Paraneoplastic Erythrocytosis: First Manifestation of a Large Hepatocellular Carcinoma Successfully Treated by Radical Liver Resection and Adjuvant Thalidomide

Abstract

The paraneoplastic syndromes occur in upto 28% of patients with hepatocellular carcinoma (HCC). Among them, erythrocytosis is reported as just 3.9 % of frequency. We describe a 59-year-old male patient with a large HCC in a non-cirrhotic liver presenting with erythrocytosis. Four phlebotomies were performed before radical surgical resection. Extended right hepatectomy was undertaken, proving a unifocal 10.2 X 13 X 6.5 cm, extensively necrotic HCC. There were no postoperative complications, and the patient was discharged on the 6th postoperative day. Adjuvant treatment with thalidomide was indicated for 36 months. We observed a progressive decrease in haemoglobin, haematocrit, EPO, and AFP to normal levels after the surgical procedure. A periodic follow-up with laboratory parameters and CT scan was done for 46 months with no evidence of relapses, until now. This case highlights a rare manifestation of advanced liver cancer; the first documented paraneoplastic erythrocytosis in a large HCC case in Chile was successfully treated by radical liver resection and adjuvant thalidomide.