Abstract
BackgroundIt has been reported that liver metastasis rarely occurs in a cirrhotic/hepatitic liver. Thus, coexistence of liver metastasis and hepatocellular carcinoma has been scarcely reported. To the best of our knowledge, there are no cases with hepatocellular carcinoma, which developed during an observational period after hepatectomy for colorectal liver metastasis, in the worldwide English literature. Here we present a case of hepatocellular carcinoma which occurred during a period between the first and second hepatectomy for repeated colorectal liver metastasis.Case presentationA 65-year-old Japanese woman underwent rectal resection for advanced rectal cancer. Hepatitis C cirrhosis was diagnosed at that time and antiviral therapy was offered but rejected because of socioeconomic reasons. At the age of 68, she developed two colorectal liver metastases originating from the rectal cancer, which were treated by local ablation and partial hepatectomy. At the age of 71, solitary recurrent colorectal liver metastasis was observed adjacent to the previously ablated lesion in segment 4, and thus segmentectomy 4 was performed. During surgery, a small tumor in segment 8 was incidentally identified. Taking into account her history, the tumor was considered to be recurrent colorectal liver metastasis and it was extirpated by partial hepatectomy. However, the segment 4 tumor was diagnosed as recurrent colorectal liver metastasis on the basis of histological findings and the segment 8 tumor was diagnosed as hepatocellular carcinoma. Although she had a cut surface abscess postoperatively, she was discharged from hospital 21 days after the surgery and is currently doing well 18 months after the second hepatectomy. She is currently receiving interferon and ribavirin therapy to eliminate hepatitis C virus.ConclusionsIf antiviral therapy was performed earlier for the present case and viral elimination was achieved, hepatocellular carcinoma might not have developed. This case reemphasizes the importance of antiviral therapy for preventing carcinogenesis of hepatocellular carcinoma in patients with viral hepatitis even if they have other cancers.
Highlights
It has been reported that liver metastasis rarely occurs in a cirrhotic/hepatitic liver
If antiviral therapy was performed earlier for the present case and viral elimination was achieved, hepatocellular carcinoma might not have developed. This case reemphasizes the importance of antiviral therapy for preventing carcinogenesis of hepatocellular carcinoma in patients with viral hepatitis even if they have other cancers
The coexistence of colorectal liver metastasis (CRLM) and hepatocellular carcinoma (HCC), which usually occurs in an injured liver, is considered common but is hardly ever seen in daily clinical practice
Summary
We present a case of HCC developing during a period between the first and second hepatectomy for repeated CRLM. With the experience of this case, we must realize that management of liver disease, including surveillance of HCC occurrence and virus elimination, is markedly important as well as surveillance of CRC recurrence in patients with hepatitis or cirrhosis with CRC. Abbreviations CRC: colorectal cancer; CRLM: colorectal liver metastasis; CT: computed tomography; HCC: hepatocellular carcinoma; HCV: hepatitis C virus; MCT: microwave tissue coagulator; MHV: middle hepatic vein.
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