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Case Reports
. 2013 Aug;18(8):726-30.

Indefinite antiviral therapy may be required after surgical resection for hepatocellular carcinoma complicating chronic hepatitis B

Qiang Wei  1 , Xiao Xu  1 , Qi Ling  1 , Shusen Zheng  1
Affiliations
Case Reports

Indefinite antiviral therapy may be required after surgical resection for hepatocellular carcinoma complicating chronic hepatitis B

Qiang Wei et al. J Res Med Sci. 2013 Aug.

Abstract

This report describes a 66-year-old male who had a long history of hepatitis B virus (HBV) infection. He was found hepatocellular carcinoma (HCC) 5 months after lamivudine resistance mutation and then received a successful hepatectomy. Three years later, hepatitis B envelope antigen seroconversion was achieved and nucleoside analogs were discontinued. After the withdrawn of antiviral treatment, HBV reactivated and acute-on-chronic liver failure (ACLF) occurred. Anti-HBV treatment improved the patient clinical condition. Three months after the remission of ACLF, the patient was diagnosed as HCC recurrence and received another hepatectomy. This case illustrates indefinite duration antiviral therapy and tight viral control should be performed in patients with HBV-related HCC.

Keywords: Carcinoma; hepatitis B virus; hepatocellular; recurrence; therapy.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Computed tomography (CT) scans of the primary and recurrent hepatocellular carcinoma. The liver CT scan showed a 2.6 cm × 2.4 cm mass in the segment III in 2006 (a) and two occupancies (3.0 cm × 2.2 cm and 1.5 cm × 1.3 cm) located in the right lobe of cirrhotic liver in 2010 (b)
Figure 2
Figure 2
Histopathological findings of the primary and recurrent hepatocellular carcinoma (HCC). In 2006, the patient was found a focal lesion in the segment III of liver with cirrhosis. Histopathological examination of liver tumor showed HCC with high-moderate differentiation (a, H and E, original magnification ×400). Immunohistochemical study showed alpha-fetoprotein (AFP) (+) (b, H and E, original magnification ×100), CD34 (−) and cytokeratin (CK) (−). In 2010, the patient was found two occupancies located in the right lobe of cirrhotic liver. Both tumors were confirmed by pathology as poorly differentiated HCC (c, H and E, original magnification ×400) and the immunohistochemisty showed CD34 (+) (d, H and E, original magnification ×400), AFP (−) and CK (−)
Figure 3
Figure 3
Polymerase chain reaction (PCR) results of the primary and recurrent hepatocellular carcinoma (HCC). Real-time PCR showed positive expression of covalently closed circular deoxyribonucleic acid (a) and hepatitis B virus-x genes (b) in the primary and recurrent HCC; although, the serum viral load was undetectable
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