A 66-year-old woman was referred to our service due to an abdominal CT finding of a 7 cm lesion in the left hepatic lobe.
This is a healthy patient with no antecedents of interest who had attended a bedside doctor to perform a check-up and this detected in a discrete elevation of the conventional analytical test transluminal examination, which led to the conclusion that the study was interesting.
He did not present any other remarkable symptoms by equipment.
On physical examination, the patient was in good general condition, and only slight discomfort was observed when the right hypochondrium was present.
Upon admission to our unit, the following additional tests were performed:
CBC and coagulation were normal.
Other macrolide antibiotics (biochemistry: total bilirubin 1,12, alkaline phosphatase 690 (n < 258), LDH 359, GOT (AST) 185 (n < 40), GPT (ALT) 2GT73 (n < 40), G
tumour markers: CA 19.9, 10.9, alpha-fetoprotein 386.9 (n < 10), CEA 1.
EKG: sinus rhythm without significant changes.
Chest X-ray: no abnormalities.
Abdominal CT: 7 cm tumor, with well-defined borders, centered on the medial segment of the left hepatic lobe, which extends to the right hepatic lobe.
The mass produces compression of the main trunk of the portal and, above all, of the left branch of the same, as well as slight dilation of the left biliary tree.
The lesion is poorly vascularized and shows important necrotic areas.
Hepatic biopsy: nodular hyperplasia with marked steatosis, no evidence of malignancy in the material.
Discordance between imaging and analytical tests, which oriented towards a neoplasic process, and pathological (non-malignant) anatomy was established. It was decided to explain the situation to the surgery, concluding that the possibility of malignancy
The patient accepts the intervention performing a resection of hepatic segments IV and V.
During the operation, an intraoperative biopsy is sent, which is re-informed as a non-conclusive biopsy of malignancy in the macroscopically encapsulated nodule and in the resection specimen a well-defined, necrotic nodule larger than 6 cm is differentiated
Microscopically, extensive areas without atypia are differentiated, with abundant lipid vacuums and very low proliferation index and other areas with high celurarity, atypical nuclei of proliferation around 15% mitoses and index.
Finally, the tumor is classified as well differentiated hepatocarcinoma (grade II) rich in lipids.
1.
Postoperatively, the patient had no remarkable complication and was discharged with subsequent follow-up in external consultations.
It is currently asymptomatic and a control test has shown normalization of both transaminases and alpha-fetoprotein.
