A patient diagnosed with HCC within Milan criteria. has mild FDG uptake in PET scan in the portal LNs only AFP is 65.Should we list this patient for transplant?
It depend on : 1) Aetiology of liver disease, HCV chronic hepatitis is known to associated with hilar LN usually less than 2 cm it is OK but if you have a faraway LN like para-aortic group it is better to biopsy it 2) the size of LN if you have big LN like 2cm or more you can either biopsy under US or laparoscopic or follow up after after 2-3months looking for a change in size 3) if there is history of recent intra-abdominal infection like spontaneous bacterial peritonitis it can explain the LN activity 4) the HCC itself, there some criteria that is associated with higher possibility of LN evolvement;vascular invasion, worse histological grade, and non encapsulation in addition to large size tumour more than 5 cm and all these are contraindication for transplantation. At the end the chance to have positive LN intra operative during transplantation is less than 2%.
I agree with Yasser. You may wish to wait for 3 months and rescan the patient to see if the tumour suddenly goes 'out of control' rather than list the patient right now. In addition it may be useful to think about chemoembolization of the lesion whilst you are waiting.
I had the patient chemoembolised and will repeat the scan after 3 months.
Thank you
GS
I agree with Gursharan but therefore quickly move to LT if you have response on TACE
I agree with the attitude proposed. Anyway, at the moment of a future transplant I would recommend to explore the LNs and to send them or at least a sample to the pathologist if you have any doubt. I don´t know if you have a pathologist 24/7, we have. I would call a second possible recipient to be prepared just in case the LNs were positive.
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