The Endobronchial Metastasis of HCC Detected by Increased AFP in Bronchial Fluid.

SESSION TYPE: Cancer Global Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: The endobronchial metastasis of HCC is known to be relatively rare. Serum AFP(alpha-fetoprotein) is tumor marker that used for diagnosis and for response assessment of treatment. But there is not a known study about increased AFP in body fluid except for amniotic fluid and serum.CASE PRESENTATION: A 63 year old man was diagnosed with HCC in 2008, so he was treated with radiofrequency ablation(RFA) twice and trans-arterial chemo-embolization(TACE) three times. Then, there is no recurrence for 3 years. In 2011, we found mass-like lesion of the left upper lobe in the chest CT scan, performed bronchoscopy. In the bronchoscopic finding, there was a mass with necrotic changes in the occluded bronchus. But we tried to gain some malignant cell to prove the endobronchial metastasis of HCC, there was no malignant cell in the biopsy, brushing, and washing cytology specimen, we only observed necrotic cells. So we measured AFP in the right and left bronchus to compare each level. The bronchial fluid AFP in the left bronchus is 57.26 ng/ml compared by 2.06 ng/ml in the right bronchus, more higher in the left. We had suspicion of metastasis of HCC, so thoracoscopic biopsy was done, we confirmed HCC, performed left upper lobectomy. The patient recovered and now is being followed up.DISCUSSION: Although the lung is the most common site of extrahepatic spread from hepatocellular carcinoma, endobronchial meatstasis is rare, and the outcomes after pulmonary resection have not been well described. So the exact evaluation before operation is important. AFP is well known tumor marker, but there is not well known about the practical value in the diagenosis of endobrnochial metastasis.CONCLUSIONS: We reported this case because the bronchial fluid AFP level may be helpful in the situation of the difficult endobronchial biopsy under suspicious for metastasis of HCC, but more investigation about the clinical implication of AFP are needed.1) Takahito Nakagawa et al. The Journal of Thoracic and Cardiovascular Surgery 2006;131(6):1248-1254DISCLOSURE: The following authors have nothing to disclose: JiYoung Park, HongMo Kang, Jee-Hong Yoo, MyungJae Park, Cheonwoong Choi, YeeHyung KimNo Product/Research Disclosure InformationKyunghee University Hospital, Seoul, Republic of Korea.