A Ruptured Hepatoma in a Non-cirrhotic Patient with Chronic Inactive Hepatitis B

Abstract

Case Presentation: A 77-year-old male with no prior history of liver disease presented with an acute onset of diffuse abdominal pain. He had no history of illicit drug use, tobacco, or recent alcohol use. Laboratory studies were normal. A large liver mass with findings consistent of hemoperitonium was seen on CT scan. Peritoneal fluid analysis was negative for malignant cells. Hepatitis viral serologies showed positive Hepatitis B surface Antigen (HBsAg), negative Hepatitis B surface Antibody, positive Hepatitis B core antibody, negative Hepatitis B e-Antigen (HBeAg), positive Hepatitis B e-Antibody (HBeAb), and undetectable Hepatitis B virus DNA. Other serologies were negative. Serum alphafetoprotein was within normal limits. A partial hepatectomy was performed. Pathology confirmed hepatocellular cancer (HCC) in a background of a non-cirrhotic liver. Discussion: • Cirrhotic liver disease is the leading cause of primary HCC. • More than 20,000 new cases are diagnosed each year in the United States alone. • Worldwide 50% of patients diagnosed with HCC have chronic hepatitis B infection with 70-80% having underlying cirrhosis. •A direct correlation between HBV viral load and risk of developing HCC has been illustrated. •Patients with inactive or active chronic HBV have a higher incidence of HCC than the general population. •A positive HBsAG and HBeAg puts patients at higher risk when compared to patients positive for HBsAg with a negative HBeAg. • Patients with inactive HBV who consume alcohol habitually have been shown to have an increased risk of progression to HCC. • Later age of seroconversion from HBeAg to HBeAb has also been found to be directly correlated to an increased risk of developing HCC and related death. Conclusion: Though infrequent, the development of HCC in non-cirrhotic patients who are inactive carriers of HBV is still of concern. Several variables increase the risk of HCC in this patient population. Clinical follow-up with laboratory testing and radiographic studies is important, however, the frequency of surveillance in this population is not known.Figure: Abdominal MRI.