Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 7, 2009; 15(5): 578-582
Published online Feb 7, 2009. doi: 10.3748/wjg.15.578
Hepatocellular carcinoma in patients with autoimmune hepatitis
Andreas Teufel, Arndt Weinmann, Catherine Centner, Anja Piendl, Ansgar W Lohse, Peter R Galle, Stephan Kanzler
Andreas Teufel, Arndt Weinmann, Catherine Centner, Anja Piendl, Peter R Galle, Stephan Kanzler, Department of Medicine I, Johannes Gutenberg University, Mainz 55101, Germany
Ansgar W Lohse, Department of Medicine I, University of Hamburg, Hamburg 22527, Germany
Author contributions: Teufel A, Lohse AW, Galle PR, Kanzler S treatment of patients, analysis of patients’ records, preparation of manuscript; Weinmann A, Centner C, Piendl A analysis and documentation of patients’ records.
Correspondence to: Stephan Kanzler, MD, Leopoldina-Krankenhaus, Gustav-Adolf-Str. 8, Schweinfurt 97422, Germany.
Telephone: +49-9721-7202482
Fax: +49-9721-7202482
Received: April 25, 2008
Revised: June 29, 2008
Accepted: July 6, 2008
Published online: February 7, 2009

AIM: To evaluate and confirm the low incidence of hepatocellular carcinoma (HCC) in patients with autoimmune hepatitis (AIH). At present only very few cases of HCC in patients with AIH and definite exclusion of chronic viral hepatitis have been published, suggesting that HCC due to AIH is rare.

METHODS: In order to further investigate the incidence of HCC in patients with AIH, we reviewed our large cohort of 278 patients with AIH.

RESULTS: Eighty-nine patients (32%) were diagnosed with liver cirrhosis, a preneoplastic condition for HCC. We studied a total of 431 patient years of cirrhosis in these patients, an average 4.8 years per patient. During this period none of the patients of our own study cohort developed HCC. However, three patients with HCC due to AIH associated liver cirrhosis were referred to our department for further treatment of HCC. In all three patients chronic viral hepatitis was excluded.

CONCLUSION: We conclude that HCC may under rare circumstances develop due to chronic AIH dependent liver cirrhosis. Compared to other causes of liver cirrhosis such as chronic viral hepatitis, alcohol, or hemochromatosis, the incidence of HCC is significantly lower. Pathophysiological differences between AIH and chronic viral hepatitis responsible for differences in the incidence of HCC are yet to be further characterized and may lead to new therapeutic concepts in prevention and treatment of liver cancer.

Keywords: Autoimmune hepatitis, Hepatocellular carcinoma, Hepatic C virus, Hepatic B virus, Liver cirrhosis