Hepatocellular carcinoma associated with sarcoidosis

Abstract

Introduction: The association of hepatic sarcoidosis with hepatocellular carcinoma (HCC) is considerably rare. Here we report a rare case of HCC associated with sarcoidosis.

Presentation of case: A 75-year-old male with no history of alcohol addiction or viral hepatitis was referred to our hospital because of an abnormal liver mass. Subsegmentectomy of the liver was performed for the diagnosis of HCC. A histopathological examination revealed small non-necrotizing granulomas with a tendency to coalesce that were scattered in and around the carcinoma. No features of cirrhosis, steatohepatitis, and any other liver diseases were observed. Furthermore, swelling of the bilateral lung hilar lymph nodes with uptake of 18F-fluorodeoxyglucose was found on positron emission tomography/computed tomography and the tuberculin reaction test results were negative. On the basis of these findings, the final diagnosis of HCC associated with sarcoidosis was confirmed.

Discussion: By reviewing previous cases, we found only five cases that described patients diagnosed with HCC associated with sarcoidosis. Of these, four patients died within two years after diagnosis because of ruptures or inoperable huge tumors. In contrast, radical hepatectomy was performed at an earlier stage of disease in two patients, including ours, and both these patients have remained healthy with no recurrences or metastases at the latest follow-up visit.

Conclusion: Periodic checkups of the liver should be conducted for patients with systemic sarcoidosis, regardless of the presence of liver cirrhosis.

Keywords: Hepatocellular carcinoma; Liver; Sarcoidosis.

Fig. 1

(A, B) Abdominal computed tomography revealed a hypervascular tumor with washout of contrast-medium. A mass located in the right posterior section of the liver. (C) The tumor showed no gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) uptake on hepatocyte-phase images obtained by Gd-EOB-DTPA magnetic resonance imaging.

Fig. 2

(A) A resected solid encapsulated tumor is macroscopically evident. (B) Tumor cells grown in cords of variable thicknesses with bile plugs. Small non-necrotizing granulomas with a tendency to coalesce scattered in the carcinoma (arrow; H&E, ×4). (C) Small non-necrotizing granulomas in the carcinoma were observed at a higher magnification (H&E, ×40). (D) Small non-necrotizing granulomas were also observed in the background liver (arrow; H&E, ×4). (E) Small non-necrotizing granulomas in the background liver were observed at a higher magnification (H&E, ×40). (F) A slight degree of fibrosis can be seen around the portal areas (Azan stain, ×4).

Fig. 3

Swelling of the bilateral lung hilar lymph nodes with uptake of 18F-fluorodeoxyglucose observed on positron emission tomography/computed tomography.