[Primary liver cell carcinoma as complication of alpha 1-antitrypsin deficiency in a 67 year old man].
A 67-year-old male patient with pulmonary emphysema was diagnosed with liver cirrhosis. Further investigations revealed an alpha 1-antitrypsin deficiency caused by a PiZZ mutation. The liver cirrhosis was complicated by the development of a hepatocellular carcinoma. The patient died from the consequences of mesentary vein thrombosis. The protease inhibitor alpha 1-antitrypsin controls the tissue damaging effects of proteases which are produced by granulocytes. In the case of alpha 1-antitrypsin deficiency, progressive damage of the lung tissue occurs, resulting in emphysema. The accumulation of abnormal alpha 1-antitrypsin in hepatocytes can result in cirrhosis, with an increased chance of carcinoma. The deficiency is caused by a mutation in the Pi-gene on chromosome number 14. Although treatment options are at present limited, making an early diagnosis has important implications for the prognosis and intended management with respect to the prevention of complications, both in the patient as well as in first degree relatives (children and siblings).
van den Hazel
S J
SJ
Afd. Inwendige Geneeskunde, Ziekenhuis Rijnstate, Arnhem.
Meijer
J W
JW
van den Elshout
F J
FJ
de Vries
R A
RA
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D002883:Chromosomes, Human, Pair 14 / Q000235:genetics; D017809:Fatal Outcome; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008113:Liver Neoplasms / Q000209:etiology* / Q000235:genetics / Q000473:pathology; D008297:Male; D009154:Mutation; D011656:Pulmonary Emphysema / Q000209:etiology; D020246:Venous Thrombosis / Q000150:complications / Q000209:etiology; D019896:alpha 1-Antitrypsin Deficiency / Q000150:complications* / Q000235:genetics / Q000378:metabolism