Hepatocellular carcinoma associated with extrahepatic primary malignant neoplasms

Background: We studied hepatocellular carcinoma (HCC) with extrahepatic primary malignant neoplasms (EPMNs) and investigated its clinical and pathologic relevance. Method: Data from autopsies performed during the last 10 years (January 1985 to December 1994) on 146 patients with HCC were analyzed at Maebashi Red Cross Hospital. The 146 patients consisted of 116 men and 30 women ranging in age from 38 to 87 years at the time of death. Results: EPMNs were found in 21 patients: in the large bowel (6 cases), stomach (4 cases), thyroid (2 cases), urinary bladder (2 cases), small intestine (2 case), liver (1 case) and 1 case in the lung, pancreas, prostate, and breast, respectively. One patient had a malignant lymphoma in the small intestine. Ten EMPNs (47.6%) were latent or found at autopsy. The frequency of blood transfusion was significantly higher in the patients with EPMNs than in those without EPMNs. Those with EPMNs tended to be older and more likely to be male. Sixteen of the 21 patients died of liver-related causes. Two patients died of a second cancer, and 3 died of reasons other than malignancy, such as brain hemorrhage and pneumonia. Conclusion: Fully 14.4% of patients whose autopsies showed HCC had EMPNs. Survival from the time of diagnosis of HCC did not differ significantly in the patients with EPMNs. These observations suggest that EPMNs did not change the prognosis of these patients with HCC, even when their EPMNs had been detected and treated early.