Obstetrics & Gynaecology Forum Volume 29 | Issue 3 | 2019

O&G Forum 2019; 29: 29 - 30 CASE REPORT T.D. Naidoo 1 , L. Govender 1 , R.R. Green-Thompson 1 1 Discipline of Obstetrics and Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa Hepatocellular carcinoma in pregnancy: A case report and evaluation of current management trends Abstract Background: Hepatocellular carcinoma (HCC) is one of the leading global causes of mortality. However, it is rarely seen in pregnancy. The prognosis of HCC in pregnant women is relatively poor for both mother and child. Case: We present a case of a 36 year old woman at 36 weeks of gestation with jaundice and hepatomegaly. She was hepatitis B positive. The patient delivered a neonate of 2.040kg, however her condition worsened. She was subsequently diagnosed with HCC and became severely jaundiced, hypotensive and tachycardic with metabolic acidosis. Conclusion: HCC was diagnosed late in gestation and the patient had a poor outcome. Early diagnosis and management of HCC may have resulted in a better prognosis. Keywords: Hepatocellular carcinoma, Pregnancy, Jaundice, Hepatomegaly, Hepatitis Introduction Hepatocellular carcinoma (HCC) in pregnancy is extremely rare, 1-6 and may be due to a combination of factors including; a higher incidence among men, a rarity in women of reproductive age, and reduced fertility in women with advanced cirrhosis. 1, 2, 3, 6, 7 It is unclear whether pregnancy adversely a ects the prognosis of HCC, or whether HCC during pregnan- cy is di erent from HCC in non-pregnant women. 1-5, 7 e lack of symp- toms in the initial stages usually renders the tumour beyond therapy at presentation. 4, 5 We present such a case of HCC diagnosed late in gestation. Case Report A 36 year old in her 3 rd pregnancy at 36 weeks of gestation presented to our tertiary centre, with jaundice, hepatomegaly and ultrasound (US) findings of hepatomas of 7.3cm in the right lobe and 2.5cm in the left lobe. She gave a history of yellowish discoloration of the sclera of 2 days duration and right upper quadrant (RUQ) pain of 4 days dura- tion. Clinically she appeared jaundiced, with a BP of 136/74mmHg, temperature of 35.3̊C, pulse of 70 beats per minute and tenderness over the RUQ. Obstetric examination revealed an active foetus pre- senting cephalic with a symphysis-fundal height of 32cm. She was assessed as having acute hepatitis with a hepatoma, ad- mitted to our high care unit and managed in conjunction with the hepato-billiary team. The results of lab investigations were as fol- lows: The full blood count (FBC) showed a haemoglobin of 13.7, white cell count of 11.8 and platelets of 342. The liver function tests (LFTs) were consistent with liver impairment, with derangement in TB 145, DB 88, AST197, ALT86, ALP315, and LDH1161. The al- pha-feto protein (AFP) was 340 209. Hepatitis screen revealed hep- atitis B virus (Hep B) core antibody positive, hepatitis A virus (Hep A) IgM negative and hepatitis C virus (Hep C) negative. Three days later she had a precipitous labour, delivering a 2.040kg neonate with reassuring apgar scores and no post-delivery obstetric complications. On day 0 post-delivery, the patient’s jaundice wors- ened. Repeat US showed distorted liver architecture and a large lob- ulated mass containing multiple lesions varying in size from 13mm Correspondence Dr T.D. Naidoo email: Thinagrin.naidoo@kznhealth.gov.za OBSTETRICS & GYNAECOLOGY FORUM 2019 | ISSUE 3 | 29