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Hepatocellular Carcinoma Case Studies

Nicholas Nissen, MD: Monitoring of Patient

Nicholas Nissen, MD
Published Online:Jun 18, 2015
Dale P is a 61-year-old Jamaican-American male from Houston, Texas, with a history of HCV infection and cirrhosis, who works in corporate cell-phone sales.

Unresectable Hepatocellular Carcinoma: case 3


Generally, Dr. Nissen would monitor a patient every 3 months for 2 years and then every 6 months from then on. Most local recurrences will be evident within 12 months, but some can occur later, which is why frequent postresection surveillance continues to 2 years.

CASE 3: Unresectable Hepatocellular Carcinoma

Dale P is a 61-year-old Jamaican-American male from Houston, Texas, with a history of HCV infection and cirrhosis, who works in corporate cell-phone sales.

In February of 2012 the patient presented with upper right quadrant discomfort; CT scan showed the presence of a 4.1 × 3.9-cm mass consistent with HCC in the setting of cirrhosis; he was referred to the multidisciplinary team for further assessment.
  • Initial assessment showed a MELD score of 7 and Child Pugh A class
  • The patient was not considered appropriate for transplant based on prior history of successfully treated renal cancer (4 years prior) and patient declining to pursue a transplant evaluation
  • Medical history notable for heavy alcohol use and substance abuse approximately 30 years ago, stroke in mother, deep vein thrombosis in father
  • Other medical history included nonresponse to pegylated interferon and ribavirin for HCV 5 years earlier; current medications included antihypertensives and aspirin
  • Patient recommended for liver resection in April 2012
  • He underwent R0 resection. Pathology showed moderately differentiated HCC with negative margins and no evidence of microvascular invasion
  • On follow up in April 2013, patient shows no evidence of disease recurrence on MR which is performed every 3 months
On follow up in August of 2014, ~2 years post resection, there is imaging evidence of recurrence and metastasis.
  • MRI detects multiple lesions at the postsurgical site, largest ~1.7 cm, and a nodule in the inguinal lymph node, ~1.9 x 1.0 cm
  • Patient’s current assessment shows a MELD score of 9 and Child Pugh A
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