Ann Liver Transplant.  2021 Nov;1(2):194-201. 10.52604/alt.21.0017.

Fifteen-year-long journey with hepatocellular carcinoma from diagnosis during pregnancy to recurrence after liver transplantation: A case report of intractable tumor recurrence

• Hwang S
• Jung DH
• Ha TY

• KMID: 2560872
• DOI: http://doi.org/10.52604/alt.21.0017

Abstract

Hepatocellular carcinoma (HCC) during pregnancy is very rare and reported to be associated with inferior prognosis. We herein present a case of a patient who was diagnosed with HCC at the age of 26 years during pregnancy. The patient was infected with hepatitis B virus through vertical transmission. After full-term vaginal delivery, the patient underwent transarterial chemoembolization (TACE) twice and right hepatectomy consecutively. One year later, TACE was repeated and second hepatectomy was performed. Four years later, TACE was repeated and third hepatectomy was performed. Two years later, TACE was repeated and fourth hepatectomy was performed. Two years later, HCC recurred around the left hepatic duct and external beam radiotherapy was performed. Subsequently, biliary stenosis occurred, thus endoscopic retrograde biliary drainage tube was inserted. One year later, her liver function deteriorated with tumor progression and portal vein occlusion. The patient underwent deceased donor liver transplantation using an HBsAg-positive whole liver graft. At posttransplant 6 months, pulmonary metastasis occurred, which was managed with pulmonary metastasectomy twice and radiotherapy. The patient passed away 20 months after transplantation because of HCC progression. The patient had suffered from HCC for 15 years, in which she underwent hepatectomy four times, TACE 10 times, liver transplantation, pulmonary metastasectomy twice, and radiotherapy three times. The patient demonstrated unusual long-term intractable course of HCC recurrence refractory to various locoregional treatments.

Keyword

Pregnancy; Locoregional treatment; Repeat hepatectomy; Liver transplantation; Metastasectomy