Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients?
Non-alcoholic steatohepatitis (NASH) has been associated with hepatocellular carcinoma (HCC) often arising in histologically advanced disease when steatohepatitis is not active (cryptogenic cirrhosis). Our objective was to characterize patients with HCC and active, histologically defined steatohepat...
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| Format: | Article |
| Language: | English |
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Associação Brasileira de Divulgação Científica
2009-10-01
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| Series: | Brazilian Journal of Medical and Biological Research |
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| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2009001000014 |
| _version_ | 1828289983735136256 |
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| author | A.L. Chagas L.O.O. Kikuchi C.P.M.S. Oliveira D.C.P. Vezozzo E.S. Mello A.C. Oliveira L.C. Cella P. Herman T. Bachella S.H. Caldwell V.A.F. Alves F.J. Carrilho |
| author_facet | A.L. Chagas L.O.O. Kikuchi C.P.M.S. Oliveira D.C.P. Vezozzo E.S. Mello A.C. Oliveira L.C. Cella P. Herman T. Bachella S.H. Caldwell V.A.F. Alves F.J. Carrilho |
| author_sort | A.L. Chagas |
| collection | DOAJ |
| description | Non-alcoholic steatohepatitis (NASH) has been associated with hepatocellular carcinoma (HCC) often arising in histologically advanced disease when steatohepatitis is not active (cryptogenic cirrhosis). Our objective was to characterize patients with HCC and active, histologically defined steatohepatitis. Among 394 patients with HCC detected by ultrasound imaging over 8 years and staged by the Barcelona Clinic Liver Cancer (BCLC) criteria, we identified 7 cases (1.7%) with HCC occurring in the setting of active biopsy-proven NASH. All were negative for other liver diseases such as hepatitis C, hepatitis B, autoimmune hepatitis, Wilson disease, and hemochromatosis. The patients (4 males and 3 females, age 63 ± 13 years) were either overweight (4) or obese (3); 57% were diabetic and 28.5% had dyslipidemia. Cirrhosis was present in 6 of 7 patients, but 1 patient had well-differentiated HCC in the setting of NASH without cirrhosis (fibrosis stage 1) based on repeated liver biopsies, the absence of portal hypertension by clinical and radiographic evaluations and by direct surgical inspection. Among the cirrhotic patients, 71.4% were clinically staged as Child A and 14.2% as Child B. Tumor size ranged from 1.0 to 5.2 cm and 5 of 7 patients were classified as early stage; 46% of all nodules were hyper-echoic and 57% were <3 cm. HCC was well differentiated in 1/6 and moderately differentiated in 5/6. Alpha-fetoprotein was <100 ng/mL in all patients. HCC in patients with active steatohepatitis is often multifocal, may precede clinically advanced disease and occurs without diagnostic levels of alpha-fetoprotein. Importantly, HCC may occur in NASH in the absence of cirrhosis. More aggressive screening of NASH patients may be warranted. |
| first_indexed | 2024-04-13T10:29:42Z |
| format | Article |
| id | doaj.art-ae9930706022431486de8478f71ef0f7 |
| institution | Directory Open Access Journal |
| issn | 0100-879X 1414-431X |
| language | English |
| last_indexed | 2024-04-13T10:29:42Z |
| publishDate | 2009-10-01 |
| publisher | Associação Brasileira de Divulgação Científica |
| record_format | Article |
| series | Brazilian Journal of Medical and Biological Research |
| spelling | doaj.art-ae9930706022431486de8478f71ef0f72022-12-22T02:50:13ZengAssociação Brasileira de Divulgação CientíficaBrazilian Journal of Medical and Biological Research0100-879X1414-431X2009-10-014210958962Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients?A.L. ChagasL.O.O. KikuchiC.P.M.S. OliveiraD.C.P. VezozzoE.S. MelloA.C. OliveiraL.C. CellaP. HermanT. BachellaS.H. CaldwellV.A.F. AlvesF.J. CarrilhoNon-alcoholic steatohepatitis (NASH) has been associated with hepatocellular carcinoma (HCC) often arising in histologically advanced disease when steatohepatitis is not active (cryptogenic cirrhosis). Our objective was to characterize patients with HCC and active, histologically defined steatohepatitis. Among 394 patients with HCC detected by ultrasound imaging over 8 years and staged by the Barcelona Clinic Liver Cancer (BCLC) criteria, we identified 7 cases (1.7%) with HCC occurring in the setting of active biopsy-proven NASH. All were negative for other liver diseases such as hepatitis C, hepatitis B, autoimmune hepatitis, Wilson disease, and hemochromatosis. The patients (4 males and 3 females, age 63 ± 13 years) were either overweight (4) or obese (3); 57% were diabetic and 28.5% had dyslipidemia. Cirrhosis was present in 6 of 7 patients, but 1 patient had well-differentiated HCC in the setting of NASH without cirrhosis (fibrosis stage 1) based on repeated liver biopsies, the absence of portal hypertension by clinical and radiographic evaluations and by direct surgical inspection. Among the cirrhotic patients, 71.4% were clinically staged as Child A and 14.2% as Child B. Tumor size ranged from 1.0 to 5.2 cm and 5 of 7 patients were classified as early stage; 46% of all nodules were hyper-echoic and 57% were <3 cm. HCC was well differentiated in 1/6 and moderately differentiated in 5/6. Alpha-fetoprotein was <100 ng/mL in all patients. HCC in patients with active steatohepatitis is often multifocal, may precede clinically advanced disease and occurs without diagnostic levels of alpha-fetoprotein. Importantly, HCC may occur in NASH in the absence of cirrhosis. More aggressive screening of NASH patients may be warranted.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2009001000014Hepatocellular carcinomaLiver cancerFatty liverSteatohepatitisCirrhosis |
| spellingShingle | A.L. Chagas L.O.O. Kikuchi C.P.M.S. Oliveira D.C.P. Vezozzo E.S. Mello A.C. Oliveira L.C. Cella P. Herman T. Bachella S.H. Caldwell V.A.F. Alves F.J. Carrilho Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients? Brazilian Journal of Medical and Biological Research Hepatocellular carcinoma Liver cancer Fatty liver Steatohepatitis Cirrhosis |
| title | Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients? |
| title_full | Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients? |
| title_fullStr | Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients? |
| title_full_unstemmed | Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients? |
| title_short | Does hepatocellular carcinoma in non-alcoholic steatohepatitis exist in cirrhotic and non-cirrhotic patients? |
| title_sort | does hepatocellular carcinoma in non alcoholic steatohepatitis exist in cirrhotic and non cirrhotic patients |
| topic | Hepatocellular carcinoma Liver cancer Fatty liver Steatohepatitis Cirrhosis |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0100-879X2009001000014 |
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