The patient was a 91-year-old woman. Laboratory data were as follows: AST 35 IU/l (normal 5-35), ALT 21 IU/l (normal 5-30), ALP 198 U/l (normal 115-359), gamma-GTP 67 IU/l (normal 0-50), LDH 162 IU/l (normal 106-211), Alb 2.9 g/dl (normal 3.7-5.5), TB 0.7 mg/dl (normal 0.2-1.0), and PT-INR 1.18. Child-Turcotte-Pugh grade was A. The ICG-R15 was 19%. The concentration of serum AFP was 1,210 ng/ml (normal <20) and plasma DCP was 209 mAU/ml (normal <40). No serological evidence of hepatitis B or C was seen. CECT revealed a tumor measuring 20 mm in diameter in segment 2 of the liver, accompanied by tumor thrombi toward the main left portal vein (fig. 4). We diagnosed HCC with tumor thrombi. The patient requested radical surgery, so left hemi-hepatectomy was performed (fig. 5). The operation time was 304 min, and the amount of blood loss was 379 ml. Pathological findings revealed poorly differentiated HCC (fig. 6).
elderly patients, hepatocellular carcinoma