Hepatocellular carcinoma in pregnancy

Chronic Liver Disease in the Obstetric Patient

Chronic liver disease in pregnancy is rare. Historically, many chronic liver diseases were considered contraindications to pregnancy; however, with current monitoring and treatment strategies, pregnancy may be considered in many cases. Preconception and initial antepartum consultation should focus on disease activity, medication safety, risks of pregnancy, as well as the need for additional monitoring during pregnancy. In most cases, a multidisciplinary approach is necessary to ensure optimal maternal and fetal outcomes. Despite improving outcomes, pregnancy in women with the chronic liver disease remains high risk.

Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report

Background

Hepatocellular carcinoma (HCC) during pregnancy is extremely rare. Treatment strategies for cancers detected during pregnancy have been controversial. We herein report a case of recurrent HCC detected at 20 weeks of pregnancy, which subsequently prompted hepatic resection after abortion.

Case presentation

A 36-year-old woman underwent laparoscopic partial hepatectomy for HCC (20 mm in diameter) in segment 5 of the liver during follow-up after being determined as a hepatitis B virus carrier two and a half years ago. Post-surgery follow-up abdominal ultrasonography revealed a 36-mm tumor in segment 7 of the liver. Abdominal contrast-enhanced computed tomography revealed a well-enhanced tumor with a 40-mm diameter in segment 7 adjacent to the inferior vena cava and right hepatic vein, suggesting HCC recurrence. Laboratory data revealed total bilirubin (0.4 mg/dL), aspartate aminotransferase (28 IU/L), alanine aminotransferase (30 IU/L), glutamyltransferase (16 IU/L), prothrombin time (115.3%), and indocyanine green retention rate at 15 min (7.0%). α-Fetoprotein (AFP) (12,371.5 ng/mL; normal range < 10 ng/mL) and PIVKA-II (208 mAU/mL; normal range < 40 mAU/mL) were both significantly elevated. After discussions with a cancer board consisting of experts from the departments of gastroenterology, obstetrics and gynecology, and surgery, as well as obtaining appropriate informed consent from the patient and her family, we decided to perform a hepatic resection after abortion. Subsequently, abortion surgery was performed at 21 weeks and 2 days of pregnancy. After 6 days, subsegmentectomy of liver segment 7 was performed under general and epidural anesthesia, with a pathological diagnosis which was moderately differentiated HCC being established. Given the good postoperative course, without particular complications, the patient was subsequently discharged 10 days after the operation. Approximately 2 years after the surgery, the patient remains alive without recurrence, while both AFP and PIVKA-II were within normal limits.

Conclusions

Treatment strategies for HCC detected during pregnancy remain controversial. As such, decisions should be made based on HCC growth and fetal maturity after thorough multidisciplinary team discussions and obtaining appropriate informed consent from the patient and her family.

Novel treatment strategy with radiofrequency ablation and surgery for pregnant patients with hepatocellular carcinoma: a case report

Background

Hepatocellular carcinoma (HCC) during pregnancy is rare, with a poor prognosis. Recently, however, increasing resection rates have improved survival rate. Currently, various surgeries are safely performed after the second trimester and termination of pregnancy is not always necessary. However, surgery is sometimes limited by gestational age or the patient’s will. When patients with HCC refuse surgery during pregnancy, we face specific problems with respect to curability and fetal life.

Meanwhile, previous studies have revealed radiofrequency ablation (RFA) as a possible alternative to surgery for the treatment of early HCC and shown its favorable local control rate for advanced HCC. However, no case of HCC treated with RFA during pregnancy has yet been reported.

Case presentation

Here, we present the case of a 33-year-old woman, who was a hepatitis B virus carrier. The patient had been followed up because HBV carrier could develop hepatitis or HCC. And she was diagnosed with a 40-mm HCC tumor at 17 weeks of gestation. She refused surgery because she was pregnant and wanted to continue her pregnancy; therefore, we performed RFA for the local control of her HCC at 17 weeks of gestation and radical surgery at postpartum. She delivered a healthy baby and has survived without recurrence for 6 years after the surgery.

Conclusions

Surgery is potentially a curative treatment for HCC whether the patient is pregnant or not. However, various problems unique to pregnancy make it difficult to perform a straightforward surgery. Our case revealed that RFA can be safely performed in pregnant patients during the second trimester, and the combination of RFA and surgery can radically increase the resection rate of HCC during pregnancy.