Management of pregnancy-associated hepatocellular carcinoma: a case series

Abstract

INTRODUCTION: Pregnancy-associated hepatocellular carcinoma is an uncommon phenomenon and is seldom reported. Our aim was to evaluate the natural history and treatment outcome of this rare disease entity. METHODS: Between January 1992 and June 2015, five cases of HCC associated with pregnancy were referred to our centre. The management of their disease was according to treatment protocol during the time periods. Their demographics, obstetric outcome, clinico-pathological course and survival were reviewed. RESULTS: All of the ladies were diagnosed at young age (25–36 year-old). Three of them were diagnosed at their first pregnancy while two of them were diagnosed at their second pregnancy. The gestational ages at diagnosis were all late in their gestation, varied from 28 weeks to 2 weeks post-partum. All of them enjoyed good health except hepatitis B. For the disease characteristics, all of these ladies had advanced disease. Four of the ladies had multifocal disease while another had huge solitary HCC. Size of largest tumour varied from 7 to 20 cm. The alpha-fetoprotein on diagnosis were elevated, ranging from 58 ng/ml to 60500 ng/ml. Four of them had Child A cirrhosis while the other presented with Child B cirrhosis. Hepatectomy was performed for four of these patients. In all the operative specimens, the non-tumour liver histology showed no cirrhosis. Four of these patients succumbed of the disease with survival after diagnosis varied from 26 days to 35 weeks, and one patient remained recurrence-free at 6 months after operation. Another patient was still under surveillance with disease free survival more than 6 months. CONCLUSION: Pregnancy associated hepatocellular carcinoma has an aggressive tumor behavior. For women with known hepatitis B infection, screening of HCC should be advocated at the early stage of pregnancy.