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Case Reports
. 2014 Feb 28;20(8):2113-6.
doi: 10.3748/wjg.v20.i8.2113.

Pleomorphic hepatocellular carcinoma following consumption of hypericum perforatum in alcoholic cirrhosis

Evangeli S Lampri  1 , Elli Ioachim  1 , Haralampos Harissis  1 , Eufemia Balasi  1 , Antigoni Mitselou  1 , Vasiliki Malamou-Mitsi  1
Affiliations
Case Reports

Pleomorphic hepatocellular carcinoma following consumption of hypericum perforatum in alcoholic cirrhosis

Evangeli S Lampri et al. World J Gastroenterol. .

Abstract

Hepatocellular carcinoma (HCC) often develops in patients with underlying liver disease, yet HCC with syncytial giant cells (SGCs) is extremely rare. Herein, we report a 55-year-old man with a 6-year history of alcoholic cirrhosis who during his regular checkup presented with marked elevation of alpha-fetoprotein. Clinical examination and imaging analyses revealed a tumor-like lesion in segment 4 of the liver, which was removed by limited wedge resection. Histological analysis by hematoxylin and eosin staining indicated pleomorphic and atypical nodules, with some SGCs, embedded within the boundaries of the neoplastic lesion. The adjacent liver parenchyma showed microvesicular steatosis, pericellular fibrosis, and moderate hemosiderin accumulation (grade 2, as determined by Prussian blue iron stain) in hepatocytes and Kupffer cells but no copper accumulation (as determined by orcein stain). Immunohistochemical analysis showed hepatocyte antigen-positive staining for the neoplastic cells and SGCs. The diagnosis was made for cirrhosis-related HCC with SGCs. The previous reports of pleomorphic HCC have featured osteoclast-like (i.e., mesenchymal type) giant cells, making this case of epithelial type giant cells very rare. The patient's 6-month history of hypericum perforatum/St John's wort self-medication may have prompted the cirrhosis or HCC progression or the unusual SGC manifestation.

Keywords: Alcoholic cirrhosis; Giant cell carcinoma; Hepatocellular carcinoma; Hypericum perforatum; Pleomorphic liver tumor; St John’s wort; Syncytial giant cell.

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Figures

Figure 1
Figure 1
Magnetic resonance imaging showed a tumor-like lesion (arrow) and ischemia in segment 4 of the liver.
Figure 2
Figure 2
Hematoxylin and eosin-staining of a representative hepatocellular carcinoma section showing the multinuclear giant syncytial cells (arrows).
Figure 3
Figure 3
Mononuclear and multinuclear carcinoma cells showed reactivity for the hepatocyte antigen (brown). Magnification × 40.
See this image and copyright information in PMC

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