Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Acute angle branching fungus
25%
34/137
Curved gram-negative bacteria
7%
10/137
Enveloped DNA virus
28%
38/137
Naked DNA virus
9%
12/137
Trematode from undercooked fish
27%
37/137
Select Answer to see Preferred Response
This presentation is most consistent with a diagnosis of hepatocellular carcinoma (HCC). HCC is endemic in parts of Asia due to contamination of food by the carcinogen aflatoxin produced by aspergillus, a species of fungus that branches at acute angles (around 45 degrees) on pathological examination. The two major cancers to consider in the right upper quadrant are hepatocellular carcinoma and cholangiocarcinoma. The presence of alpha-fetoprotein and polycythemia without an elevation of CA 19-9 are classic findings of HCC, which is supported by the normal appearing stool and urine. One important HCC association is that it is endemic to parts of Asia due to aflatoxin food contamination. Incorrect Answers: Answer 2: Helicobacter pylori is a curved gram-negative bacteria that primarily infects the stomach and early GI tract. It is associated with gastric adenocarcinoma and MALT lymphoma. Besides constitutional symptoms of malignancy, these would present with early satiety and epigastric pain without findings of jaundice or elevated alpha fetoprotein levels. Answer 3: Ebstein-Barr virus is an enveloped DNA virus that is associated with nasopharyngeal carcinoma as well as several types of lymphoma. These would present with either facial symptoms or systemic symptoms (such as night sweats) respectively. EBV is unrelated to HCC. Hepatitis B is an enveloped DNA virus that could cause HCC; however, this is unlikely given this patient's negative hepatitis B surface antigen. Answer 4: Papillomavirus is a naked DNA virus that produces the oncogenic factors E6 (inactivating p53) and E7 (inactivating retinoblastoma protein). Infection with oncogenic strains of HPV such as 16 and 18 is associated with cervical and genital cancer. Answer 5: Clonorchis sinensis is a trematode that is acquired from eating undercooked fish. This fluke causes bile duct inflammation and obstruction eventually leading to cholangiocarcinoma if untreated. Cholangiocarcinoma would present with symptoms of bile duct obstruction such as pale stool, dark urine, jaundice, and pruritus. Bullet Summary: HCC is characterized by jaundice, RUQ pain, and elevations of alpha-fetoprotein in addition to general symptoms and has a strong association with aspergillus aflatoxin contamination in its endemic form.
2.7
(15)
Please Login to add comment