Jaundice in a pregnant woman

Acta Gastroenterol Belg. 2017 Jul-Sep;80(3):422-424.

Abstract

A 34-year-old woman in the 22nd week of gestation presented with generalized pruritis and weight loss since the first trimester of pregnancy. Physical examination revealed cutaneous scratch lesions, jaundice, and hepatomegaly. Blood tests revealed cholestasis with elevated direct bilirubinemia. Auto-antibody and viral hepatitis tests were negative. Liver ultrasound was normal. The initial diagnosis was cholestasis of pregnancy. However despite treatment with ursodeoxycholic acid, the patient did not improve. Delivery was by cesarean section at the 26th week of pregnancy for obstetrical reasons. A new liver ultrasound showed a heterogeneous nodular mass. Nuclear magnetic resonance (NMR) of the liver showed an 11-cm mass centered on the hilum, dilated intrahepatic bile ducts, involvement of the hepatic veins, and hilar adenopathy. A liver biopsy revealed fibrolamellar hepatocellular carcinoma (FHC).

Keywords: pregnancy and fibrolamellar hepatocellular carcinoma (FHC).

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Bilirubin / blood
  • Carcinoma, Hepatocellular* / pathology
  • Carcinoma, Hepatocellular* / physiopathology
  • Cesarean Section / methods
  • Diagnosis, Differential
  • Female
  • Gestational Age
  • Hepatomegaly / diagnosis
  • Humans
  • Jaundice* / diagnosis
  • Jaundice* / etiology
  • Liver* / diagnostic imaging
  • Liver* / pathology
  • Magnetic Resonance Spectroscopy / methods
  • Pregnancy
  • Pregnancy Complications, Neoplastic* / pathology
  • Pregnancy Complications, Neoplastic* / physiopathology
  • Pruritus / diagnosis
  • Ultrasonography / methods

Substances

  • Bilirubin

Supplementary concepts

  • Fibrolamellar hepatocellular carcinoma