Hepatocellular Carcinoma - Erler Zimmer

Hepatocellular Carcinoma - Erler Zimmer

Clinical History

A 60-year-old man is admitted with jaundice, melena, and abdominal distension, revealing a past medical history of untreated Hepatitis C infection from previous intravenous drug use. Further inquiry discloses a 9-month history of significant fatigue, weight loss, nausea, and intermittent dull right upper quadrant pain. Liver ultrasound reveals two large lesions within the liver. Unfortunately, the patient dies soon after admission from a suspected esophageal variceal hemorrhage.

Pathology

This liver specimen from the postmortem examination displays a multinodular appearance consistent with macronodular cirrhosis. The multiple nodules vary in size, reaching up to 2cm in diameter, and are separated by narrow bands of fibrous tissue. Additionally, two large round tumors are visible, measuring 8cm and 6cm in diameter, with a variegated cut surface due to focal necrosis, hemorrhage, and bile staining. This illustrates hepatocellular carcinoma that has developed on the background of a cirrhotic liver.

Further Information

Hepatocellular carcinoma (HCC) is the most common primary malignant liver cancer, arising from hepatocytes in the liver. Risk factors for developing HCC include viral infections (Hepatitis B and Hepatitis C), liver cirrhosis, aflatoxin exposure, Non-Alcoholic Fatty Liver Disease (NAFLD), hemochromatosis, and Wilson's Disease—an inherited disorder causing excessive copper accumulation in the liver, brain, and eyes. HCC incidence is highest in Asia and sub-Saharan Africa, with a higher risk in males. Acquired driver mutations in oncogenes and tumor suppressor genes, specifically gain-of-function mutations in beta-catenin and loss-of-function mutations in p53, are associated with HCC development.

Clinically, HCC can present with abdominal pain, fatigue, weight loss, abdominal fullness, and, less commonly, jaundice, gastrointestinal, or variceal bleeding. Hematogenous metastatic spread typically involves the lungs, abdominal lymph nodes, and bones. Death often results from cachexia, hemorrhage, or liver failure. Treatment varies based on the tumor stage, patient's general status, and comorbidities, including surgical resection or ablation, chemotherapy, and potentially curative liver transplantation.