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Friday 26 January 2018

CASE 474: LEFT LIVER LOBE TUMOR, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM


Man  52 yo  with HBV chronic hepatitis ,    follow up  every 6 months  and negative AFP, HBV -DNA . But  ultrasound   detected  a big tumor # 6 cm in diameter in left lobe of liver.
US  1:  transverse scanning of  this tumor is well bordered,   hypoechoic pattern.
US 2:  longitudinal scanning  at tumor site.
US 3:  color Doppler=  vascular supply to tumor is from left  liver.





MRI  with Primovist  uptaked  and washed out  as a HCC in liver ( MRI 1, 2, 3, 4).





Blood test  Wako=  only DCP  raised =91 UI.


Summary:  in case of  HBV chronic hepatitis,, ultrasound detected  a big tumor in liver, Wako test only raised DCP.

OPERATION   PER OP  VIEW BY ENDOSCOPY THE TUMOR AT LEFT LOBE of LIVER ANTERIOR AND POSTERIOR and MACRO SPECIMEN of  TUMOR.










MICROSCOPIC IS WELL DIFFERENTIATED HCC.



DISCUSSION: WHY IN THIS CASE   WAKO TEST IS  NOT SUITABLE ?  WHICH VALOUR of WAKO TEST COULD BE  PPV FOR HCC ?

 Wako test post op  4 days after operation  = AFP:1.3 ng/mL;  L3: 0.5%;  DCP: 55 mAU/mL.

This 52 yo male  patient with chronic HBV but  AFP is lower than cut of value screening and no  ultrasound  screening  before  operation.   Wako test is  only DCP  rising  to 92 mAU/mL. Reference  ( publication April 12,2016 http:// doi.org/10.1371/journal.pone.0153227  : Diagnostic evaluation of DCP versus AFP  for Hepatitis Bvirus related  HCC   in China):

1-  30-40%  HCC in CLD with  AFP normal serum level.
2-  non HCC patients  have  15-58%  AFP  rise  over  cutt of value  20ng/mL.
3-  in CLD having cirrhosis  AFP rises  11-47%  but non HCC.
4-  DCP  rises level that correlated with size tumor and advanced progress.
5 - DCP drops very fast after surgery, and  rises  early in recurrent HCC.

Conclusion : AFP only not sensitive for screening  HCC. So DCP in Wako test is the choice for routine screening  HCC and monitoring after treatment.

BLOOD TEST  WAKO  AGAIN    RESULT IS  AFP: 1,5;   L3 : 0,5;   DCP DROP TO 38mUI/mL


CONCLUSION  2:

DCP IS VERY SENSITIVE FOR DETECTION of HCC AND FOLLOW UP POST OP.

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