University of Texas/ Rio Grande Valley (DHR) McAllen, TX, United States
Alfarooq M. Alshaikhli, MD1, Alsadiq Al-Hillan, MD2, Mohammed Alani, MD3, Shilpa Jain, MD4, Shima Ghavimi, MD5, Tejas V. Joshi, MD6 1University of Texas/ Rio Grande Valley (DHR), McAllen, TX; 2Baylor College of Medicine/Beaumont Health (Royal Oak) Program, Houston, TX; 3Eisenhower Medical Center, Rancho Mirage, CA; 4Baylor College of Medicine, Houston, TX; 5Marshall University Joan C. Edwards School of Medicine, Huntington, WV; 6Joan C. Edwards School of Medicine, Marshall University, Houston, TX
Introduction: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related deaths worldwide. Patients may present with paraneoplastic syndromes such as hypoglycemia or erythrocytosis which may aid in the diagnosis of the occult malignancy. We report a case of HCC diagnosed by non-targeted biopsy completed as part of an evaluation of cirrhosis, thrombocytosis, and elevated Alpha fetoprotein (AFP).
Case Description/Methods: A 62-year-old male with PMH of EtOH was recently diagnosed with HCV cirrhosis during admission for abdominal distension and 3 episodes of hematemesis. His laboratory workup on admission revealed an AFP level (707 ng/mL), platelets (700,000/μl.), Creatinine (2.06). EGD showed small esophageal varices and portal hypertensive gastropathy. Additional workup including JAK2 mutation testing was negative and work-up for myeloproliferative disorder was unremarkable. MRI liver protocol did not reveal any discrete lesions. The patient underwent a non-targeted liver biopsy which showed moderately differentiated HCC.
Discussion: Liver Biopsy is indicated in patients with high suspicion of HCC and negative contrast-enhanced imaging.
Paraneoplastic phenomenon present in about 20% of patients either upon diagnosis or during follow-up. They tend to be a poor prognostic factor except those with erythrocytosis. Patients may present with one or more of them. The major paraneoplastic phenomena in patients with HCC are erythrocytosis, hypoglycemia, hypercholesterolemia, hypercalcemia, and some Cutaneous features.
The prevalence of thrombocytosis in HCC patients is about 2.7%. Relative to surrounding nontumor tissue, HCC tumor tissue, in patients w/ thrombocytosis, has been found to have an increased amount of TPO protein and TPO mRNA transcripts. It might be undervalued as most HCC patients have associated liver cirrhosis. Thrombocytosis associated with large tumor volumes, high serum AFP, high rates of thrombosis, and poor treatment compliance.
Figure: Figure 1(a-b): Liver Biopsy shows malignant cells, Figure 2: MRI of the liver shows no discrete lesions.
Disclosures: Alfarooq Alshaikhli indicated no relevant financial relationships. Alsadiq Al-Hillan indicated no relevant financial relationships. Mohammed Alani indicated no relevant financial relationships. Shilpa Jain indicated no relevant financial relationships. Shima Ghavimi indicated no relevant financial relationships. Tejas Joshi indicated no relevant financial relationships.
Alfarooq M. Alshaikhli, MD1, Alsadiq Al-Hillan, MD2, Mohammed Alani, MD3, Shilpa Jain, MD4, Shima Ghavimi, MD5, Tejas V. Joshi, MD6. P2930 - A Case of Imaging-Negative HCC With Rare Paraneoplastic Syndrome, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.