2009 Volume 50 Issue 5 Pages 238-243
Here we report a 75 y-o male with chronic hepatitis C who developed hepatocellular carcinoma (HCC) in spite of the clearance of HCV with standard interferon (IFN) therapy 13 years ago. To see if the development of HCC was related to HCV replication, we examined both positive and negative strands of HCV RNA in the liver tissue by using digoxigenin-labeled cRNA probes. The results showed negative for both strands. In 1994, he was diagnosed as chronic hepatitis C and his liver histology showed F1A1. He received standard IFN therapy for 24 weeks and became a sustained virological responder (SVR). After that, he was followed up by blood test and ultrasound (US) examination every 6 months. In Aug, 2007, he was found to have a hypoechoic tumor (1.5 cm in diameter) in segment 8 of the liver, which was compatible with HCC. Radiofrequency ablation was successfully done two months later. In Feb, 2008, liver biopsy was done again to examine progression of liver histology and the presence of positive/negative strands of HCV RNA in the liver, but the results showed F1A0, and both strands were negative. To deny the possibility of involvement of occult hepatitis B virus (HBV) in this case, we examined for HBsAg/HBV DNA in serum and liver as well as for immunostaining of HBsAg/HBcAg in the liver (regrettably not for integration of HBV DNA in HCC tissue). The results revealed all were negative, therefore we concluded this possibility was very low. The current case suggests that the aged, male patients may have a certain risk to develop HCC in spite of the clearance of HCV with therapy, even in the absence of advanced liver fibrosis or alcohol abuse, thus should be carefully followed up long after the clearance of the virus.
