title: Multicentric occurrence of hepatocellular carcinoma with nonalcoholic steatohepatitis.
abstract: OBJECTIVE
  To reveal the manner of hepatocellular carcinoma (HCC) development in patients with nonalcoholic steatohepatitis (NASH) focusing on multicentric occurrence (MO) of HCC.
  
  
  METHODS
  We compared clinicopathological characteristics between patients with and without MO of HCC arising from NASH background. The clinical features were implicated with reference to the literature available.
  
  
  RESULTS
  MO of HCC was identified with histological proof in 4 out of 12 patients with NASH-related HCC (2 males and 2 females). One patient had synchronous MO; an advanced HCC, two well-differentiated HCCs and a dysplastic nodule, followed by the development of metachronous MO of HCC. The other three patients had multiple advanced HCCs accompanied by a well-differentiated HCC or a dysplastic nodule. Of these three patients, one had synchronous MO, one had metachronous MO and the other had both synchronous and metachronous MO. There were no obvious differences between the patients with or without MO in terms of liver function tests, tumor markers and anatomical extent of HCC. On the other hand, all four patients with MO of HCC were older than 70 years old and had the comorbidities of obesity, type 2 diabetes mellitus (T2DM), hypertension and cirrhosis. Although these conditions were not limited to MO of HCC, all the conditions were met in only one of eight patients without MO of HCC. Thus, concurrence of these conditions may be a predisposing situation to synchronous MO of HCC. In particular, old age, T2DM and cirrhosis were suggested to be prerequisite for MO because these factors were depicted in common among two other cases with MO of HCC under NASH in the literature.
  
  
  CONCLUSIONS
  The putative predisposing factors and necessary preconditions for synchronous MO of HCC in NASH were suggested in this study. Further investigations are required to clarify the accurate prevalence and predictors of MO to establish better strategies for treatment and prevention leading to the prognostic improvement in NASH.
authors.affiliation: Hirokazu Kawai, Department of Clinical Laboratory, Niigata University Medical and Dental Hospital, Niigata 951-8510, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Kawai
authors.forename: Minoru
authors.initials: M
authors.lastname: Nomoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Suda
authors.forename: Kenya
authors.initials: K
authors.lastname: Kamimura
authors.forename: Atsunori
authors.initials: A
authors.lastname: Tsuchiya
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tamura
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takamura
authors.forename: Masato
authors.initials: M
authors.lastname: Igarashi
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Wakai
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamagiwa
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Shogo
authors.initials: S
authors.lastname: Ohkoshi
authors.forename: Isao
authors.initials: I
authors.lastname: Kurosaki
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Shirai
authors.forename: Masahiko
authors.initials: M
authors.lastname: Okada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyagi