Hepatocellular carcinoma associated with autoimmune chronic hepatitis: Report of two cases

Abstract

We report two patients with autoimmune chronic hepatitis who developed hepatocellular carcinoma. Hepatocellular carcinoma is thought to be a rare complication of autoimmune chronic hepatitis. The first patient, a 65-year-old woman, was admitted to our clinic in Feb. 1987, complaining of abdominal distension. On admission to hospital, laboratory data showed the positive LE test, LE cell and ANA (×80) and hypergammaglobulinemia. A liver biopsy showed liver cirrhosis and severe chronic inflammatory cell infiltration. The patient was diagnosed as having lupoid hepatitis developing liver cirrhosis. In 1989, she complained of foot edema and ascites which necessitated hospital admission. Laboratory data showed hypothyroidism and positive thyroid test and microsome test, diagnosed as having chronic thyroiditis. In addition, anti-HCV in her sera was positive, but negative for HBsAg and HBcAb. Ultrasonographic examination and CT scanning revealed mass lesion in the liver. After TAE, partial lobectomy was performed. Hepatocellular carcinoma was diagnosed by the resected liver specimens. The second patient, a 78-year-old man, was admitted to our clinic in Jan. 1990, complaining of abdominal distension. On admission to hospital, laboratory data showed the positive AMA (>320) and anti-M2, high level of ALP and hypergammaglobulinemia. HBsAg, HBcAb and anti-HCV were negative in this case. The patient was diagnosed as having PBC developing liver cirrhosis. Ultrasonographic examination and CT scanning revealed multiple mass lesions in the liver, although serum alphafetoprotein level was not so high. The patient deteriorated rapidly and died in May 1990. Autopsy confirmed the diagnosis of hepatocellular carcinoma complicating PBC. © 1991, Japanese Society of National Medical Services. All rights reserved.