Hepatocellular carcinoma associated to Behçet's disease

The occurrence of hepatocellular carcinoma (HCC) on a healthy liver is exceptional and represents a real diagnosis challenge for the clinician. Recently a particularly increased risk of cancer during Behc¸et’s disease (BD) was reported by several studies. Only a few sporadic cases of liver cancer associated with this vascultis have been reported. We report an original observation of non-fibrolamellar HCC occurring on healthy liver in a Tunisian patient followed for BD. A 43-year-old man, followed since the age of 25 for BD with isolated cutaneous and mucosal involvement, and treated by colchicine, was admitted for exploration of a pain of the right hypochondrium evolving since a few months associated with an important slimming, anorexia, and evening fever. The clinical examination noted a firm and painful hepatomegaly. Radiological exploration (ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI)) showed a bulky hepatic tumor with highly developed arterial blood supply. Ultrasound-guided biopsy concluded at HCC without signs of fibrolamellar type or cirrhosis. Biological tests were without abnormalities and specific investigations eliminated underlying chronic hepatopathy (chronic viral hepatitis B or C, hemochromatosis, Wilson’s disease or autoimmune hepatitis). The patient was treated symptomatically given the advanced stage of cancer. He quickly died after a month because of a multi-organ failure. HCC on healthy liver is exceptional and BD was suggested as a possible contributing factor. Thus, regular radiological monitoring seems to be recommended in any patient followed for BD, especially those with hepatic veins thrombosis.