title: Metastatic breast cancer mimicking hepatocellular carcinoma: differences in noninvasive guidelines.
abstract: Hepatocellular carcinoma (HCC), unlike most solid tumors, can be diagnosed noninvasively. We present a case that highlights an important clinical difference between two established guidelines: National Cancer Comprehensive Network (NCCN) and Barcelona-2000 EASL Conference (European Association for the Study of the Liver). Our patient had a large liver mass extending into the right atrium with elevation of the alpha-fetoprotein to 1,130 ng/mL. The radiographic and laboratory evidence is sufficient using NCCN guidelines to initiate palliative treatment for HCC. The Barcelona-2000 EASL Conference guideline for noninvasive diagnosis is restricted to cirrhotic patients. Our patient did not have a history of chronic liver disease or active hepatitis, and a biopsy was performed that demonstrated breast cancer.
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA.
authors.forename: Anna H
authors.initials: AH
authors.lastname: Bartram
authors.forename: John Lee
authors.initials: JL
authors.lastname: Villano
authors.forename: Dean M
authors.initials: DM
authors.lastname: Ferrera
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D006063:Chorionic Gonadotropin / Q000032:analysis; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D017410:Practice Guidelines as Topic; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D006063:Chorionic Gonadotropin; D000509:alpha-Fetoproteins