepatic ducts, which was clinically and radiologically diagnosed as cholangiocarcinoma. The patient underwent right hepatectomy with excision of the bile duct and left hepaticojejunostomy. Histological examination revealed an intraductal moderately differentiated hepatocellular carcinoma. The rest of the liver parenchyma showed features secondary to biliary obstruction but no tumor. A case of hepatocellular carcinoma presenting as an intraductal tumor with obstructive jaundice and no evidence of parenchymal tumor is presented.

Hepatocellular Carcinoma Presenting as an Incidental Isolated Malignant Portal Vein Thrombosis

Portal vein thrombosis is frequently associated with hepatocellular carcinoma (HCC). Tumor invasion into the portal vein by direct venous extension or metastasis occurs in up to 70% of HCC patients (Cedrone et al., Liver 16:94-8, 1996). However, presentation as an isolated malignant portal vein thrombosis without any evidence of obvious hepatoma-like lesions in the liver by imaging studies is extremely uncommon. We present an unusual case of HCC presenting as a malignant portal vein thrombus, proven on biopsy of the thrombus without any evidence of primary liver lesion. This, to our knowledge, is the first case of HCC presenting as an incidental isolated malignant portal vein thrombosis. The importance of doing delayed enhancement imaging studies to rule out malignant portal vein thrombosis is emphasized. A 60-year-old man presented with acute substernal chest pain. Physical examination revealed icterus. Examination of the abdomen did not reveal any organomegaly. Liver function test revealed a predominantly conjugated bilirubinemia. Abdominal sonogram revealed thrombosis and occlusion of the posterior right portal vein. Liver parenchyma was homogenous with no intrahepatic mass. Computed tomography (CT) of the abdomen and pelvis after administration of oral and intravenous contrast with delayed views revealed arterial enhancement of the right portal vein thrombus with delayed washout. MRI of the abdomen with gadolinium confirmed the right portal vein thrombus without focal hepatic mass. Aspiration of the right portal vein thrombus under CT guidance revealed hepatocellular carcinoma which was confirmed by immunohistochemistry. Serum alpha-fetoprotein level was very high. Patient was started on sorafenib with subsequent decrease in alpha-fetoprotein level. He was doing well till the date of this report. This unusual case of hepatocellular carcinoma presenting as an incidental malignant portal vein thrombosis without any primary liver lesion is extremely rare. Other reported cases of malignant portal vein thrombosis have been in patients with underlying hepatoma, cirrhosis, or with intrabiliary hepatocelluar carcinoma. In the clinical setting of portal vein thrombosis, imaging studies showing enhancement of the thrombus in the arterial phase are important in leading to the diagnosis of malignancy.

A Case of Hepatocellular Carcinoma Presenting with Pruritus as the Presenting Manifestation with Resolution after Trans Arterial Chemo Embolization

Purpose: Pruritus secondary to high bile acid levels is well known (20%) in patients with advanced chronic hepatitis C. We report a case of patient presenting with pruritus as a possible paraneoplastic manifestation of hepatoma. Case Report: A 54 yr old Caucasian man with known diagnosis of Hepatitis C for 6 years was referred to our hepatology service because of a suspected large hepatocellular carcinoma. His only complaint at the time of presentation was severe pruritus. He had signs of portal hypertension and cirrhosis on a CT scan of his abdomen six years prior. A CT scan done almost one year before showed a 7.7 × 5.5 cm mass in the liver which showed early enhancement with late wash out consistent with hepatocellular carcinoma. A biopsy was not done at that time as his platelet count was profoundly low in the 20–30,000 range. His past medical history was unremarkable. Significant physical findings included skin excoriations from scratching, spider nevi, and a liver span of 12 cm with no discrete palpable masses or ascites. Laboratory Findings included hemoglobin 13.7 g/dl, platelets 33,000/UL, total bilirubin 1 mg/dl, alkaline phosphatase 208 U/L, ALT 99 U/L, AST 164 U/L and serum bile acid 81 Umol/L. A repeat CT scan showed again a large 9.3 × 7.4 × 10 cm mass in the right lobe of the liver without any evidence of biliary obstruction as well as several smaller subcentimeter lesions in the left lobe. The patient had tried multiple agents for pruritus including benadryl, cholestyramine, cyproheptadine & rifampin without much relief of his symptoms. In view of the large and multiple lesions he was deemed not to be a candidate for transplant, radiofrequency ablation, or surgical resection. He then underwent three cycles of Transarterial Chemoembolization (TACE) targeting the dominant lesions. After the first cycle, patient reported significant decrease in pruritus. Repeat CT scan showed significantly decreased amount of enhancing tumor. On a recent 6 month follow up the patient was still free of pruritus. Conclusion: Our case demonstrates association of pruritus with hepatocellular carcinoma. Although there have been rare reports of hepatocellular carcinoma presenting with pruritus, this is the first report where resolution was demonstrated after treatment of the cancer with TACE. Hepatocellular carcinoma should be considered in a patient with underlying cirrhosis and new onset pruritus.

