title: Multifocal hepatocellular carcinoma and precancerous lesions in a patient with autoimmune hepatitis-related cirrhosis.
abstract: 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.
authors.affiliation: The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, The Mount Sinai Medical Center, New York, New York 10029, USA. Stephen.Ward@mssm.edu
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Ward
authors.forename: Kemal
authors.initials: K
authors.lastname: Deniz
authors.forename: Sasan
authors.initials: S
authors.lastname: Roayaie
authors.forename: Lihui
authors.initials: L
authors.lastname: Qin
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D011230:Precancerous Conditions / Q000473:pathology*