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Case #4

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Expand Physical Exam

03/05/XX

48-year-old male has a 10 cm palpable mass and pain in the R upper quadrant.

Expand X-Rays & Scans

03/06/XX

Abdominal CT scan: 14 x 12cm heterogenous mass within inferior R lobe of liver highly suspicious for primary hepatic malignancy. No intrahepatic biliary ductal dilatation. Portal, superior mesenteric, splenic veins all normal. No lymphadenopathy seen. Chest CT negative.

Expand Laboratory

03/07/XX

AFP 3.1(0 -8.0 ng/ml). Hepatitis B and C screens negative.

Expand Operative Findings

03/15/XX

15 x 16 cm lobulated mass extends from the inferior R lobe of liver segment 5 and 6. The mass is fairly well circumscribed and contains a large, thin-walled dilated vein. No evidence of metastasis in abdomen.

Expand Pathological Reports

03/10/XX

Liver mass aspiration R lobe: mod diff hepatocellular carcinoma

03/15/XX

Liver resection: hepatocellular carcinoma 14 x 10 x 12 cm, grade 1-2 w/focal 3 of 4. Tumor is largely encapsulated and has a pushing margin. Focal vascular invasion seen. Margins negative.

Expand Treatment

03/15/XX

Partial R hepatic lobectomy and cholecystectomy.