World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
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Case Report

Volume 4, Number 6, December 2013, pages 248-251

A Case Report of Hepatocellular Carcinoma in a Non-cirrhotic Patient With Liver Iron Overload Associated With Myelodysplastic Syndrome


Figure 1.
Figure 1. MRI. The tumor showed high intensity on T1 (a), T2 (b), and diffusion-weighted (c) images. The non-tumorous area of the liver showed prominently low intensities both on T1 and T2, indicating extensive iron deposition in the liver parenchyma. On diffusion-weighted image, the parenchyma also showed low intensity due to T2-blackout effect.
Figure 2.
Figure 2. Resected specimen. On microscopic examination, the tumor had the features of a moderately differentiated hepatocellular carcinoma with trabecular and solid patterns, surrounded by non-fibrotic liver parenchyma on the H&E staining (a). The iron stain showed an extensive intracellular iron deposition in the liver parenchyma but none in the tumor itself (b).
Figure 3.
Figure 3. Bone marrow smear. (a) Bone marrow smear showed dysplastic change of three-lineage (erythroid, myeloid, and megakaryocyte) to be diagnosed as refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS), WHO classification of MDS. (b) Ringed sideroblasts occupied 40% of erythroid precursors.
Figure 4.
Figure 4. Computed tomography. Post-operative 2 years computed tomography at portal phase showing multicentric recurrence of hepatocellular carcinoma in the liver.


Table 1. Reported Cases of HCC Associated With Secondary Hemochromatosis
Author (Journal/year)Primary diseaseAge GenderCirrhosisBlood transfusionTreatment (outcome)
MDS: myelodysplastic syndrome; RA: refractory anemia; RCMD-RS: refractory cytopenia with multilineage dysplasia and ringed sideroblasts; TACE: transarterial chemoembolization.
Barry et al (Lancet 1968)Hereditary spherocytosis64 MalePresentNoneActinomycin D (Death at age of 65)
Tomas et al (Eur J Gastroenterol Hepatol 1997)None Coalminer61 MaleAbsent Mild fibrosisNone (Iron containing water intake)Right hepatectomy (No recurrence)
Chung et al (Hepatol Res 2003)MDS (RA)40 MaleAbsent180 concentrated erythrocyte transfusionsDeferoxamine TACE (No recurrence)
Current ReportMDS (RCMD-RS)67 MaleAbsentNoneResection TACE (Progressive disease)