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Hepatocellular Carcinoma Case Studies

Nicholas Nissen, MD: Consideration of Different Modalities

Nicholas Nissen, MD
Published Online:Jun 18, 2015
Jose V is a 73-year-old Filipino store owner from Queens, New York, with a history of chronic hepatitis B (HBV) infection and unresectable hepatocellular carcinoma (uHCC).

Unresectable Hepatocellular Carcinoma: case 1

Dr. Nissen says that surgery has a higher risk for liver failure than transarterial chemoembolization (TACE). It is more invasive and has more morbidity. It is relatively common for patients to choose a nonsurgical approach to treatment.

CASE 1: Unresectable Hepatocellular Carcinoma

Jose V is a 73-year-old Filipino store owner from Queens, New York, with a history of chronic hepatitis B (HBV) infection and unresectable hepatocellular carcinoma (uHCC).

In May 2014, patient was referred to a hepatologist with an elevated ALT (68 IU/mL)
  • Medical history includes type II diabetes, previously treated with metformin and a sulfonylurea; currently controlled with diet and exercise regimen; other MH was unremarkable
  • Family history was relevant for a sister who was diagnosed with HCC and chronic HBV infection at age 60
  • No symptoms of liver disease were noted; patient had mild tenderness over the right upper quadrant
  • Ultrasound revealed a hyperechoic lesion in the left lobe; MRI with gadolinium showed an 11-cm mass in the left lobe with imaging characteristics consistent with HCC. No evidence of metastatic disease was noted on bone scan and uncontrasted CT scan of the chest.
  • Based on laboratory findings and clinical features, the patient was determined to have Child Pugh Class A, with a MELD score of 8
  • Consultation with the multidisciplinary team recommended surgical resection, however patient was fearful of surgery and opted for TACE procedure
In June of 2014, follow-up CT scan showed evidence of residual disease at the TACE site; a second TACE was scheduled for 10 weeks following the first TACE. In August of 2014, an MRI showed evidence of residual disease in the periphery of the tumor approximately 6 weeks following the second TACE procedure.
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