A case of liver cirrhosis type B accompanied by hepatocellular carcinoma under lamivudine and adefovir treatment

• Published in: Kanzo Vol. 48; no. 9; pp. 429 - 438
• Main Authors: Nambu, Shuji, Terasaki, Teiichi, Atarashi, Yoshinari, Matsui, Kazuhiro, Tsukada, Kazuhiro
• Format: Journal Article
• Language: Japanese
• Published: The Japan Society of Hepatology 2007
• Subjects: adefovir; hepatocellular carcinoma; lamivudine; liver cirrhosis type B
• ISSN: 0451-4203; 1881-3593
• DOI: 10.2957/kanzo.48.429

A 56 year-old male with liver cirrhosis type B started lamivudine (LMV) treatment against acute exacerbation of the hepatitis on March in 2002. Although his liver function improved, LMV-resistant HBV appeared, leading to breakthrough hepatitis on November in 2002. Administration of adefovir dipivoxil (ADV) in combination with LMV began on January in 2003. Since then, HBV DNA levels in his serum gradually decreased to less than measurement sensitivity and his liver function improved. On September in 2003, namely 18 months and 8 months after starting LMV monotherapy and the combination treatment respectively, he developed a small HCC and underwent resection of the HCC on November. Histologically, the tumor tissue was composed of moderately differentiated HCC, and the non-tumor tissue showed liver cirrhosis with mild inflammation. HBsAg and HBcAg were immunohistochemically detected not only in normal hepatocytes but also in HCC cells. He has taken LMV and ADV continuously and been alive without recurrence for more than three years after the surgery. This case suggests that it is important to pay attention to development of HCC in patients with liver cirrhosis type B under nucleotide analogues administration, even if their blood HBV DNA concentrations are continuously less than measurement sensitivity, leading to improvement of their liver functions.