Case presentation A 78-year-old female, who was in her usual state of health, was presented to the hospital when she noticed vague gastrointestinal symptoms, including bloating, dyspepsia, occasional episodes of nausea and vomiting, abdominal discomfort, and 9.07 kg weight loss over one month. History Hypertension Stroke 20 years ago Mild chronic obstructive pulmonary disease (COPD) with 50- pack-year smoking history Rheumatoid arthritis Laboratory findings White count - 8.49 x10 9 /L Hemoglobin - 14.4 g/dl Hematocrit - 47.4% MCV - 77.2 L/cell Platelets - 294 × 10 9 /L, with prothrombin slightly elevated at 12 seconds INR - 1.1 Alkaline phosphatase - 164 units/L AST - 42 units/L Bilirubin - Normal A CAT scan of the abdomen revealed a large mass lesion in the right lobe of the liver measuring 4.8 × 10.1 cm and irregularity of the wall of the transverse colon (Figure 1).
Alpha-fetoprotein…
