CASE 595: HCC WITH NEGATIVE WAKO TEST, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER,HCMC,VIETNAM

Male patient 58yo, with HCV infection that had been treated by interferon for several months.

In check-up, ultrasound detected one round mass # 3cm look like a cyst.

WAKO tests= AFP=5.7, L3= 0.5, DCP=16.

MSCT with CE detected non tumor.

Gado MRI of  liver reported HCC.

MR image shows a lesion in hepatic segment V; with the size 24mm, well-defined. The lesion demonstrates high signal intensity on T2WI and low signal intensity on T1WI.

The lesion had restricted on Diffusion Dynamic MRI: On arterial phase image demonstrates unequivocal arterial enhancement relative to the surrounding liver; On the portal venous phase has decreased in enhancement relative to the surrounding liver (washout); On the delay phase has decreased in enhancement relative to the surrounding liver and enhance capsule is found which helps further solidify the imaging diagnosis of HCC.

-This patient has negative Wako test. Volk et al (2007) and Hann et al (2013) demonstrate of  Wako test with sensitivity (83%) and specificity (>90%) for detecting HCC.

Operation removed the liver tumor.

 Histopathologic report= HCC well-differentiated.