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

Isamu Sano, Naoki Kawagishi, Michio Abe, Takashi Tsuchiya, Takahiro Satomi, Motonobu Arai, Takao Kunori, Syuuichi Watabe, Junzou Ito, Yukinori Sasaki, Kaori Koyama

The Department of Surgery, Iwaki Municiptal Iwakikyouritsu General Hospital

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 7l-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. HBsAg was negative and HCVAb was positive. Serum alphafetoprotein and CA19-9 were within normal limitis. Immunological examination showed slightly increased serum IgM, but AMA, ANA and ASMA 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.

Key words
precirrhotic primary biliary cirrhosis, hepatocellular carcinoma

Reprint requests
Isamu Sano GI Labs, Institute of Endocrinology, Gunma University
3-39-15 Syouwacho, Maebashi, 371, JAPAN

Accepted
June 17, 1992

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