Hepatocellular carcinoma in variegate porphyria: a serious complication.
Variegate porphyria is an acute hepatic porphyria resulting from a partial deficiency of protoporphyrinogen oxidase, the penultimate enzyme in haem biosynthesis. Cutaneous symptoms and acute neurovisceral attacks are well-known clinical characteristics of the disease. Less studied, however, is the risk of developing hepatocellular carcinoma, an aggressive type of liver cancer. We describe here two Swiss patients with variegate porphyria and this serious complication. Common risk factors, including alcohol over-consumption or chronic hepatitis, were absent in both patients. Interestingly, one patient carried mutation 1082-1083insC in the PPOX gene, a prevalent sequence deviation in the Swiss variegate porphyria population, which was also found in a French patient with variegate porphyria and hepatocellular carcinoma. Recent studies indicate that individuals with acute hepatic porphyria have a 36- to 61-fold increased risk of manifesting hepatocellular carcinoma. The incidence rate ratio in the Swiss population was estimated to be 34, comparable with those found in the French and Finnish populations. Because this tumour is associated with a rising mortality, we suggest regular screening for hepatocellular carcinoma in all patients with variegate porphyria.
Schneider-Yin
Xiaoye
X
Zentrallabor and Swiss Porphyrin Reference Laboratory, Stadtspital Triemli, Zürich, Switzerland.
van Tuyll van Serooskerken
Anne-Moon
AM
Went
Philip
P
Tyblewski
Wojciech
W
Poblete-Gutiérrez
Pamela
P
Minder
Eliabeth I
EI
Frank
Jorge
J
D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D004252:DNA Mutational Analysis; D017809:Fatal Outcome; D005260:Female; D005420:Flavoproteins / Q000235:genetics; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology* / Q000235:genetics / Q000473:pathology / Q000628:therapy; D024101:Mitochondrial Proteins / Q000235:genetics; D009154:Mutation; D010166:Palliative Care; D046350:Porphyria, Variegate / Q000150:complications* / Q000235:genetics / Q000473:pathology; D050768:Protoporphyrinogen Oxidase / Q000235:genetics; D012867:Skin / Q000473:pathology; D013557:Switzerland; D016896:Treatment Outcome
D005420:Flavoproteins; D024101:Mitochondrial Proteins; C493978:PPOX protein, human; D050768:Protoporphyrinogen Oxidase