Sonya Bhaskar, MD1, Kati Räsänen, MD, MSPH1, Myles R.. McCrary, MD, PhD1, Saurabh Agrawal, MD2 1University of South Florida, Tampa, FL; 2Tampa General Hospital/ University of South Florida, Tampa, FL
Introduction: Patients who undergo liver transplantation due to HCC (Hepatocellular Carcinoma) are often at a higher risk of recurrence. However, the development of de novo HCC is unusual. Here, we describe a case of newly diagnosed HCC in a post- orthotic liver transplant (OLT) patient ten years after transplant.
Case Description/Methods: Patient is a 75-year-old female with a history of hyperlipidemia who underwent OLT for cirrhosis secondary to non-alcoholic fatty liver disease ten years prior. Her explant showed no evidence of malignancy Patient was compliant with her immunosuppressive regimen. Patient presented to an outside hospital for a COVID infection and had a CT Abdomen/Pelvis without contrast which showed numerous, ill-defined and hypoattenuating masses to the liver concerning for metastatic disease versus invasive multifocal liver malignancy. She followed up with her transplant hepatology team and underwent further evaluation. MRI of her abdomen showed a large, mildly T2 hyperintense, hypo enhancing mass epicentered in the right hepatic lobe measuring 15.3 x 12.4 x 12.1 cm with multiple areas of necrosis centrally. Tumor thrombus was seen within the right and left portal veins with numerous additional of tumor deposits in segments II and III. There was no intrahepatic biliary dilatation. Patient’s AFP was 502, and her last set of liver function tests were normal. Pathology from her liver biopsy confirmed well-differentiated hepatocellular carcinoma, well- with extensive necrosis. Her case was presented at tumor board and it was recommended she follow up with oncology to start tyrosine kinase inhibitor therapy and possible liquid Transcatheter Arterial Chemoembolization (TACE). Unfortunately, the patient clinically decompensated within months of diagnosis and opted for Hospice care.
Discussion: Patients with OLTs are at a higher risk for malignancy than the general population, with skin malignancies being the most common. Even among solid tumors, HCC is not common and thus screening for HCC is only indicated for those who were transplanted for HCC or had HCC in their explanted liver. The presence of de novo occurrence of HCC is rare. It has been previously reported within 3 to 22 years post OLT but often in the setting of recurrent cirrhosis, alcohol use or history of HCC. Tyrosine kinase therapy was recommended over immunotherapy given her use of immunosuppressive medications. Our patient’s case is unusual and unfortunate as she had no prior history of HCC nor allograft fibrosis or cirrhosis.
Figure: A-B: Liver biopsy slides: Summary of path findings: The liver biopsy demonstrates trabecular-predominate effacement of normal liver architecture by a morphologically bland, neoplastic population resembling mature hepatocytes. They have mostly eosinophilic cytoplasms and occasional subtle nuclear irregularities. The lesional cells are positive for Arginase1 and HepPar1, which are specific for hepatocellular carcinoma. Cumulatively, the morphologic features and immunostaining patterns are consistent with a well-differentiated hepatocellular carcinoma. C: MRI Abdomen showing a mildly T2 hyperintense mass within the right hepatic lobe with multiple central areas of necrosis
Sonya Bhaskar indicated no relevant financial relationships.
Kati Räsänen indicated no relevant financial relationships.
Myles McCrary indicated no relevant financial relationships.
Saurabh Agrawal: Astra Zeneca – Advisor or Review Panel Member.
Sonya Bhaskar, MD1, Kati Räsänen, MD, MSPH1, Myles R.. McCrary, MD, PhD1, Saurabh Agrawal, MD2. P3886 - A Case of De Novo Hepatocellular Cancer Following Liver Transplantation, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.