Case 1: An Intraductal Papillary Lesion

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• 65 year-old Chinese women

• Hepatitis B carrier

• 10 years ago: Right hemicolectomy for stage 2 colonic adenocarcinoma; no adjuvant therapy

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•  Asymptomatic 

• Serum CEA rose from 3.0 to 9.6 µg/L over 3 months

• Liver panel normal

• PET scan: Nodule at hilum of liver. Intrahepatic bile ducts not dilated.

• Impression: Hepatocellular carcinoma (HCC) versus colonic metastasis.   

• Liver lobectomy

 

• Case 1 - Images

 

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Case 2: An Intraductal Papillary Lesion

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• 72 year-old Chinese man

• Hepatitis B carrier

• Diabetes mellitus, hypertension

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• Presents with painless obstructive jaundice

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• Anti-HBc positive

• AFP 3.7 µg/L, CEA 3.7 µg/L, CA19-9 47 u/ml

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• PTC insertion

• Biopsy through PTC

• Diagnostic laparoscopy: "Cirrhosis"

• Partial hepatectomy

 

• Case 2 - Images

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Case 3: An Intrahepatic Mass

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• 50 year-old Chinese man

• Asymptomatic

• No clinical history or laboratory results of note

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• CT scan of abdomen: Incidental solitary 5-cm mass in posterior aspect of right lobe of non-cirrhotic liver

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• Consult case of hepatic resection

• "Strange-looking HCC in the liver"

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• Case 3 - Images

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Case 4: A Potential Pitfall

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• 45 year-old Chinese man

• Serum tumor markers negative

• Hepatitis virus markers negative

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• CT scan of abdomen: 6 cm mass in a non-cirrhotic liver

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• Percutaneous needle core biospy

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• Case 4 - Images

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Case 5: A Great Mimic

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• 45 year-old Chinese women

• Small bowel surgery 2 years ago

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• Multiple liver nodules

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• Fine needle aspiration cytology and needle core biopsy of liver lesion

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• Case 5 - Images

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Case 6: A Young Woman with Perisinusoidal Fibrosis

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May 2012

• 21 year-old women

• Bruising, menorrhagia and abdominal distension x 5 months

• Daily fevers of 39°C and night sweats

• Weight loss

• Hepatosplenomegaly with ascites

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• Hb of 9g/dl, white cell count of 4.0 x 10⁹/l, platelet count of 34 x 10⁹/l

• Serology for hepatitis B, C, HIV, CMV, and EBV were negative

• Anti-nuclear antibody and anti-double stranded DNA were negative

• Lactate dehydrogenase was within normal limits

• Direct Coombs test was negative

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• Bone marrow aspiration was not conclusive

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June 2012

• Splenectomy - splenomegaly and worsening thrombocytopenia

• Histopathology: "Lymphoid proliferation"

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​October 2012

• Worsening jaundice with conjugated hyperbilirubinemia

• Fibroscan score of F4

• Liver biopsy: Cholestatic liver injury with cirrhosis

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January 2013 (Singapore)

• Worsening jaundice, ascites, fever and night sweats

• Menorrhagia and gingival bleeding

• Cachexia, scleral icterus, ascites, hepatomegaly & inguinal lymphadenopathy

• Repeat liver biopsy

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• Case 6 - Images

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