Resection of Giant Hepatocellular Carcinoma: Case Report
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 6
Abstract
Huge hepatocellular carcinoma (>10cm) resection it is not frequent in cirrhotic livers due to high mortality rates and poor survival rates. Nevertheless, patients with normal livers have a different prognosis, and can bear until 80% liver resection. This case reports the 60-year-old female patient with abdominal tumor and big in the records of any liver disease. HCC diagnosis was achieved with imaging exams and high blood levels of Alpha-fetoprotein (AFP). Surgical removal was proposed, the left trissegmentectomy. This case shows radical tumor resection the curative treatment. Hepatocellular carcinoma (HCC) is the primary malignant tumor of the liver, being the fifth most frequent malignant tumor and the third in terms of mortality. Its incidence is estimated to be between 500,000 to 1 million cases a year and is more frequent in tropical countries, underdeveloped or developing. It is more common in males, between the ages of 50 and 60 years, with the ratio of 8:1 in high incidence regions and ranging from 1.5 to 3:1 in regions of low incidence. Its etiology is directly linked to cirrhosis of the liver, as well as to infection by hepatitis virus’s B and C, alcohol consumption, aflatoxin contamination and metabolic diseases, liver being the most important hemochromatosis. HCC has variable clinical presentations, depending on the presence of cirrhosis, typically, degree of tumor liver failure or atypical manifestations and, being more findings Paraneoplastic frequent: weight loss, hepatomegaly, abdominal pain, ascites, jaundice, fever and splenomegaly [1,2]. Laboratory changes arising from the HCC are non-specific and depend on the tumor extension and severity of liver injury. AFP high above 400mg/mL makes the diagnosis; however, 20 to 30% of cases may have normal AFP. Imaging research methods are essential for the diagnosis of the HCC, with the most employees the ultrasonography (USG), computed tomography (CT), and magnetic resonance imaging (MRI). The treatment can be divided into curative: partial resection, liver transplantation, ablative therapies or palliation: TACE, hormone therapy, chemo/radiotherapy, symptomatic and supportive treatment. Despite the cirrhosis is one of the most important risk factors for the development of the HCC, approximately 10 to 15% of cases the liver is normal. Patients without a history of chronic liver disease are rarely diagnosed early, usually are not conducted routine tests for these patients (USG abdomen or dosage of AFP), then the diagnosis is made late, when the patient exhibits symptoms due to large tumor mass. In these cases there is no transplant indication according to the criteria of Milan (single tumor less than or equal to 5 cm, or no more than 3 tumors smaller than 3cm) and non-surgical therapies such as trans arterial chemoembolization (TACE), percutaneous radiofrequency ablation, percutaneous ethanol injection and microwave coagulation therapy have been shown to be ineffective. The only curative treatment in these cases would be resection by more than 60% of patients [3,4]. Case Report Female patient, 60 years sought the emergency room of Santa Casa de Misericordia de Sao Paulo hospital complaining of abdominal pain and vomiting for 2 months. Pain was diffused throughout the abdominal region accompanied by weight loss of 10kg in 2 months. Concerns have noticed increased abdominal volume, jaundice accompanied by pruritus. Patient was bleached +/4+, her history revealed jaundice +/4+. Flaccid abdomen, painful mass in right hypochondrium palpable until umbilical scar. CT scan (Figure 1) revealed large expansive mass with lobulated margins on the anterior surface of the liver, which featured the heterogeneouscontrast enhancement. Such lesion measured about 17.6 x 18.4 x 14.3 cm, occupied all the left lobe and part of the right lobe of the liver. Also enhanced numerous small vessels within the lesion. There was also other smaller satellite lesions. Gallbladder with homogeneous content and small diffuse parietal thickening. Bile duct dilatation most evident in the left lobe. Small amount of free fluid in pelvic cavity, presence of splenomegaly and aortoiliac iliac atheromatous plaques. In laboratory tests showed increased liver enzymes: alkaline phosphatase of 2231U/L (70-290 U/L), gamma glutamyl transferase of 989U/L (< 38 U/L), TGO of 307U/L (8-33 U/L), TGP of 114 (7-35 U/L), AFP greater than 1000ng/ml (up to 8ng/ml), bilirubin total 12.8mg/dL (0.3-1.2mg/dL), direct bilirubin of 7.4mg/dL (0.3-1.2mg/dL) and indirect bilirubin of 5.4mg/dL (up to 1.0mg/dL).
Authors and Affiliations
Fabio GF
Keywords
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- EP ID EP578624
- DOI 10.26717/BJSTR.2017.01.000514
- Views 178
- Downloads 0
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