Multifocal hepatocellular carcinoma and precancerous lesions in a patient with autoimmune hepatitis-related cirrhosis

Ward S. C. , Deniz K. , Roayaie S., Qin L.

SEMINARS IN LIVER DISEASE, vol.28, no.1, pp.123-127, 2008 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Review
  • Volume: 28 Issue: 1
  • Publication Date: 2008
  • Doi Number: 10.1055/s-2008-1040326
  • Title of Journal : SEMINARS IN LIVER DISEASE
  • Page Numbers: pp.123-127


A 44-year-old woman with a 29-year history of autoimmune hepatitis (AIH) received a living donor liver transplant for multifocal hepatocellular carcinoma (HCC) and cirrhosis in 2007. Her initial laboratory workup at our institution in 1996 revealed a positive antismooth muscle antibody with a titer of 1:640. Serum electrophoresis showed a monoclonal gamma globulin spike with elevated IgG, IgA, and IgM. The patient was negative for hepatitis B and hepatitis C (HCV) by serology and serum polymerase chain reaction. She was treated with corticosteroids and azathioprine, but her disease progressed. In 1997, a liver needle biopsy revealed cirrhosis, and a focus of small cell change. In 2004, a 2-cm exophytic mass was detected on magnetic resonance imaging. Follow-up imaging in 2005 and 2006 showed growth of the exophytic mass and development of new tumors. The exophytic mass was treated with ethanol ablation and she received a transplant. Examination of the explant revealed multiple high-grade dysplastic nodules and four moderately differentiated HCCs, one of which is arising in a high-grade dysplastic nodule. We believe this to be the first case in the English literature documenting the presence of preneoplastic lesions in an HCV-negative patient with AIH who developed HCC.