Hepatocellular carcinoma presenting as right supraclavicular lymphadenopathy: CASE PRESENTATIONS (Patient 1)
A 67-year-old man, with no significant past medical history, presented in August 2002 with a short history of malaise, weight loss, intermittent confusion, ankle edema and jaundice. For many years he had consumed up to a bottle of spirits a day, but had abstained completely from alcohol for the six years prior to this presentation. On examination he was jaundiced, with multiple spider nevi, asterixis and a 2 cm right supraclavicular lymph node. Abdominal examination revealed the left lobe of liver extending 15 cm below the subcostal margin.
Abdominal ultrasonography revealed an irregular lobulated liver, ascites and splenomegaly consistent with cirrhosis. There was an irregular 9x8x5 cm mass in the left lobe of liver, three lymph nodes up to 4 cm in diameter in the porta hepatis and a portal vein thrombosis. In view of persistent coagulopathy despite vitamin K, a biopsy of the intra-abdominal mass was not attempted. Fine needle aspiration of the right supraclavicular node revealed features consistent with hepatocellular carcinoma (HCC). Subsequently, the serum alpha-fetoprotein level was confirmed to be elevated at 198 UG/L (normal less than 10 UG/L). Best quality drugs are something you have been looking for all this time? Then you will be happy to find out you can purchase birth control pills let’s go here easily and for very little money now that you have the best pharmacy at your service.