Abstract
A case of hepatocellular carcinoma (HCC) complicating primary biliary cirrhosis (PBC) is reported. In July 1983, a 45-year-old male was found to have liver injury by a routine medical health check. The diagnosis of asymptomatic PBC was made based on findings of elevated serum alkaline phosphatase and IgM, positivity of anti-mitochondrial antibody and no clinical symptoms. The liver biopsy specimen indicated histologically compatible findings of PBC. He was followed up as an outpatient. In January 1991 he was admitted for hematoemesis caused by rupture of the esophageal varices and treated with EIS. In May 1991 elevation of alpha-fetoprotein (27ng/dl) was revealed, but HCC was not detected by abdominal US or by CT. Further, the alpha-fetoprotein level gradually increased. In January 1992 he was readmitted for hematoemesis caused by esophageal varices and EIS was performed again. However, a space occupying lesion (3 cm in diameter) was detected in the right hepatic lobe by abdominal US and CT. A markedly high value of alpha-fetoprotein was detected (3501mg/dl) . Celiac angiography revealed hypervascular lesions in the same area. These morphological examinations indicated hepatocellular carcinoma. Define TEA was performed as the treatment for HCC. The alpha-fetoprotein level decreased significantly after TAE, but his liver function gradually worsened, and he died. A relationship between chronic HCV infection and the development of HCC in PBC is suggested. However, this patient was negative for both HBV and HCV markers.
