A Rare Case of Hepatocellular Carcinoma in Addition to Diffused Cirrhosis-like HCC

Abstract

Purpose: Hepatocellular carcinoma (HCC) usually arises from underlying chronic liver disease and cirrhosis. Diffused cirrhosis like HCC is a rare variant of carcinoma, especially when diagnosed after liver transplant in the explanted liver. Only one case in a series of 10 patients studied has been reported. We presented the case of a 62-year-old Caucasian male who came to our clinic for a liver transplant evaluation. He was diagnosed with Hepatitis C 17 years ago and treated with interferon/ribavirin for 6 months, but was a poor responder. He used to be a heavy drinker but quit 30 years ago and has a past medical history of IV heroin abuse. His physical exam showed no ascites, hepatomegaly or splenomegaly. His laboratory findings included a normal basic metabolic panel with an AST of 115, ALT 227, alkaline phosphatase of 63, GGT of 81, bilirubin of 0.5, and INR of 1.1. His MELD score on his initial visit was 7 with an AFP level of 4.7. Two and a half years later, he was diagnosed with a single 5 × 5.3 cm lesion HCC. A liver biopsy confirmed the diagnosis of both HCC and cirrhosis. He then had a Radio Frequency Ablation (RFA) of the lesion followed by Transcatheter Arterial Chemoembolization (TACE) with LC Beads loaded with Doxorubicin. The lesion decreased to 3.4 × 3 cm, meeting the Milan criteria for liver transplant. His AFP pre- and post- RFA/TACE were 3.9 and 4.7, respectively. He then went for an orthotopic liver transplant. The gross examination of the explanted liver showed multiple yellow and green nodules, as seen in the picture attached, as well as a necrotic mass in the right lobe consistent with the previously treated HCC. The pathology showed well differentiated HCC with multiple nodules consistent with diffused cirrhosis-like variant of HCC. At least 70 viable tumor nodules were seen on the pathology slides, correlating with several hundred seen on the gross specimen. Small or large vessel invasion of the tumor was not identified. This is the first case reported of a single HCC lesion after transplant with underlying diffused cirrhosis-like HCC diagnosed in the explant. Liver transplant seems to be the definite treatment for these cases.Figure: No Caption available.