title: Non-alcoholic fatty liver disease and hepatocellular carcinoma in a 7-year-old obese boy: coincidence or comorbidity?
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) may develop from non-alcoholic fatty liver disease (NAFLD) either in the presence or in the absence of established cirrhosis. Non-cirrhotic patients with NAFLD-related HCC are usually adult, male and obese. However, this association has not been reported yet in younger age groups. Objectives In the present study, the clinical case of a 7-yaer-old obese boy with steatosis and HCC is presented.
  
  
  METHODS
  A 7-year-old boy, with no evidence of chronic liver disease, was admitted for assessment of a liver mass. Preliminary assessment was suggestive of a combined and severe liver steatosis together with a malignant disease.
  
  
  RESULTS
  A biopsy confirmed the suspected diagnosis of HCC; interestingly, the non-neoplastic liver was surrounded and characterized by the presence of steatosis and ballooning, and being absent of lobular inflammation and fibrosis. Chemotherapy and diet changes were conducted successfully with ultrasound characteristics suggesting improvements on both aspects: conventional liver mass resection could take place.
  
  
  CONCLUSIONS
  This case report suggests that HCC might develop in paediatric age patients with obesity-related NAFLD, even in the absence of fibrosis.
authors.affiliation: Hepato-Metabolic Diseases Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Nobili
authors.forename: A
authors.initials: A
authors.lastname: Alisi
authors.forename: C
authors.initials: C
authors.lastname: Grimaldi
authors.forename: D
authors.initials: D
authors.lastname: Liccardo
authors.forename: P
authors.initials: P
authors.lastname: Francalanci
authors.forename: L
authors.initials: L
authors.lastname: Monti
authors.forename: A
authors.initials: A
authors.lastname: Castellano
authors.forename: J
authors.initials: J
authors.lastname: de Ville de Goyet
mesh_terms: D001706:Biopsy; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy; D002648:Child; D015897:Comorbidity; D006801:Humans; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000209:etiology / Q000473:pathology / Q000628:therapy; D063766:Pediatric Obesity / Q000150:complications* / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Hepatocellular carcinoma; non-alcoholic fatty liver disease; obesity; steatosis