A Case of an Early Histologic Stage of Asymptomatic Primary Hillary Cirrhosis Complicated with Hepatocellular Carcinoma

Abstract

We report a very rare case of an early histologic stage of asymptomatic primary biliary cirrhosis (PBC) with hepatocellular carcinoma (HCC), in which antimitochondrial antibody (AMA) was negative. A 71-year-old man was diagnosed as having HCC in another hospital and was sent to this hospital to have an operation for HCC. During the course of illness, he complained of no symptoms and there were neither icterus nor cutaneous signs of chronic liver disease. The abdomen was soft and no masses were palpable except for a palm-sized mass in the epigastric area. The laboratory data showed high elevation levels of serum ALP, γ-GTP and LAP. HBs Ag was negative and HCV Ab was positive. Serum alphafetoprotein and CA 19-9 were within normal limitis. Immunological examination showed slightly increased serum Ig M, but AMA, ANA and AS MA were negative. Abdominal ultrasonography, CT and angiography revealed a 70 cm mass in the lateral segment of the left hepatic lobe. He underwent laparotomy and lateral segmentectomy. Histologically, the tumor was a moderately well-differentiated HCC (Edmondson II). The non-neoplastic area around the tumor showed inflammatory changes consistent with precirrhotic PBC in stage 2. The patient had an uneventful postoperative course and was doing well 20 months after surgery.