2007 Volume 48 Issue 12 Pages 604-609
A 65-year-old man with a 5-year history of non-insulin dependent diabetes and hypertension was referred to our hospital for close examinations of hepatic steatosis and a tumor (40mm in diameter) in S7, suggested by ultrasonography on an occasional medical check-up. He was obese with BMI at 27.8, merely a social drinker, negative for HBsAg nor anti-HCV, and had serum values of hepato-biliary enzymes and tumor markers within normal range. Since ultrasonography and angiography confirmed the presence of the liver tumor with a diagnosis of single hepatocellular carcinoma (HCC), we performed surgical operation. The tumor was diagnosed histologically as a well to moderately differentiated HCC with trabecular pattern, while the non-canceraous areas of the liver showed only a picture of steatohepatitis without advanced fibrosis (F1, A2). With the patient's history taken together, it was most likely that a nonalcoholic steatohepatitis (NASH) was the cause of the HCC without cirrhosis in this case. The HCC recurred 82 months later, and 3 times again after that, but was treated successfully by radio-frequency ablation therapy every time, and the patient is now alive and well without any sign of recurrence. This case warrants more attention to NASH even at a stage well before developing cirrhosis of the liver.
