Hepatocellular Carcinoma Developed From Non-Cirrhotic Liver: A Case Report

Abstract

Non-alcoholic steatohepatitis (NASH) is recognized as a crucial factor in the development of hepatocellular carcinoma (HCC) from non-viral cirrhosis. It is generally known that cirrhosis, fibrosis of the liver, works as a carcinogenic promoter, and it is uncommon for non-cirrhotic liver to develop into HCC. Here we report a case of HCC that developed from non-cirrhotic NASH. A 76-year-old male presented to our hospital with abdominal distention. His medical history included impaired glucose tolerance and hypertension. He denied any use of alcohol. Ultrasonography revealed a lobular mass in S5 of the liver with a marginal low echo that measured 50 × 40 mm. Contrast-enhanced computed tomography confirmed HCC. Laboratory analysis revealed normal hepatic and biliary enzymes, as well as normal levels of tumor markers, including alpha-fetoprotein and protein induced by vitamin K absence or antagonist-II. Virus markers were negative for HBs-Ag, HBV-DNA, HCV-Ab, and HCV-RNA. As a result, he was chosen as a candidate for surgical resection; subsegmental resection of S5 and S6 was performed. The resected specimens of the tumor revealed moderately differentiated HCC; rich macrovesicular lipid depositions were observed over the background liver, which was compatible with A2F1. Based on the histological findings, he was diagnosed with HCC developed from non-cirrhotic NASH. This case report is informative for clinicians by raising awareness of the potential risk of HCC in non-cirrhotic NASH. J Med Cases. 2016;7(11):508-511 doi: https://doi.org/10.14740/jmc2681w