Hepatocellular carcinoma in pregnancy

In nonpregnant women, the majority of neoplastic liver masses are malignant. On the contrary, liver masses identified during pregnancy are more commonly benign. Hepatocellular carcinoma (HCC) in pregnancy is very rare. There are only 37 reported cases of (HCC) in pregnancy [1–3]. Risk factors for HCC include hepatitis B virus (HBV) or HCV infections, aflatoxin exposure, cirrhosis, alcohol abuse, metabolic liver disease, carcinogen exposure, steroids, and male gender [4]. Relevant for this chapter, there is a report of association between high parity, HBsAg carriers, oral contraceptives, and HCC. Detailed medical history and the level of serum a-fetoprotein (AFP) may be helpful as screening tools [5–7]. Diagnosis Most patients complain of right upper quadrant pain or distention and weight loss. An irregular liver mass together with excessively high serum AFP levels are suggestive of HCC [8]. AFP may also be used for screening HCC in high-risk pregnant women. Liver sonography and/or magnetic resonance imaging together with fine liver aspiration are used for definitive diagnosis during pregnancy [5,9]. Treatment These imaging methods and measures (liver sonography and/or magnetic resonance imaging together with fine liver aspiration) are also used for staging. Partial hepatectomy is the treatment of choice [6]. The choice of aggressive approach is based on anatomical and surgical considerations, and tumor spread. Prognosis Although a shorter median survival for pregnant women with HCC has been suggested, the small number of published cases precludes any firm conclusions. Two case reports of HCC diagnosed in the second trimester reported favorable outcomes for both mother and child [6,10].