title: Successful Treatment in a Case of Massive Hepatocellular Carcinoma with Paraneoplastic Syndrome.
abstract: Paraneoplastic syndromes of hepatocellular carcinoma (HCC) are not uncommon. However, the prognosis is poor and follow-up and improvement of paraneoplastic syndromes with treatment have been reported rarely. We report a successful case in an aged man of a massive HCC with paraneoplastic syndrome, treated by combined intraarterial chemotherapy and hepatic resection. Paraneoplastic syndrome (erythrocytosis and hyperlipidemia) was monitored throughout the treatment and erythropoietin (EPO) mRNA also was analyzed in the resected liver. The hemoglobin level and serum levels of EPO and total cholesterol (T-cho) decreased dramatically with treatment, along with a decrease in serum levels of alpha-fetoprotein and protein induced by vitamin vitamin K absence II (PIVKA-II). Semiquantitative reverse transcription polymerase chain reaction (RT-PCR) revealed that the residual cancer expressed EPO RNA but the nontumor tissue did not. This was a rare case of paraneoplastic syndrome of HCC that was treated successfully. This case indicates that paraneoplastic syndrome reflected tumor progression and that serum levels of both EPO and T-cho might be used as tumor markers.
authors.affiliation: Division of Gastroenterology and Hepatology, Niigata, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Tsuchiya
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Kubota
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Takizawa
authors.forename: Kazuki
authors.initials: K
authors.lastname: Yamada
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Wakai
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Terasu
authors.initials: T
authors.lastname: Honma
authors.forename: Masashi
authors.initials: M
authors.lastname: Watanabe
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Shirai
authors.forename: Hiroki
authors.initials: H
authors.lastname: Maruyama
authors.forename: Minoru
authors.initials: M
authors.lastname: Nomoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyagi