Kawaguchi Toshihiro, Ide Tatsuya, Koga Hironori, Kondo Reiichiro, Miyajima Ichiro, Arinaga-Hino Teruko, Kuwahara Reiichiro, Amano Keisuke, Niizeki Takashi, Nakano Masahito, Kuromatsu Ryoko, Torimura Takuji
Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67, Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Department of Pathology, Kurume University School of Medicine, 67, Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
Clin J Gastroenterol. 2018 Feb;11(1):69-74. doi: 10.1007/s12328-017-0789-1. Epub 2017 Oct 29.
We report on a 62-year-old man with chronic hepatitis C who developed rapidly growing hepatocellular carcinoma (HCC) after achieving sustained virological response at post-treatment week 24 (SVR 24) by direct-acting antiviral (DAA) treatment. In 2008, he failed interferon therapy at 56 years of age. He received daclatasvir plus asunaprevir for 24 weeks after confirmation of no liver tumor by abdominal ultrasonography. He had no advanced liver fibrosis. Three months after initiation of DAA treatment, a liver tumor measuring 6 mm in diameter was detected by ultrasonography and confirmed with magnetic resonance imaging. After achieving SVR 24, the tumor increased in size to 16 mm. Two months later, a tumor biopsy was performed, and histology revealed moderately to poorly differentiated HCC. The patient's alpha-fetoprotein (AFP) level was within the normal range, but the Lens culinaris agglutinin-reactive fraction of AFP level was elevated. The diameter of the tumor increased to 32 mm at 2 months after diagnosis. Lymph node metastasis in porta hepatis was found by positron emission tomography at 4 months after diagnosis. The patient received hepatic arterial infusion chemotherapy and radiation therapy, but died later. Careful monitoring is required during and after DAA treatment because HCC can grow fast even in patients with normal AFP and no advanced liver fibrosis.
我们报告了一名62岁的慢性丙型肝炎男性患者，他在接受直接抗病毒药物（DAA）治疗24周后实现了持续病毒学应答（SVR 24），但随后发生了快速生长的肝细胞癌（HCC）。2008年，他56岁时干扰素治疗失败。在腹部超声确认无肝肿瘤后，他接受了24周的达卡他韦加利匹韦林治疗。他没有晚期肝纤维化。DAA治疗开始三个月后，超声检查发现一个直径6毫米的肝肿瘤，并经磁共振成像确认。达到SVR 24后，肿瘤大小增加到16毫米。两个月后，进行了肿瘤活检，组织学显示为中分化至低分化HCC。患者的甲胎蛋白（AFP）水平在正常范围内，但AFP水平的豆凝集素反应性部分升高。诊断后2个月，肿瘤直径增加到32毫米。诊断后4个月，正电子发射断层扫描发现肝门淋巴结转移。患者接受了肝动脉灌注化疗和放射治疗，但后来死亡。DAA治疗期间及之后需要仔细监测，因为即使AFP正常且无晚期肝纤维化的患者，HCC也可能快速生长。
