Hepatocellular carcinoma in young morbid obese patients with non-alcoholic fatty liver disease
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CASE REPORT
Hepatocellular carcinoma in young morbid obese patients with non‑alcoholic fatty liver disease Maki Tobari1 · Etsuko Hashimoto2 · Makiko Taniai2 · Takayoshi Nishino1 · Katsutoshi Tokushige2 Received: 16 May 2020 / Accepted: 16 August 2020 © Japanese Society of Gastroenterology 2020
Abstract We report the two youngest cases of hepatocellular carcinoma (HCC) in non-alcoholic fatty liver disease (NAFLD) among our 119 NAFLD-HCC patients. A 36-year-old man was referred to our hospital due to a 5 cm in diameter liver tumor with elevation of α-fetoprotein and des-γ-carboxy prothrombin found at his annual health check. He had no symptoms other than 20 kg weight loss. He has been morbidly obese since he was a child. At the time of the diagnosis of NAFLD-HCC, blood chemistry showed FIB4-index 0.52, α-fetoprotein 11.1 ng/mL and des-γ-carboxy prothrombin 361 mAU/mL. He underwent curative operation. The non-cancerous lesion showed steatohepatitis with mild fibrosis. A 41-year-old man was diagnosed as having a huge liver tumor (15 cm in diameter) during medical examination for 10 kg weight loss. He had no clinical symptoms except weight loss. He has been morbidly obese since childhood. NAFLD was diagnosed at age 20. At the time of the HCC diagnosis, blood chemistry showed FIB4-index 1.42, α-fetoprotein 1974 ng/mL, and des-γ-carboxy prothrombin 82,602 mAU/mL. He underwent curative operation. We have to be aware that HCC can develop in young NAFLD patients without advanced fibrosis. Concerning tumor markers, elevation of des-γ-carboxy prothrombin was more sensitive than α-fetoprotein. Keywords Non-alcoholic fatty liver disease · Non-alcoholic steatohepatitis · Hepatocellular carcinoma · Obesity Abbreviations NAFLD Non-alcoholic fatty liver disease HCC Hepatocellular carcinoma T2D Type 2 diabetes NASH Non-alcoholic steatohepatitis MBOAT7 Membrane bound O-acyltransferase domain-containing 7 * Etsuko Hashimoto drs‑[email protected] Maki Tobari [email protected] Makiko Taniai [email protected] Takayoshi Nishino [email protected] Katsutoshi Tokushige [email protected] 1
Department of Internal Medicine and Gastroenterology, Tokyo Women’s Medical University Yachiyo Medical Center, 477‑96 Owada‑shinden Yachiyo‑shi, Chiba, Japan
Institute of Gastroenterology, Tokyo Women’s Medical University, 8‑1, Kawada‑cho, Shinjyuku‑ku, Tokyo, Japan
2
HCA Hepatocellular adenoma SH-HCC Steatohepatitic hepatocellular carcinoma AFP α-Fetoprotein DCP Des-γ-carboxy prothrombin BMI Body mass index AST Aspartate aminotransferase ALT Alanine aminotransferase γ-GT Gamma-glutamyl transpeptidase HCV Hepatitis C virus Gd-EOB-DTPA Gadolinium thoxybenzyl diethylenetriamine pentaacetic acid CT Computed tomography MRI Magnetic resonance imaging
Introduction Because of the worldwide obesity pandemic, the incidence of non-alcoholic fatty liver disease (NAFLD) has increased dramatically. Global prevalence of NAFLD is about 25% among adults [1] and is currently the leading cause of
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