[Premalignant lesions and hepatocellular carcinoma on non cirrhotic liver overloaded with iron].
A 68-year old mildly obese Caucasian man underwent hepatic resection for multinodular hepatocellular carcinoma which had developed in the left lobe of a non-cirrhotic liver. The only risk factors found were heavy drinking, smoking, and serum markers of hepatitis B virus without virus genome in hepatocytes. The non tumoral liver was mildly fibrotic and iron overloaded (hepatic iron index: 1.6) with three types of iron-free lesions: (i) periportal clear hepatocyte foci, (ii) hyperplastic nodules and (iii) dysplastic or neoplastic nodules with well to moderately-differentiated hepatocellular carcinoma. The genetic investigation was negative for the C282Y and the H63D mutations of the HFE gene. This observation illustrates the multistep process of carcinogenesis in the non-cirrhotic liver and raises the question of i) the origin of this iron overload possibly linked to insulin resistance syndrome and ii) the role of iron as a co-carcinogen.
Attia
A
A
Service d'Hépato-Gastroentérologie et de Chirurgie Digestive et Transplantation Hépatique, Hôpital Saint-André.
Blanc
J F
JF
Saric
J
J
Balabaud
C
C
Bioulac-Sage
P
P
D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology*; D006509:Hepatitis B; D006801:Humans; D007333:Insulin Resistance; D019190:Iron Overload / Q000150:complications / Q000473:pathology*; D008103:Liver Cirrhosis; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology*; D008297:Male; D011230:Precancerous Conditions / Q000473:pathology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects