Hepatocellular Carcinoma in Two Patients with Autoimmune Hepatitis, A Single Center Experience and Review of the Literature

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The coincidence risk of autoimmune hepatitis (AIH) and hepatocellular carcinoma (HCC) in the absence of viral hepatitis is extremely low and most of the previous reports have been isolated case reports (1). Meanwhile, most of the previous cases have been reported before HCV screening and it is believed that some of them were secondary to HCV co-pathogenesis (2). Therefore, HCC is a rare sequel of AIH, and an incidence of about 1% has been reported from different geographic areas (3). Herein we report our experience in two female patients aged 35 and 39 with AIH and cirrhosis, who affected by HCC. Case No. 1 was diagnosed as AIH in 2005. She was admitted in the liver transplant list. Alpha-fetoprotein (AFP) level was 4.4 ng/mL (normal < 5 ng/mL). Routine work up for the liver transplantation was started. Magnetic resonance imaging (MRI) demonstrated a contrast enhancing lesion with the diameter of 3.5 cm (Figure 1). Liver biopsy showed well differentiated HCC. She was successfully transplanted, the explanted liver showed cirrhosis and a well-defined 3.5 cm single nodule in the right lobe. She had an uneventful postoperative period and now after two years, she is in a good condition without HCC recurrence. Case No. 2 was diagnosed as AIH in 2003, She was admitted in the liver transplant list. She was considered in the liver transplant waiting list. Alpha-fetoprotein (AFP) level was 14.2 ng/mL. Magnetic resonance imaging (MRI) demonstrated a contrast enhancing lesion with the diameter of 3.5 cm. Liver biopsy showed well differentiated HCC. She was successfully transplanted, the explanted liver showed cirrhosis and two well-defined nodules in the right lobe, 3X3X2.5 cm and 1X1x1 cm. Both of the nodules were well differentiated hepatocellular carcinoma and