Continuing Medical Education

Delayed presentation and diagnosis of metastatic hepatocellular carcinoma in pregnancy

Coceka Nandipha Mnyani, Jennifer Coryn Hull, Mbaliso Buntu Mbakaza, Ahmed Omar Ali Krim, Ermos Nicolaou

Abstract


Hepatocellular carcinoma (HCC) is rare in women of reproductive age. If diagnosed, the underlying cirrhosis is associated with infertility
in the majority of cases. There is limited literature on HCC in pregnancy, even more so for cases of metastatic disease. We present a case of
delayed presentation and diagnosis of metastatic HCC in pregnancy.
A 30-year-old pregnant woman presented at 23 weeks’ gestation and was diagnosed as HIV-infected, with anaemia. She was initiated on
an efavirenz-based fixed-dose combination and oral haematinics. She subsequently presented at 32 weeks’ gestation with dyspnoea, and was
diagnosed with pre-eclampsia. She was also found to have hepatosplenomegaly and ascites. She went into spontaneous preterm labour at 32
weeks and 4 days. A diagnosis of metastatic HCC was made postpartum, based on the radiological findings and biochemistry. We discuss
the challenges of diagnosing metastatic HCC in pregnancy.


Authors' affiliations

Coceka Nandipha Mnyani, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

Jennifer Coryn Hull, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

Mbaliso Buntu Mbakaza, Department of Radiology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

Ahmed Omar Ali Krim, Department of Radiology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa

Ermos Nicolaou, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa; Maternal Fetal Medicine Centre, Morningside MediClinic, Johannesburg, South Africa

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Keywords

Metastatic hepatocellular carcinoma; Pregnancy

Cite this article

South African Medical Journal 2015;105(10):877. DOI:10.7196/SAMJnew.8781

Article History

Date submitted: 2015-09-21
Date published: 2015-09-21

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