“Hockey Stick” may Strike Back: Hepatocellular Carcinoma on Noncirrhotic Liver as a Late Toxicity of Lombo-Aortic Radiotherapy for Seminoma. A Review Triggered by an Unusual Case

Abstract

Most patients with testicular seminoma have been treated with a curative intent for decades. Second cancers after radiotherapy for testicular seminoma before 1990 are a growing issue, and are related to previous generation of dose planning and delineating strategies. Among those cancers, hepatocellular carcinoma is an extremely rare occurrence, especially when affecting patients with healthy, noncirrhotic liver. Here, we describe such a case in a patient of our institution, and subsequently review the relevant literature and large epidemiologic studies. Understanding those late and serious toxicity features may help cancer care teams to screen and treat those patients appropriately. ( J CLIN EXP HEPATOL 2016;6:54-58) M ajor improvement in testicular cancer treatment in the second half of the 20th century made it a curable disease, mainly thanks to platinum-based chemotherapy and radiation therapy. 1,2 Cancer of the testis has one of the best 5-year survival rate. 3,4 Avoiding long-term iatrogenic morbidity is now part of the treatment plan. Among the many malignancies arising from the radiotherapy field of previously treated testicular cancer patients, hepatocellular carcinoma is a rare occurrence. We describe a case of a patient presenting with in-field hepatocellular carcinoma 34 years after radiotherapy for testicular seminoma. CASE REPORTA 62-year-old man presented in April 2013 with dehydration and acute renal failure. Relevant medical history reported a left testicular seminoma in 1979, for which he underwent left orchidectomy, adjuvant platinum-based chemotherapy, and radiotherapy. Other history included transient ischemic attack in 2002. He had lost 8 kg over the past 8 months. On examination, there was no symptom of portal hypertension or chronic liver failure. Abdominal ultrasound (US) found a heterogeneous liver mass. Thoracic and abdominal computerized tomography scan (CT scan) found a 16 cm great axis tumor occupying left liver lobe almost entirely, associated with left portal thrombosis (Figure 1). The thrombus was believed to be of tumorous nature. Angio-CT scan of the liver confirmed the invasion of the left portal vein branch by the tumor. The Right liver lobe was not affected and presented normal radiological features. No distant metastases were found. Gastroscopy and colonoscopy showed no suspicious lesions. Alphafetoprotein level was 374,000 ng/mL. Other tumor markers were within normal range. Liver biopsies were performed. Pathology report came to the conclusion of a well-differentiated hepatocarcinoma (Figure 2). Liver function test were unaffected. Every major cause of cirrhosis and liver disease was ruled out including alcoholic cirrhosis, autoimmune hepatitis, hemochromatosis, Non-Alcoholic Steato-Hepatitis (NASH) or fatty liver disease, primary biliary cirrhosis, sclerosing cholangitis, and Wilson's disease. Viral serologies were negative for hepatitis B (HBs antigen and HBc antibody), hepatitis C, and cytomegalovirus (CMV), and there were no clinical suspicions of viral hepatitis. N...

A metastasized hepatocellular carcinoma in the capsule of an undescended testis in the right inguinal area: report of a rare case

“…In this case, the AFP level of the patient was markedly elevated (> 1210 ng/mL). Korenbaum reported an unusual case of hepatocellular carcinoma which was a second cancer after radiotherapy for testicular seminoma [ 16 ]. In this case, the patient had not received any chemotherapy before the tumor in the liver was detected.…”