Semin Liver Dis 2000; 20(2): 227-232
DOI: 10.1055/s-2000-9948
DIAGNOSTIC PROBLEMS IN HEPATOLOGY

Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

A 67-Year-Old Man with Hepatitis C Virus Infection and a Liver Tumor

Arief Suriawinata, Katya Ivanov, Menahem Ben Haim1 , Myron E. Schwartz1
  • The Lillian and Henry M. Stratton-Hans Popper Department of Pathology
  • 1Department of Surgery of the Mount Sinai School of Medicine, New York, New York
Further Information

Publication History

Publication Date:
31 December 2000 (online)

 

CASE REPORT

A 67-year-old Caucasian man was found to have an incidental mass in the right lobe of the liver. He had a history of diabetes mellitus, hypertension, three operations for herniated lumbar discs, and coronary artery disease, for which he underwent three-vessel coronary artery bypass grafts 6 months prior. There was no history of liver disease, ethanol use, or occupational exposure. He had been treated with furosemide, carvedilol, transdermal nitroglycerin, and insulin.

On physical examination, the patient's blood pressure was 160/90 mmHg. Other vital signs were within normal limits. Chest auscultation was remarkable for scattered ronchi and wheezes. There were no signs of liver failure or any features of chronic liver disease.

Laboratory work-up included complete blood count, which showed mild anemia (Hgb 11.3 g/dL), a normal coagulation screen, normal chemistry and a normal liver function profile. The patient had a positive hepatitis C virus antibody (anti-HCV) by RIBA. Anti-HBs (hepatitis B surface), HBsAg (hepatitis B surface antigen) and anti-HBc (hepatitis B core) were negative. CA 19-9 was 36.2 U/mL (normal < 37.0), alpha-fetoprotein (AFP) was 2.2 ng/ml (normal < 20.0) and carcinoembryonic antigen (CEA) was 0.9 ng/mL (normal < 5.0).

Chest x-ray showed mild congestion without infiltrates or pleural effusion. Echocardiography demonstrated global hypokinesia with an ejection fraction of 45%. A sonogram of the upper abdomen demonstrated a 6-cm solid lesion in the right lobe of the liver. A CT scan showed the mass in the posterior right lobe, which was enhanced during the arterial phase (Fig. [1]). A MRI confirmed a well-circumscribed lesion in the right inferior segment, which was bright on T2-weighted images. Intraoperatively, there was a 8 × 5 cm firm, white-gray mass involving segments VI, VII, and VIII. The remaining liver parenchyma was unremarkable. The patient underwent a right hepatic lobectomy, which he tolerated well.

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