CASE 330 : SMALL HCC, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

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case-330-small-hcc-

Man  66 yo with history  no infected  HBV, HCV but  high values of liver enzymes for a long time.

Ultrasound of liver showed fatty infiltrating in liver.

Blood test of HCC RISK  positive  with AFP: 33.6 ng/ml; AFP-L3%: 62,4% and DCP: 21mAU/mL.

MRI of liver  with PRIMOVIST and DWI detected a  small focal lesion, size  of 0.8cm at the liver border in  segment 6,  very  bright  in DWI  and captured  and washed out  Primovist like a HCC.

Diagnosis  was made for a small HCC,  wait for operation.

DISCUSSION:

Biopsy or not for  the case:  hepatologist and  radiologist said no because worrying of sedding cancer cells.

RFA or  SURGERY? RFA  could  perform if ultrasound  can see the tumor. Yes,  WE CAN SEE  THIS  HCC ( see  2 US  pictures).

This case is  planning to do RFA in  next week and test HCC Risk (WAKO)  24 hours after this procedure.

After 48 hrs RFA [ 27-08-2015] 2nd Wako test repeated (AFP: 21.7 ng/ml, AFP-L3 : 60.5%, DCP: 21mAU/mL
Wako test  again  10 days after RFA [ 6-09-2015] 3rd Wako test ( AFP: 7.6ng/ml, AFP-L3: 42.1%,DCP: 20 mAU/mL)
Wako test  will be performed one month after RFA.

REFERENCE:
MayoClinics Report HCC_AFP_L3