Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review

Karla Sawada Toda; Luciana Kikuchi; Aline Lopes Chagas; Ryan Yukimatsu Tanigawa; Denise Cerqueira Paranaguá-Vezozzo; Túlio Pfiffer; Manoel de Souza Rocha; Venâncio Avancini Ferreira Alves; Flair José Carrilho

doi:10.14218/JCTH.2015.00027

Hepatocellular Carcinoma Related to Schistosoma mansoni Infection: Case Series and Literature Review

J Clin Transl Hepatol. 2015 Dec 28;3(4):260-4. doi: 10.14218/JCTH.2015.00027. Epub 2015 Dec 15.

Authors

Karla Sawada Toda¹, Luciana Kikuchi¹, Aline Lopes Chagas¹, Ryan Yukimatsu Tanigawa², Denise Cerqueira Paranaguá-Vezozzo¹, Túlio Pfiffer³, Manoel de Souza Rocha⁴, Venâncio Avancini Ferreira Alves², Flair José Carrilho⁵

Affiliations

¹ São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Gastroenterology University of São Paulo School of Medicine, São Paulo, Brazil.
² São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Pathology University of São Paulo School of Medicine, São Paulo, Brazil.
³ São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Oncology University of São Paulo School of Medicine, São Paulo, Brazil.
⁴ São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil; Departments of Radiology, University of São Paulo School of Medicine, São Paulo, Brazil.
⁵ São Paulo Clínicas Liver Cancer Group, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, São Paulo, Brazil.

Abstract

Background and aims: Schistosomiasis is a major chronic disease of humans in endemic regions, and infected individuals may develop a spectrum of pathology, including hepatic fibrosis, hepatosplenomegaly, and portal hypertension. Hepatocellular carcinoma (HCC) is considered the fifth most common cancer in the world, and there is limited and controversial evidence suggesting that Schistosoma mansoni infection may be a possible risk factor for HCC. The aim of this study was to report a case series of patients with HCC and S. mansoni infection and to conduct a literature review on the topic.

Methods: From January 2002 to January 2015, an institutional database was screened retrospectively to identify patients with HCC and S. mansoni infection at a single center in the Department of Gastroenterology of University of São Paulo School of Medicine and Hospital das Clínicas, Brazil.

Results: Seven cases were included. The mean age of patients was 62.1±10.3 years; six (85.7%) were male and one (14.3%) was female. All cases had positive epidemiology, coming from endemic areas of S. mansoni infection in Brazil, and four (57.1%) had previous complications (upper gastrointestinal bleeding) related to portal hypertension or surgery intervention (splenectomy) performed more than 10 years before the HCC diagnosis. Nontumoral portal vein thrombosis was identified in five (71.4%) patients. All patients had negative serology for HCV, and four (57.1%) had positivity of HBVcore antibodies without evidence of viral replication. According to BCLC staging, one (14.3%) patient was BCLC A and received TACE instead of RFA because HCC size was >30 mm; three (42.8%) BCLC B patients received sorafenib instead of local regional treatment due to the presence of nontumoral TPV. During follow-up, all patients developed tumoral progression and died.

Conclusions: It remains unclear if S. mansoni infection alone has carcinogenic potential. The available literature indicates that S. Mansoni, in the presence of HBV and HCV infections, likely acts as a cofactor for the hepatic lesion and potentiates injury.

Keywords: Hepatocellular carcinoma; Schistosoma mansoni; Schistosomiasis.