Hepatocellular Carcinoma as a Rare Cause of an Excessive Increase in α-Fetoprotein during Pregnancy

Entezami, Michael; Becker, Rolf; Ebert, Andreas D.; Pritze, W; Weitzel, H.

doi:10.1006/gyno.1996.0257

Cited by 15 publications

(5 citation statements)

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“…Hepatocellular carcinoma (HCC) is rare in females of reproductive age, accounting for only 2.3% of cases in Hong Kong [1]. HCC during pregnancy is even rarer with only 32 reports in the medical literature [1–5]. Fibrolamellar HCC (FLHCC), a distinct histopathological subtype associated with a better prognosis, has only been described once during pregnancy [6].…”

Section: Introductionmentioning

confidence: 99%

Fibrolamellar hepatocellular carcinoma in pregnancy

Louie-Johnsun

Hewitt

Perera

et al. 2003

HPB

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Section: Introductionmentioning

confidence: 99%

Fibrolamellar hepatocellular carcinoma in pregnancy

Louie-Johnsun

Hewitt

Perera

et al. 2003

HPB

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“…8 Abdominal distension and raised AFP levels during pregnancy can cause diagnostic difficulty. 9 Estrogen stimulation of HCC growth is probably not a factor in our case with negative receptor staining. 10 However, caution may still be needed in advising on hormone replacement therapy in female HBV carriers after BMT.…”

Section: Discussionmentioning

confidence: 64%

Aggressive hepatocellular carcinoma complicating pregnancy after autologous bone marrow transplantation for non-Hodgkin's lymphoma

Lie

Liang

et al. 2002

Bone Marrow Transplant

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Summary:In the Asia-Pacific region, autologous and allogeneic bone marrow transplantation (BMT) in patients infected with the hepatitis B virus (HBV) may be complicated by fatal hepatic failure due to viral reactivation. Survivors may suffer from accelerated hepatitis and cirrhosis. We report the first case of hepatocellular carcinoma (HCC) after autologous BMT for mediastinal B cell lymphoma. The tumor developed rampantly during a planned pregnancy 5 years after BMT. Less than 40 cases of HCC complicating pregnancy have been reported, and outcome is invariably poor. Immunosuppression and HBV reactivation after autologous BMT, as well as immune tolerance and hormonal changes associated with pregnancy may contribute to the rapid tumor growth. Biochemical and radiological surveillance for HCC should be strengthened in HBV carriers after BMT, especially in patients with the histology of chronic liver disease, or biochemical/ virological evidence of increased HBV activity. Bone Marrow Transplantation (2002) 29, 177-179. DOI: 10.1038/sj/bmt/1703339 Keywords: autologous bone marrow transplanation; hepatitis B virus; hepatocellular carcinoma; pregnancyThe incidence of secondary malignancy is increased after bone marrow transplantation (BMT). The commonest secondary malignancy after autologous BMT is therapy-related myelodysplasia (t-MDS). 1 After allogeneic BMT, the incidence of post-transplantation lymphoma (PTLD) is also increased. 2,3 The incidence of other common solid malignancies, including lung and breast carcinoma, increase with longer follow-up of survivors. 2 Hepatocellular carcinoma (HCC) is the second commonest malignancy in the Southern Chinese (10% population hepatitis B virus (HBV) carriers). We report the first case of aggressive HCC after autologous BMT. Materials and methodsBetween 1991 and 2000, 159 and 525 consecutive autologous and allogeneic BMTs were performed at the Queen Mary Hospital. Among all marrow recipients, 23 autologous and 60 allogeneic cases were HBV carriers. 4 Their median age was 35 years (range 5-56 years), and they included 56 men and 27 women. The protocol for myeloablation and HBV chemoprophylaxis were according to the study protocol during the time periods. 5 HBV carriers were monitored by serial hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) and hepatitis B e antibody (anti-HBe), liver biochemistry, half-yearly alpha-fetoprotein (AFP) and ultrasound (USG), and quantitative serum circulating HBV DNA (Digene Capture II) assays, at 1-6 monthly interval. 6 The median overall survival of 83 HBV cases was 23 months, with an actuarial median follow-up of 115 months. There were 32 deaths, 10 due to conditioning toxicity and liver failure (Ͻday 100), 13 due to relapse, and eight due to graft-versus-host disease (GVHD). One patient died of aggressive HCC, during a rare planned pregnancy after autologous BMT. Among the other 647 BMT recipients, no other cases of a solid tumor developing after BMT have been detected to date. Case history and resultsA 29-year-old w...

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“…Detailed information on the characteristics of the individual patients is shown in Table 1 [, 11, ]. The mean age of the 48 patients was 30.2 ± 6.0 years (range 17–45 years, median 29.5 years).…”

Section: Resultsmentioning

confidence: 99%