title: Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review.
abstract: OBJECTIVE
  Schistosomiasis is a major chronic disease of humans in endemic regions, and infected individuals may develop a spectrum of pathology, including hepatic fibrosis, hepatosplenomegaly, and portal hypertension. Hepatocellular carcinoma (HCC) is considered the fifth most common cancer in the world, and there is limited and controversial evidence suggesting that Schistosoma mansoni infection may be a possible risk factor for HCC. The aim of this study was to report a case series of patients with HCC and S. mansoni infection and to conduct a literature review on the topic.
  
  
  METHODS
  From January 2002 to January 2015, an institutional database was screened retrospectively to identify patients with HCC and S. mansoni infection at a single center in the Department of Gastroenterology of University of São Paulo School of Medicine and Hospital das Clínicas, Brazil.
  
  
  RESULTS
  Seven cases were included. The mean age of patients was 62.1±10.3 years; six (85.7%) were male and one (14.3%) was female. All cases had positive epidemiology, coming from endemic areas of S. mansoni infection in Brazil, and four (57.1%) had previous complications (upper gastrointestinal bleeding) related to portal hypertension or surgery intervention (splenectomy) performed more than 10 years before the HCC diagnosis. Nontumoral portal vein thrombosis was identified in five (71.4%) patients. All patients had negative serology for HCV, and four (57.1%) had positivity of HBVcore antibodies without evidence of viral replication. According to BCLC staging, one (14.3%) patient was BCLC A and received TACE instead of RFA because HCC size was >30 mm; three (42.8%) BCLC B patients received sorafenib instead of local regional treatment due to the presence of nontumoral TPV. During follow-up, all patients developed tumoral progression and died.
  
  
  CONCLUSIONS
  It remains unclear if S. mansoni infection alone has carcinogenic potential. The available literature indicates that S. Mansoni, in the presence of HBV and HCV infections, likely acts as a cofactor for the hepatic lesion and potentiates injury.
authors.affiliation: São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Karla Sawada
authors.initials: KS
authors.lastname: Toda
authors.affiliation: São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Luciana
authors.initials: L
authors.lastname: Kikuchi
authors.affiliation: São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Aline Lopes
authors.initials: AL
authors.lastname: Chagas
authors.affiliation: São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Pathology University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Ryan Yukimatsu
authors.initials: RY
authors.lastname: Tanigawa
authors.affiliation: São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Denise Cerqueira
authors.initials: DC
authors.lastname: Paranaguá-Vezozzo
authors.affiliation: São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Oncology University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Túlio
authors.initials: T
authors.lastname: Pfiffer
authors.affiliation: São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Radiology, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Manoel de Souza
authors.initials: Mde S
authors.lastname: Rocha
authors.affiliation: São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Pathology University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Venâncio Avancini Ferreira
authors.initials: VA
authors.lastname: Alves
authors.affiliation: São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Flair José
authors.initials: FJ
authors.lastname: Carrilho
keywords: Hepatocellular carcinoma; Schistosoma mansoni; Schistosomiasis