Hepatocellular carcinoma with chronic B-type hepatitis complicated by autoimmune hemolytic anemia: a case report.
A 57-year-old man consulted a local hospital because of a persistent slight fever. At the age of 37 years he was diagnosed having B-type hepatitis, but left the liver dysfunction untreated. Twenty years later, he was diagnosed having chronic hepatitis B, hepatocellular carcinoma (HCC) and macrocytic anemia, and referred to our hospital for further investigation. A HCC with a maximum diameter of 5.2 cm was detected in segment 8. Results of blood tests included 1.8 mg/dL serum total bilirubin, 0.9 mg/dL bilirubin, less than 10 mg/dL haptoglobin, 7.9 g/dL hemoglobin, 130 fL MCV, and 14.5% reticulocytes. A bone marrow sample showed erythroid hyperplasia. The direct Coombs test gave a positive result. We diagnosed the anemia as autoimmmune hemolytic anemia (AIHA), for which prednisolone could not be administered due to positivity for HBsAg and HBeAg. After preparation of washed blood cells for later transfusion, the patient underwent systematic resection of segment 8. The cut surface of the resected specimen demonstrated an encapsulated yellow-brownish tumor measuring 52 mm multiply 40 mm which was diagnosed pathologicaly as moderately differentiated HCC. On the 9th postoperative day, the patient's temperature rose to 38 centigrade, and exacerbated hemolysis was observed. The maximum total bilirubin value was 5.8 mg/dL and minimum hemoglobin level was 4.6 g/dL. He tolerated this period without blood transfusion. Currently he is being followed up as an outpatient, and shows no signs of HCC recurrence or symptoms of anemia. AIHA associated with HBV infection has been described in only three previous cases, and the present case is the first in which surgery was performed for accompanying HCC.
Okada
Toshie
T
Department of Gastroenterological Surgery, Dokkyo University School of Medicine, Kitakobayashi 880, Mibu, Shimotsuga, Tochigi 321-0293, Japan.
Kubota
Keiichi
K
Kita
Junji
J
Kato
Masato
M
Sawada
Tokihiko
T
D000744:Anemia, Hemolytic, Autoimmune / Q000175:diagnosis / Q000209:etiology*; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000601:surgery; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008099:Liver / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged
Immunol Invest. 1994 Nov;23(6-7):449-56
7851962
Ann Ital Med Int. 2003 Apr-Jun;18(2):107-10
12886829
Fukushima J Med Sci. 1995 Jun;41(1):43-9
8606041
Z Gastroenterol. 1997 Jul;35(7):567-9
9273990
BMC Nephrol. 2003 Aug 29;4:7
12946280
Turk J Gastroenterol. 2003 Sep;14(3):204-7
14655068
South Med J. 1996 Apr;89(4):444-5
8614893
Arch Dis Child. 1980 Mar;55(3):233-4
7387169
J Clin Gastroenterol. 2001 Mar;32(3):245-7
11246355
Indian J Med Sci. 2003 Nov;57(11):504-6
14646159
Cancer. 1981 Aug 1;48(3):721-4
7248899
Ann Ital Med Int. 2001 Oct-Dec;16(4):256-9
11799634
Recenti Prog Med. 1999 Nov;90(11):592-4
10608148
Rinsho Ketsueki. 1995 Apr;36(4):339-46
7783339
J Gen Virol. 2002 Jun;83(Pt 6):1267-80
12029141
Am J Hematol. 2004 Apr;75(4):243-5
15054819
Int J Hematol. 1998 Dec;68(4):439-43
9885443
Minerva Pediatr. 1987 Oct 15;39(19):803-6
2830479
J Clin Gastroenterol. 2001 Sep;33(3):232-3
11500615