title: Hepatocellular carcinoma incidentally detected at second hepatectomy for repeated colorectal liver metastasis in a patient with hepatitis C virus-related cirrhosis: a case report.
abstract: BACKGROUND
  It has been reported that liver metastasis rarely occurs in a cirrhotic/hepatitic liver. Thus, coexistence of liver metastasis and hepatocellular carcinoma has been scarcely reported. To the best of our knowledge, there are no cases with hepatocellular carcinoma, which developed during an observational period after hepatectomy for colorectal liver metastasis, in the worldwide English literature. Here we present a case of hepatocellular carcinoma which occurred during a period between the first and second hepatectomy for repeated colorectal liver metastasis.
  
  
  METHODS
  A 65-year-old Japanese woman underwent rectal resection for advanced rectal cancer. Hepatitis C cirrhosis was diagnosed at that time and antiviral therapy was offered but rejected because of socioeconomic reasons. At the age of 68, she developed two colorectal liver metastases originating from the rectal cancer, which were treated by local ablation and partial hepatectomy. At the age of 71, solitary recurrent colorectal liver metastasis was observed adjacent to the previously ablated lesion in segment 4, and thus segmentectomy 4 was performed. During surgery, a small tumor in segment 8 was incidentally identified. Taking into account her history, the tumor was considered to be recurrent colorectal liver metastasis and it was extirpated by partial hepatectomy. However, the segment 4 tumor was diagnosed as recurrent colorectal liver metastasis on the basis of histological findings and the segment 8 tumor was diagnosed as hepatocellular carcinoma. Although she had a cut surface abscess postoperatively, she was discharged from hospital 21 days after the surgery and is currently doing well 18 months after the second hepatectomy. She is currently receiving interferon and ribavirin therapy to eliminate hepatitis C virus.
  
  
  CONCLUSIONS
  If antiviral therapy was performed earlier for the present case and viral elimination was achieved, hepatocellular carcinoma might not have developed. This case reemphasizes the importance of antiviral therapy for preventing carcinogenesis of hepatocellular carcinoma in patients with viral hepatitis even if they have other cancers.
authors.affiliation: Department of Surgery, Yokohama Ekisaikai Hospital, 1-2 Yamada-cho, Naka-ku, Yokohama, 231-0036, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Surgery, Yokohama Ekisaikai Hospital, 1-2 Yamada-cho, Naka-ku, Yokohama, 231-0036, Japan. dmorioka@hotmail.com.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Morioka
authors.affiliation: Department of Surgery, Yokohama Ekisaikai Hospital, 1-2 Yamada-cho, Naka-ku, Yokohama, 231-0036, Japan.
authors.forename: Chizuru
authors.initials: C
authors.lastname: Matsumoto
authors.affiliation: Department of Surgery, Yokohama Ekisaikai Hospital, 1-2 Yamada-cho, Naka-ku, Yokohama, 231-0036, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Miura
authors.affiliation: Department of Surgery, Yokohama Ekisaikai Hospital, 1-2 Yamada-cho, Naka-ku, Yokohama, 231-0036, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Miura
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000556:secondary* / Q000601:surgery; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000209:etiology*; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D033162:Incidental Findings; D008103:Liver Cirrhosis / Q000209:etiology*; D008113:Liver Neoplasms / Q000209:etiology / Q000556:secondary* / Q000601:surgery; D059146:Metastasectomy; D012007:Rectum / Q000601:surgery
chemical_list: D000998:Antiviral Agents
keywords: Case report; Cirrhosis; Colorectal cancer; Hepatocellular carcinoma; Liver metastasis; Viral hepatitis