De novo hepatocellular carcinoma in a non cirrhotic allograf
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Hepatocellular carcinoma recurrence after liver transplantation is a well-known complication but the development of de novo hepatocellular carcinoma in non cirrhotic allograft with no previous history of hepatic malignancy either in the donor or the recipient is extremely rare.

A 33 year old man underwent deceased donor liver transplantation due to HBV HDV cirrhosis in 1991. The donor was healthy, with negative viral serology. Pre-transplant assessment and explant liver pathology revealed no tumor. He developed an 8 cm mediastinal thymus cancer in 2014, chronic myeloid leukemia in 2015, and a 16 mm renal cell carcinoma in 2017. After 27 years, in 2018, his routine follow up sonography showed incidentally a 37 mm hepatic nodule in segment VII which revealed after percutaneous liver guided biopsy a hepatocellular carcinoma.

As no extrahepatic metastasis was noted, a segmentectomy was done. The pathological report confirmed a moderately differentiated hepatocellular carcinoma nodule of 50 mm diameter with the absence of microvascular invasion, and the non tumoral liver showed histological features of NASH (SAF score: S1A2F3, NAS score: A3F3 and LAFSc:5) with the absence of HBsAg and HBcAg.

This case emphasizes the importance of long term close surveillance by imaging of the graft even in the absence of viral recurrence and graft cirrhosis.

Journal: American journal of transplantation
Source: https://doi.org/10.1111/ajt.16476
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