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- W2979449743 abstract "INTRODUCTION: About 20% of hepatocellular cancers (HCC) arise in the absence of cirrhosis, such as in the setting of glycogen storage disease (GSD) and anabolic steroid use. Non-cirrhotic HCC tends to have a lower male predominance, bimodal age distribution, and lower prevalence of hepatitis B, C, and alcohol abuse. There is a larger tumor burden at time of HCC diagnosis but a higher amenability to hepatic resection given preserved liver function and better overall survival than cirrhotic patients. CASE DESCRIPTION/METHODS: Case 1 A 16-year-old male presented after a motor vehicle accident for evaluation of traumatic injuries. He was a body-builder who used anabolic steroids. Physical exam showed a palpable liver edge. Labs were unremarkable. Computed tomography scan of the abdomen showed an incidentally discovered mass in the right hepatic lobe. Magnetic resonance imaging (MRI) of the abdomen showed a 15.1 × 15.0 × 10.8 cm right hepatic lobe mass concerning for a hepatic neoplasm. He underwent partial hepatectomy. Resected surgical specimen showed a β-catenin activated well-differentiated hepatocellular carcinoma. Case 2 A 26-year-old man with GSD type 1a was evaluated for iron-deficiency anemia. Physical exam showed tachycardia, conjunctival pallor, and palpable liver edge. Labs were notable for hemoglobin of 12.6 gm/dL, platelet count of 529 × 10 3 /µL, alanine aminotransferase 92 U/L, and aspartate aminotransferase 82 U/L. MRI of the abdomen showed multiple large arterially enhancing liver masses within the right and left hepatic lobes. The largest lesion within the right lobe of the liver measured 20.2 × 17.7 × 13.5 cm. Endoscopic ultrasound showed a large right heterogenous hepatic lobe lesion, appearing malignant which underwent fine needle aspiration. Pathology was consistent with β-catenin activated hepatocellular neoplasm. The patient is scheduled for a right hepatectomy with possible living donor liver transplantation given the large and multifocal nature of his liver masses. DISCUSSION: There are four different phenotypes of hepatocellular adenomas; the β-catenin subtype has the highest malignant potential. Anemia in GSD appears to be related to large hepatic adenoma formation and warrants imaging of the abdomen to evaluate for a bleed or growth of the lesions. No effective imaging tool or biomarker separates hepatocellular adenoma from HCC, so it is important to keep a low threshold to biopsy a hepatic adenoma with suspicious imaging features." @default.
- W2979449743 created "2019-10-18" @default.
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- W2979449743 date "2019-10-01" @default.
- W2979449743 modified "2023-09-23" @default.
- W2979449743 title "2220 Incidental Finding of Hepatocellular Neoplasms in Non-Cirrhotic Patients: A Case Series" @default.
- W2979449743 doi "https://doi.org/10.14309/01.ajg.0000598412.01867.4d" @default.
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