Hepatocellular carcinoma presenting as pyogenic liver abscess: characteristics, diagnosis, and management.

We performed a 17-year retrospective analysis of 10 cases of hepatocellular carcinoma presenting as pyogenic liver abscess. Spontaneous tumor necrosis and biliary obstruction caused by tumor thrombi, superimposed with bacterial infection, were the two major pathogeneses. Exact diagnosis of the underlying hepatocellular carcinoma was made for five of the 10 patients before management was attempted. Main clinical manifestations included fever, chills, right-upper-quadrant pain, malaise, anorexia, jaundice, and hepatomegaly. Characteristics such as middle age and male sex, seropositivity for hepatitis B and/or hepatitis C, chronic liver disease, unexplained anemia, marked weight loss, and a severely inversed albumin/globulin ratio raise suspicions about the underlying hepatocellular carcinoma. Management strategies included percutaneous drainage (n = 3), surgical drainage (n = 4), and hepatectomy (n = 3) in addition to administration of parenteral antibiotics in all cases. The prognosis was dismal, with a mean survival of 3.5 months (range, 8 days to 6 months).

A resected case of hepatocellular carcinoma presenting with obstructive jaundice

A resected case of hepatocellular carcinoma presenting with obstructive jaundice

Intraductal hepatocellular carcinoma treated by intralumenal brachytherapy

Hepatocellular carcinoma (HCC) rarely presents as biliary tract occlusion [1,2]. Intralumenal iridium-192 brachytherapy has been used to treat extrahepatic bile duct carcinoma and may be curative if the macroscopic tumour has been resected surgically [3]. We describe a rare event, a case of HCC presenting with bilary tract occlusion treated with intralumenal iridium-192 brachytherapy.

A Case of Hepatocellular Carcinoma Presenting as Acute Abdomen

A Case of Hepatocellular Carcinoma Presenting as Acute Abdomen

肝外発育型肝細胞癌１３例の検討

肝外発育型肝細胞癌１３例の検討

Hepatocellular carcinoma presenting as acute spontaneous haemothorax

Hepatocellular carcinoma may present in various ways, but only a few instances present with symptoms of distant metastases. This report describes a case of hepatocellular carcinoma presenting with acute haemothorax and haemorrhagic shock secondary to spontaneous rupture of chest wall metastasis. Hepatocellular carcinoma is a frequent malignancy in Asia and should be considered in the list of differential diagnosis of spontaneous haemothorax.

Hepatocellular carcinoma presenting as intracranial metastasis

The authors describe two cases of hepatocellular carcinoma presenting with the initial manifestations of an intracranial mass lesion without any symptoms or signs suggestive of the primary hepatic site of the tumor. The only clue of hepatic dysfunction was mild elevation of the SGOT and SGPT. The diagnosis could not be made until operation. It is unusual for the initial clinical presentation to be related to intracranial metastasis without evidence of hepatic involvement. Measurement of the serum α-fetoprotein and liver ultrasound examination are the most helpful screening tools for diagnosing hepatocellular carcinoma. The literature of hepatoma with cranial metastasis is reviewed.

Hepatocellular carcinoma presenting with pathologic fracture due to bone metastases.

Two cases of hepatocellular carcinoma presenting with pathologic fracture due to bone metastases are reported. The patients did not exhibit clinical evidence of liver disease on presentation, and there was no previous history of liver disease. Liver function tests were normal in 1 case, while in the other the only abnormality was a slightly raised alkaline phosphatase. In 1 case the diagnosis was made by needle biopsy of a metastatic bone lesion, and in the other only at autopsy. The literature concerning this mode of presentation of hepatocellular carcinoma, and of liver cell carcinoma with skeletal metastases is reviewed. It is considered that hepatocellular carcinoma should be included in the differential diagnosis of carcinoma metastatic to bone.