Open Access

Peer-reviewed

Case Report

Main Article Content

Salem Bouomrani corresponding author
Mesfar Rim
Amri DhiaEddine
Nesrine Belgacem
Amin Hammami
Warda Mahdhaoui
Ali Naffati

Abstract

The occurrence of hepatocellular carcinoma (HCC) on a healthy liver is exceptional and represents a real diagnosis challenge for the clinician. Recently a particularly increased risk of cancer during Behc¸et’s disease (BD) was reported by several studies. Only a few sporadic cases of liver cancer associated with this vascultis have been reported. We report an original observation of non-fibrolamellar HCC occurring on healthy liver in a Tunisian patient followed for BD. A 43-year-old man, followed since the age of 25 for BD with isolated cutaneous and mucosal involvement, and treated by colchicine, was admitted for exploration of a pain of the right hypochondrium evolving since a few months associated with an important slimming, anorexia, and evening fever. The clinical examination noted a firm and painful hepatomegaly. Radiological exploration (ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI)) showed a bulky hepatic tumor with highly developed arterial blood supply. Ultrasound-guided biopsy concluded at HCC without signs of fibrolamellar type or cirrhosis. Biological tests were without abnormalities and specific investigations eliminated underlying chronic hepatopathy (chronic viral hepatitis B or C, hemochromatosis, Wilson’s disease or autoimmune hepatitis). The patient was treated symptomatically given the advanced stage of cancer. He quickly died after a month because of a multi-organ failure. HCC on healthy liver is exceptional and BD was suggested as a possible contributing factor. Thus, regular radiological monitoring seems to be recommended in any patient followed for BD, especially those with hepatic veins thrombosis.

Keywords
liver cancer, Behçet's disease, hepatocellular carcinoma, vasculitis, non-cirrhotic liver

Article Details

How to Cite
Bouomrani, Salem, Mesfar Rim, Amri DhiaEddine, Nesrine Belgacem, Amin Hammami, Warda Mahdhaoui, and Ali Naffati. 2019. “Hepatocellular Carcinoma Associated to Behçet’s Disease”. Current Cancer Reports 1 (1), 20-23. https://doi.org/10.25082/CCR.2019.01.004.

