Development of hepatocellular carcinoma (HCC) in a patient with chronic hepatitis C 7 years after treatment with interferon

Background: Persistent hepatitis C virus (HCV) infection is a major risk factor for the development of HCC. A number of large-scale retrospective cohort studies have demonstrated that interferon (IFN) therapy reduces the incidence of HCC not only in sustained virological responders, but also in transient biochemical responders without the elimination of HCV. Case report: At the age of 44 ys, a man was diagnosed as having chronic hepatitis C. From 1993, he was given IFN-alpha for 48 weeks. Cessation of the therapy was followed by a biochemical and virological relapse. In 2001, ultrasonography (US) showed a small mass about 2.5cm in diameter in the right lobe of the liver, that was diagnosed as HCC. In 2001, the tumor was removed by surgical segmentectomy. Histology revealed a well-differentiated HCC, with precirrhotic chronic hepatitis in the surrounding liver tissue. Postoperatively, the oncological follow-up with serial US and CT scans revealed no recurrence of the tumor. As the patient exhibited high serum iron and transferrin saturation levels, between 2002 and 2004 he underwent serial phlebotomies for iron depletion. The patient has now been tumor-free for 3 years. Since January 2004, he has been on a novel antiviral therapy with a combination of peginterferon plus ribavirin. Conclusion: Although treatment with IFN may statistically decrease the incidence of HCC in chronic hepatitis C, it cannot perfectly prevent its development, especially in virologically non-responsive cases. Therefore, a regular follow-up of these pts, with monitoring of alpha-fetoprotein and abdominal US, should be recommended for detecting the possible appearance of HCC in an early stage.