Hepatocellular carcinoma in patients with non-alcoholic steatohepatitis

liver411

Journal of Hepatology, Vol. 37 (1) (2002) pp. 154-160 ?2002
European Association for the Study of the Liver. Published by
Elsevier Science B.V. All rights reserved.
PII: S0168-8278(02)00099-5

Case Report
Hepatocellular carcinoma in patients with non-alcoholic steatohepatitis

Masahiko Shimada 1, Etsuko Hashimoto 1 * [email protected] ,
Makiko Taniai 1, Kiyoshi Hasegawa 1, Hiroaki Okuda 1, Naoaki Hayashi 1, Ken Takasaki 1 and Jurgen Ludwig 2
1 Institute of Gastroenterology, Tokyo Women's Medical University, 8-1
Kawada-cho Shinjuku-ku, 162 8666 Tokyo, Japan
2 Division of Anatomic Pathology, Mayo Clinic, Rochester MN, USA
Received 18 October 2001; received in revised form 21 December 2001;
accepted 22 March 2002

Abstract
We describe six patients with non-alcoholic steatohepatitis (NASH) and
hepatocellular carcinoma (HCC). From 1990 to 2001, we treated 82 patients with NASH and observed six patients (three men and three women, aged 56-72 years) in this group who were referred with HCC or developed the complication during follow-up. In five of these six patients, NASH was associated with obesity (cases 3, 4 and 5), hyperlipidemia (case 5), or diabetes mellitus (cases 1, 3 and 6). We confirmed the presence of HCC by ultrasonography-guided tumor biopsy or surgery except in case 3 where we diagnosed the tumor by ultrasonography, computed tomography and selective hepatic arteriography. The carcinomas measured 1.5-6.0cm in diameter and three were well differentiated. When HCC was diagnosed, cirrhosis was present in all instances. Four of the six tumor patients also had esophageal varices but only one patient had a history of variceal bleeding and ascites. Treatment of HCC consisted of surgery (cases 1 and 5), transcatheter arterial embolization or infusion and/or percutaneous ethanol injection (cases 2, 3, 4, and 6). In patients with NASH cirrhosis, the development of treatable HCC is sufficiently common to warrant regular screening for this grave complication.

Keywords: Cirrhosis; Hepatocellular carcinoma; Non-alcoholic steatohepatitis
*Corresponding author. Tel.: +81-3-3353-8111, ext. 25214; fax:
+81-3-5269-7435