Hepatocellular carcinoma associated with sarcoidosis

Abstract

INTRODUCTIONThe association of hepatic sarcoidosis with hepatocellular carcinoma (HCC) is considerably rare. Here we report a rare case of HCC associated with sarcoidosis.PRESENTATION OF CASEA 75-year-old male with no history of alcohol addiction or viral hepatitis was referred to our hospital because of an abnormal liver mass. Subsegmentectomy of the liver was performed for the diagnosis of HCC. A histopathological examination revealed small non-necrotizing granulomas with a tendency to coalesce that were scattered in and around the carcinoma. No features of cirrhosis, steatohepatitis, and any other liver diseases were observed. Furthermore, swelling of the bilateral lung hilar lymph nodes with uptake of 18F-fluorodeoxyglucose was found on positron emission tomography/computed tomography and the tuberculin reaction test results were negative. On the basis of these findings, the final diagnosis of HCC associated with sarcoidosis was confirmed.DISCUSSIONBy reviewing previous cases, we found only five cases that described patients diagnosed with HCC associated with sarcoidosis. Of these, four patients died within two years after diagnosis because of ruptures or inoperable huge tumors. In contrast, radical hepatectomy was performed at an earlier stage of disease in two patients, including ours, and both these patients have remained healthy with no recurrences or metastases at the latest follow-up visit.CONCLUSIONPeriodic checkups of the liver should be conducted for patients with systemic sarcoidosis, regardless of the presence of liver cirrhosis.

Sarcoidosis Masquerading as Long-Standing Cholestasis

“…Hepatocellular carcinoma (HCC) remains an ongoing risk in these patients, regardless of cirrhosis development, albeit the relationship is poorly understood. Laboratory abnormalities in aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT) are all increased [ 8 ]. On ultrasound, hypoechoic nodules are characteristic, although hyperechoic findings may represent granulomas on the background of fibrosis.…”

Extrapulmonary Sarcoidosis Manifested as Cirrhosis with Portal Hypertension

“…Long-term follow-up is necessary to prevent complications such as variceal bleeding or hepatocellular carcinoma. 11 , 12 …”

Treatment Efficacy and Prognostic Factors for Huge HCC Based on Barcelona Clinic Liver Cancer Staging

“…The number of tumor lesion is not required, but the tumor is too large and close to major blood vessels, so few residual livers were left after liver resection with restricted margin (Arai et al, 2014). Surgical resection is difficult to achieve same effect similar to the same staging of BCLC.…”