Hepatocellular carcinoma occurring in a young Crohn's disease patient

Abstract

Reported herein is a case of hepatocellular carcinoma (HCC) occurring in a 25-year-old Japanese man who was diagnosed with Crohn's disease (CD) at 14 years of age; treatment included predonisolone, azathioprine, and infliximab. The tumor was located in right upper lobe and the size was 8 cm in diameter; histology was poorly differentiated HCC with pleomorphic cellular changes. Adjacent normal liver showed no evidence of cirrhosis or viral hepatitis. Until now, only six cases of HCC arising in patients with CD have been reported in the English-language literature. Most of these patients had early onset of CD and HCC: none had cirrhosis or virus hepatitis. Most patients had a long disease history of CD and were being medicated with several immunosuppressive agents. Some factors associated with CD might indirectly or directly be related to the development of HCC in CD patients, although the possibility that these HCC occurred coincidentally in CD patients, including the present patient, cannot be ruled out. Accumulation of cases is necessary to evaluate the relationship between CD and HCC precisely.

Are Anti-TNF-α Agents Safe for Treating Psoriasis in Hepatitis C Virus Patients with Advanced Liver Disease? Case Reports and Review of the Literature

“…To the best of our knowledge, only a few cases have been reported [10,11,12,13,14] of HCC arising in patients treated with anti-TNF-α agents (infliximab, etanercept, adalimumab) for inflammatory bowel disease. Notably, in all reported cases, the patients did not have any established chronic liver disease, and all but 1 patient had a medical history of prolonged treatment with azathioprine, which is likely to have played an important role in the development of HCC in these patients [11].…”

Extra-intestinal malignancies in inflammatory bowel diseases: An update with emphasis on MDCT and MR imaging features

“…Please cite this article in press as: Dohan 6 A. Dohan et al HCC developed approximately 15.1 years after the onset of CD (range: 6-36 years) [21,65,66]. HCC in IBD patients have a variable histopathological presentation, ranging from well-differentiated tumors with trabecular pattern [61,65] to poorly differentiated HCC with pleomorphic cellular changes [21,64,67].…”

“…Prolonged treatment by azathioprine has been advocated as a risk factor for the development of HCC because the majority of patients were receiving this treatment at the time HCC was diagnosed or because they had received azathioprine before [21,[62][63][64][66][67][68][69]. However, HCC may develop in patients who did not receive azathioprine [61].…”

“…Only two HCCs developed in CD patients with CD and PSC [68,69]. CD patients with HCC are younger (mean age: 35 years) than the standard population with HCC [21,61]. The majority of HCC were found in patients with quiescent CD that mostly involved the colon.…”

“…Consequently, radiologists are currently on the frontline of management of IBD patients in many occasions. Because of the rarity of extra-intestinal malignancies in IBD patients, knowledge of their imaging features is based on case reports and scarce studies that included a few patients [21][22][23][24].…”