Ewha Med J.  2014 Dec;37(Suppl):S33-S36. 10.12771/emj.2014.37.S.S33.

Hepatocellular Carcinoma Arising from Non-Cirrhotic Non-Alcoholic Steatohepatitis

• Roh M
• Kim TY
• Sohn JH
• Park JK
• Lee S
• Kim HJ
• Pyo J
• Oh YH

• KMID: 2171309
• DOI: http://doi.org/10.12771/emj.2014.37.S.S33

Abstract

The major risk factors of hepatocellular carcinoma include hepatitis B or C virus infection and alcohol consumption in Korea which lead to liver cirrhosis development and progression. However, prevalence of non-alcoholic fatty liver disease related hepatocellular carcinoma is rising worldwide and hepatocellular carcinoma cases in patients with non-cirrhotic non-alcoholic steatohepatitis are increasing. A hypoechoic nodule was incidentally detected in a 52-year-old woman, with no evidence of liver cirrhosis or specific hepatocellular carcinoma findings on radiological examination. Non-cirrhotic non-alcoholic steatohepatitis-associated hepatocellular carcinoma was diagnosed based on clinical, laboratory, and histopathological findings of liver biopsy. To our knowledge, this is the first such case report in Korea.

Keyword

Carcinoma, hepatocellular; Fatty liver; Non-alcoholic fatty liver disease

MeSH Terms

Alcohol Drinking
Biopsy
Carcinoma, Hepatocellular*
Fatty Liver*
Female
Hepatitis B
Humans
Korea
Liver
Liver Cirrhosis
Middle Aged
Prevalence
Risk Factors

Figure

• 

  Fig. 1 Abdominal ultrasonography. It shows a 1.6 cm size well-defined hypoechoic nodule in liver segment III (arrow).

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  Fig. 2 Liver magnetic resonance imaging (MRI). (A) Liver MRI (arterial phase) shows a well-enhanced and homogenous nodule in the liver segment III (arrow). (B) Liver MRI (hepatobiliary phase) shows a liver nodule with low signal intensity (arrow).

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  Fig. 3 Histologic findings. (A) Histologic findings of liver reveals diffuse macro- and microvesicular fatty change with moderate ballooning degeneration and moderate lobular activity (H&E, ×100). (B) Histologic findings of liver reveals diffuse periportal fibirosis and occasional bridging fibrosis (Masson's trichrome stain, ×100). (C) Immunohistochemical staining shows negativity at hepatitis B core antigen (×200).

Reference

1. Ertle J, Dechene A, Sowa JP, Penndorf V, Herzer K, Kaiser G, et al. Non-alcoholic fatty liver disease progresses to hepatocellular carcinoma in the absence of apparent cirrhosis. Int J Cancer. 2011; 128:2436–2443.

2. Malik SM, Gupte PA, de Vera ME, Ahmad J. Liver transplantation in patients with nonalcoholic steatohepatitis-related hepatocellular carcinoma. Clin Gastroenterol Hepatol. 2009; 7:800–806.

3. Starley BQ, Calcagno CJ, Harrison SA. Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection. Hepatology. 2010; 51:1820–1832.

4. Ichikawa T, Yanagi K, Motoyoshi Y, Hamasaki K, Nakao K, Toriyama K, et al. Two cases of non-alcoholic steatohepatitis with development of hepatocellular carcinoma without cirrhosis. J Gastroenterol Hepatol. 2006; 21:1865–1866.

5. Guzman G, Brunt EM, Petrovic LM, Chejfec G, Layden TJ, Cotler SJ. Does nonalcoholic fatty liver disease predispose patients to hepatocellular carcinoma in the absence of cirrhosis? Arch Pathol Lab Med. 2008; 132:1761–1766.

6. Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology. 1990; 11:74–80.

7. Adams LA, Lindor KD. Nonalcoholic fatty liver disease. Ann Epidemiol. 2007; 17:863–869.

8. Duan XY, Qiao L, Fan JG. Clinical features of nonalcoholic fatty liver disease-associated hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int. 2012; 11:18–27.

9. Michelotti GA, Machado MV, Diehl AM. NAFLD, NASH and liver cancer. Nat Rev Gastroenterol Hepatol. 2013; 10:656–665.

10. Yeh MM, Brunt EM. Pathology of nonalcoholic fatty liver disease. Am J Clin Pathol. 2007; 128:837–847.

11. Reddy SK, Steel JL, Chen HW, DeMateo DJ, Cardinal J, Behari J, et al. Outcomes of curative treatment for hepatocellular cancer in nonalcoholic steatohepatitis versus hepatitis C and alcoholic liver disease. Hepatology. 2012; 55:1809–1819.