Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on Azathioprine

Hepatocellular carcinoma rarely occurs in patients without underlying cirrhosis or liver disease. While inflammatory bowel disease has been linked to certain forms of liver disease, hepatocellular carcinoma is exceedingly rare in these patients. We report the twelfth case of hepatocellular carcinoma...

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Main Authors: Valérie Heron, Kyle Joshua Fortinsky, Gillian Spiegle, Nir Hilzenrat, Andrew Szilagyi
Format: Article
Language:English
Published: Karger Publishers 2016-05-01
Series:Case Reports in Gastroenterology
Subjects:
Online Access:http://www.karger.com/Article/FullText/444012
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author Valérie Heron
Kyle Joshua Fortinsky
Gillian Spiegle
Nir Hilzenrat
Andrew Szilagyi
author_facet Valérie Heron
Kyle Joshua Fortinsky
Gillian Spiegle
Nir Hilzenrat
Andrew Szilagyi
author_sort Valérie Heron
collection DOAJ
description Hepatocellular carcinoma rarely occurs in patients without underlying cirrhosis or liver disease. While inflammatory bowel disease has been linked to certain forms of liver disease, hepatocellular carcinoma is exceedingly rare in these patients. We report the twelfth case of hepatocellular carcinoma in a patient with Crohn’s disease. The patient is a 61-year-old with longstanding Crohn’s disease who was treated with azathioprine and was found to have elevated liver enzymes and a new 3-cm liver mass on ultrasound. A complete workup for underlying liver disease was unremarkable and liver biopsy revealed hepatocellular carcinoma. The patient underwent a hepatic resection, and there is no evidence of recurrence at the 11-month follow-up. The resection specimen showed no evidence of cancer despite the initial biopsy revealing hepatocellular carcinoma. This case represents the third biopsy-proven complete spontaneous regression of hepatocellular carcinoma. Although large studies have failed to show a definite link between azathioprine and hepatocellular carcinoma, the relationship remains concerning given the multiple case reports suggesting a possible association. Clinicians should exercise a high degree of suspicion in patients with Crohn’s disease who present with elevated liver enzymes, especially those on azathioprine therapy.
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spelling doaj.art-9e272f9bf4784fe0921de7de9c4fb5aa2022-12-21T23:53:49ZengKarger PublishersCase Reports in Gastroenterology1662-06312016-05-01101505610.1159/000444012444012Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on AzathioprineValérie HeronKyle Joshua FortinskyGillian SpiegleNir HilzenratAndrew SzilagyiHepatocellular carcinoma rarely occurs in patients without underlying cirrhosis or liver disease. While inflammatory bowel disease has been linked to certain forms of liver disease, hepatocellular carcinoma is exceedingly rare in these patients. We report the twelfth case of hepatocellular carcinoma in a patient with Crohn’s disease. The patient is a 61-year-old with longstanding Crohn’s disease who was treated with azathioprine and was found to have elevated liver enzymes and a new 3-cm liver mass on ultrasound. A complete workup for underlying liver disease was unremarkable and liver biopsy revealed hepatocellular carcinoma. The patient underwent a hepatic resection, and there is no evidence of recurrence at the 11-month follow-up. The resection specimen showed no evidence of cancer despite the initial biopsy revealing hepatocellular carcinoma. This case represents the third biopsy-proven complete spontaneous regression of hepatocellular carcinoma. Although large studies have failed to show a definite link between azathioprine and hepatocellular carcinoma, the relationship remains concerning given the multiple case reports suggesting a possible association. Clinicians should exercise a high degree of suspicion in patients with Crohn’s disease who present with elevated liver enzymes, especially those on azathioprine therapy.http://www.karger.com/Article/FullText/444012AzathioprineSpontaneous regressionHepatocellular carcinomaCrohn’s disease
spellingShingle Valérie Heron
Kyle Joshua Fortinsky
Gillian Spiegle
Nir Hilzenrat
Andrew Szilagyi
Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on Azathioprine
Case Reports in Gastroenterology
Azathioprine
Spontaneous regression
Hepatocellular carcinoma
Crohn’s disease
title Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on Azathioprine
title_full Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on Azathioprine
title_fullStr Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on Azathioprine
title_full_unstemmed Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on Azathioprine
title_short Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on Azathioprine
title_sort resected hepatocellular carcinoma in a patient with crohn s disease on azathioprine
topic Azathioprine
Spontaneous regression
Hepatocellular carcinoma
Crohn’s disease
url http://www.karger.com/Article/FullText/444012
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AT kylejoshuafortinsky resectedhepatocellularcarcinomainapatientwithcrohnsdiseaseonazathioprine
AT gillianspiegle resectedhepatocellularcarcinomainapatientwithcrohnsdiseaseonazathioprine
AT nirhilzenrat resectedhepatocellularcarcinomainapatientwithcrohnsdiseaseonazathioprine
AT andrewszilagyi resectedhepatocellularcarcinomainapatientwithcrohnsdiseaseonazathioprine