Development of a hepatocellular carcinoma in a chronic hepatitis C patient 18 years after achieving a sustained virological response to interferon therapy: case report and literature review

We report on a chronic hepatitis C patient who developed hepatocellular carcinoma (HCC) 18 years after achieving a sustained virological response (SVR) to interferon therapy. We also review other reports of patients who developed HCC a long time after interferon therapy. The patient was a 67-year-old man with chronic hepatitis C who achieved an SVR to interferon therapy at the age of 49 years in 1992. Eighteen years later, however, a tumor measuring 19 mm in diameter in segment 7 of the liver was found by abdominal ultrasound. The tumor had a typical HCC enhancement pattern by dynamic computed tomography. A moderately to poorly differentiated HCC was confirmed by fine-needle aspiration biopsy. Fibrosis and inflammation in the liver parenchyma improved pathologically from F3A2 to F2A1 according to the New Inuyama Classification. Liver steatosis remained after achieving an SVR and the serum alanine aminotransferase level was persistently slightly elevated. The HCC was treated by transcatheter arterial chemoembolization combined with radiofrequency ablation. Patients with chronic hepatitis C who have achieved an SVR to interferon therapy, and those who have risk factors for the development of HCC, such as being male, of advanced age (<50 years is rare), or with progressive liver fibrosis and steatosis as a hepatic manifestation of metabolic syndrome, should undergo careful long-term follow-up.