title: Hepatocellular carcinoma in patients with autoimmune liver diseases: two case reports and literature review.
abstract: OBJECTIVE
  Hepatocellular carcinoma has been reported as a rare complication of autoimmune liver diseases. We describe herein two patients with this neoplasia associated with autoimmune hepatitis and primary biliary cirrhosis, and we also review the literature.
  
  
  METHODS
  The first case corresponds to a 49-year-old woman presented for evaluation of right upper abdominal pain. She had been diagnosed with autoimmune hepatitis 4 years before. Alpha-fetoprotein was markedly elevated and an abdominal MRI showed a 10 cm x 9.0 cm mass. She received transarterial chemoembolization, and currently the disease has progressed to the lungs and bones, and she is on supportive care. The second case corresponds to a 68-year-old woman presented for evaluation of a liver mass found in a screening ultrasound. She had been diagnosed with primary biliary cirrhosis 5 years previously. At admission alpha-fetoprotein was 1000 ng/mL and an abdominal MRI revealed a 4 cm x 3 cm liver tumor. She was treated with percutaneous radiofrequency ablation getting complete response, and currently she has no evidence of neoplastic disease. These two patients constitute the only cases of hepatocellular carcinoma associated to autoimmune liver diseases that have been attended in our Institute.
  
  
  CONCLUSIONS
  These cases highlight that hepatocellular carcinoma secondary to autoimmune hepatitis and primary biliary cirrhosis, although rare, can occur in the absence of coexistent viral hepatitis, or excessive alcohol consumption. The utility of screening for hepatocellular carcinoma in autoimmune liver diseases is still not defined.
authors.affiliation: Department of Oncology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City. judithmj@quetzal.innsz.mx
authors.forename: Judith
authors.initials: J
authors.lastname: Meza-Junco
authors.forename: Aldo J
authors.initials: AJ
authors.lastname: Montaño-Loza
authors.forename: Braulio
authors.initials: B
authors.lastname: Martínez-Benitez
authors.forename: Eric
authors.initials: E
authors.lastname: Kimura-Hayama
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D005260:Female; D019693:Hepatitis, Autoimmune / Q000150:complications*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins