Extrahepatic Primary Malignant Neoplasms Associated with Hepatocellular Carcinoma: High Occurrence of B Cell Tumors

Abstract

In a consecutive series of 317 patients with hepatocellular carcinoma (HCC), 32 (10.1%) had 35 extrahepatic primary malignant neoplasms (PMNs) (3 patients had triple cancers). Twenty-five PMNs occurred before the diagnosis of HCC, 7 were synchronous and 3 metachronous. These 35 PMNs were: 6 cancers of the colon, 3 of the stomach, 1 of the rectum, 4 of the breast, 2 of the lung, 1 of the larynx, 3 of the prostate, 1 of the penis, 1 of the urinary bladder, 1 of the uterus, 2 of the skin, and the remaining 10 were immunoproliferative cancers, all of B cell origin (7 non-Hodgkin’s lymphoma, 2 multiple myeloma, and 1 chronic lymphocytic leukemia). Thus, in this series, B-lymphocyte-derived neoplasms were the most frequent PMNs associated with HCC. These 10 patients showed no difference for age, male:female ratio, HCC cytotype, presence of cirrhosis, alcohol abuse, markers related to hepatitis B and C virus, and serum level of a-fetoprotein when compared with the 22 patients with HCC and other PMNs and the 285 with HCC alone. B cell neoplasms constitute half of the synchronous or metachronous cancers, and must, therefore, be kept in mind in the management of HCC patients.

Analysis of Extrahepatic Multiple Primary Malignancies in Patients with Hepatocellular Carcinoma according to Viral Infection Status

“…Genitourinary (mainly prostate) and colorectal tumors are described as the most prevalent sites in Western series [1, 5, 9, 11, 13, 15]. Previous Japanese studies consistently reported gastric cancer as the most frequent EHPM in HCC patients [2–4, 10, 14].…”

Hepatocellular carcinoma in a patient with chronic lymphocytic leukaemia involving the liver

“…Common oncogenic cellular pathways may contribute to the development of hepatocellular carcinoma and chronic lymphocytic leukaemia. The relationship between non-Hodgkin lymphoma and hepatocellular carcinoma1 2 has been published. However, no conclusions can be drawn from these studies as some of the patients reported had serology consistent with prior viral hepatitis infection, which can be associated with both types of malignancies.…”

Simultaneous Hepatic Relapse of Non-Hodgkin’s Lymphoma and Hepatocellular Carcinoma in a Patient with Hepatitis C Virus-Related Cirrhosis

“…On the other hand, an Italian study of 317 patients with HCC found B cell-derived neoplasms to represent the most frequent cancers associated with HCC, accounting for 10 of 35 extrahepatic primary neoplasms, or 28.6% [1]. Disagreement between these two reports concerning the frequency of B cell neoplasms in patients with HCC is likely to involve the difference in ethnicity between study subjects.…”

“…These were varied: 7 cases of NHL, 2 cases of multiple myeloma, and 1 chronic lymphocytic leukemia [1]. These cases also showed a relatively nonspecific distribution pattern, that of double cancers with the B cell neoplasms involving essentially any part of the body.…”

“…An Italian study reported B cell malignant diseases as the most frequent neoplasms associated with hepatocellular carcinoma (HCC) [1], but few such cases have involved colocalization of both within the liver. According to the report on the focal liver lesions detected by imaging techniques in 414 patients with non-Hodgkin’s lymphoma (NHL) [2], only 1 case presented with simultaneous coexistence with NHL and HCC.…”