title: Pleomorphic hepatocellular carcinoma following consumption of hypericum perforatum in alcoholic cirrhosis.
abstract: Hepatocellular carcinoma (HCC) often develops in patients with underlying liver disease, yet HCC with syncytial giant cells (SGCs) is extremely rare. Herein, we report a 55-year-old man with a 6-year history of alcoholic cirrhosis who during his regular checkup presented with marked elevation of alpha-fetoprotein. Clinical examination and imaging analyses revealed a tumor-like lesion in segment 4 of the liver, which was removed by limited wedge resection. Histological analysis by hematoxylin and eosin staining indicated pleomorphic and atypical nodules, with some SGCs, embedded within the boundaries of the neoplastic lesion. The adjacent liver parenchyma showed microvesicular steatosis, pericellular fibrosis, and moderate hemosiderin accumulation (grade 2, as determined by Prussian blue iron stain) in hepatocytes and Kupffer cells but no copper accumulation (as determined by orcein stain). Immunohistochemical analysis showed hepatocyte antigen-positive staining for the neoplastic cells and SGCs. The diagnosis was made for cirrhosis-related HCC with SGCs. The previous reports of pleomorphic HCC have featured osteoclast-like (i.e., mesenchymal type) giant cells, making this case of epithelial type giant cells very rare. The patient's 6-month history of hypericum perforatum/St John's wort self-medication may have prompted the cirrhosis or HCC progression or the unusual SGC manifestation.
authors.affiliation: Evangeli S Lampri, Vasiliki Malamou-Mitsi, Department of Pathology, Ioannina University Medical School, 45110 Ioannina, Greece.
authors.forename: Evangeli S
authors.initials: ES
authors.lastname: Lampri
authors.affiliation: Evangeli S Lampri, Vasiliki Malamou-Mitsi, Department of Pathology, Ioannina University Medical School, 45110 Ioannina, Greece.
authors.forename: Elli
authors.initials: E
authors.lastname: Ioachim
authors.affiliation: Evangeli S Lampri, Vasiliki Malamou-Mitsi, Department of Pathology, Ioannina University Medical School, 45110 Ioannina, Greece.
authors.forename: Haralampos
authors.initials: H
authors.lastname: Harissis
authors.affiliation: Evangeli S Lampri, Vasiliki Malamou-Mitsi, Department of Pathology, Ioannina University Medical School, 45110 Ioannina, Greece.
authors.forename: Eufemia
authors.initials: E
authors.lastname: Balasi
authors.affiliation: Evangeli S Lampri, Vasiliki Malamou-Mitsi, Department of Pathology, Ioannina University Medical School, 45110 Ioannina, Greece.
authors.forename: Antigoni
authors.initials: A
authors.lastname: Mitselou
authors.affiliation: Evangeli S Lampri, Vasiliki Malamou-Mitsi, Department of Pathology, Ioannina University Medical School, 45110 Ioannina, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Malamou-Mitsi
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000209:etiology; D018450:Disease Progression; D022781:Hepatocytes / Q000187:drug effects; D006801:Humans; D020902:Hypericum / Q000009:adverse effects*; D007150:Immunohistochemistry; D008099:Liver / Q000187:drug effects; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000188:drug therapy; D008113:Liver Neoplasms / Q000150:complications* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010010:Osteoclasts / Q000187:drug effects; D008517:Phytotherapy; D010936:Plant Extracts / Q000009:adverse effects; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D010936:Plant Extracts; D000509:alpha-Fetoproteins
keywords: Alcoholic cirrhosis; Giant cell carcinoma; Hepatocellular carcinoma; Hypericum perforatum; Pleomorphic liver tumor; St John’s wort; Syncytial giant cell