References

  1. Budny A, Kozlowski P, Kami´nska M, et al. Epidemiology and risk factors of hepatocellular carcinoma. Pol Merkur Lekarski, 2017, 43(255): 133-139. https://europepmc.org/abstract/med/28987047
  2. Forner A, Reig M and Bruix J. Hepatocellular carcinoma. Lancet, 2018, 391(10127): 1301-1314. https://doi.org/10.1016/S0140-6736(18)30010-2
  3. Renedo F, De la Revilla J and Calleja JL. Carcinoma Hepatocelular. Medicine, 2008, 10(12): 770-776. https://doi.org/10.1016/S0211-3449(08)73153-9
  4. Casanova-Mart´ınez L, Castillo-Grau P, Jaquotot-Herranz M, et al. Hepatocellular carcinoma in non-cirrhotic liver. Revista Espa˜nola de Enfermedades Digestivas, 2012, 104(9): 505-506. https://doi.org/10.4321/S1130-01082012000900016
  5. Bouomrani S, Kilani I, Nouma H, et al. Non fibrolamellar hepatocellular carcinoma on a healthy liver. Pan African Medical Journal, 2014, 18: 155. https://doi.org/10.11604/pamj.2014.18.155.2762
  6. Bouomrani S, Ba¨ıli H, Souid K, et al. Colon cancer in Behc¸et’s disease. Journal Africain d’H´epato- Gastroent´erologie, 2016, 10(1): 1-5. https://doi.org/10.1007/s12157-015-0629-1
  7. Giat E, Ehrenfeld M and Shoenfeld Y. Cancer and autoimmune diseases. Autoimmun Review, 2017, 16(10): 1049- 1057. https://doi.org/10.1016/j.autrev.2017.07.022
  8. Lin Y, Li G, Zheng W, et al. Behc¸et’s disease associated with malignancy: a report of 41 Chinese cases. International Journal of Rheumatic Diseases, 2014, 17(4): 459-465. https://doi.org/10.1111/1756-185X.12269
  9. Jung YS, Han M, Kim DY, et al. Cancer risk in Korean patients with Behc¸et’s disease: A nationwide populationbased study. PLoS One, 2017, 12(12): e0190182. https://doi.org/10.1371/journal.pone.0190182
  10. Na SJ, Kang MJ, Yu DS, et al. Cancer risk in patients with Behc¸et disease: A nationwide population-based dynamic cohort study from Korea. Journal of the American Academy of Dermatology, 2018, 78(3): 464-470. https://doi.org/10.1016/j.jaad.2017.09.035
  11. Murata I, Omagari K, Nishihata S, et al. A case of Behc¸et disease associated with hepatocellular carcinoma. Gan no rinsho. Japan Journal of Cancer Clinics, 1989, 35(5): 625- 631. https://europepmc.org/abstract/med/2541273
  12. Ahn JK, Oh JM, Lee J, et al. Behc¸et’s disease associated with malignancy in Korea: a single center experience. Rheumatology International, 2010, 30(6): 831-835. https://doi.org/10.1007/s00296-009-1319-3
  13. Kwon KM, Jang BK, Chung WJ, et al. A case of primary hepatic leiomyosarcoma with intrahepatic and abdominal subcutaneous metastasis in Behc¸et’s disease. The Korean Journal of Hepatology, 2005, 11(4): 386-391. https://www.e-cmh.org/journal/view.php?number=575
  14. Giannini EG, Marenco S, Bruzzone L, et al. Hepatocellular carcinoma in patients without cirrhosis in Italy. Digestive and Liver Disease, 2013, 45(2): 164-169. https://doi.org/10.1016/j.dld.2012.08.018
  15. Arslanoglu A, Seyal AR, Sodagari F, et al. Current Guidelines for the Diagnosis and Management of Hepatocellular Carcinoma: A Comparative Review. Ajr American Journal of Roentgenology, 2016, 207(5): W88-W98. https://doi.org/10.2214/AJR.15.15490
  16. Chedid MF, Kruel CRP, Pinto MA, et al. Hepatocellular carcinoma: diagnosis and operative management. Arquivos Brasileiros de Cirurgia Digestiva, 2017, 30(4): 272-278. https://doi.org/10.1590/0102-6720201700040011
  17. Kee KM and Lu SN. Diagnostic efficacy of ultrasound in hepatocellular carcinoma diagnosis. Expert Review of Gastroenterology & Hepatology, 2017, 11(4): 277-279. https://doi.org/10.1080/17474124.2017.1292126
  18. Sun H and Song T. Hepatocellular carcinoma: Advances in diagnostic imaging. Drug Discoveries & Therapeutics, 2015, 9(5): 310-318. https://doi.org/10.5582/ddt.2015.01058
  19. Wang LH, Wang WM, Hsu SM, et al. Risk of Overall and Site-specific Cancers in Behc¸et Disease: A Nationwide Population-based Study in Taiwan. The Journal of Rheumatology, 2015, 42(5): 879-884. https://doi.org/10.3899/jrheum.140770
  20. Bayraktar Y, Egesel T, Saˇglam F, et al. Does hepatic vein outflow obstruction contribute to the pathogenesis of hepatocellular carcinoma? Journal of Clinical Gastroenterology, 1998, 27(1): 67-71. https://doi.org/10.1097/00004836-199807000-00014
  21. Bayraktar Y, Balkanci F, Bayraktar M, et al. Budd-Chiari syndrome: a common complication of Behc¸et’s disease. The American Journal of Gastroenterology, 1997, 92(5): 858- 862. https://www.ncbi.nlm.nih.gov/pubmed/9149201