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Onzi et al. Hepatoma Res 2019;5:7 Hepatoma Research
DOI: 10.20517/2394-5079.2018.114

Case Report Open Access

Hepatocellular carcinoma in non-alcoholic fatty liver
disease with and without cirrhosis

Georgia Onzi , Fernanda Moretti , Silvana Sartori Balbinot , Raul Angelo Balbinot , Jonathan Soldera 2
1
1
2
2
1 Internal Medicine, Hospital Geral, Universidade de Caxias do Sul, Caxias do Sul 95084-180, Brazil.
2 Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95084-180, Brazil.
Correspondence to: Prof. Jonathan Soldera, Clinical Gastroenterology, Universidade de Caxias do Sul, Vereador Mario Pezzi Av., 699/601,
Caxias do Sul 95084-180, Brazil. E-mail: jonathansoldera@gmail.com

How to cite this article: Onzi G, Moretti F, Balbinot SS, Balbinot RA, Soldera J. Hepatocellular carcinoma in non-alcoholic fatty liver
disease with and without cirrhosis. Hepatoma Res 2019;5:7. http://dx.doi.org/10.20517/2394-5079.2018.114

Received: 12 Dec 2018 First Decision: 8 Jan 2019 Revised: 14 Jan 2019 Accepted: 15 Jan 2019 Published: 11 Mar 2019

Science Editor: Guang-Wen Cao Copy Editor: Cui Yu Production Editor: Huan-Liang Wu

Abstract
Non-alcoholic fatty liver disease has become the leading chronic liver disease in the developed world, with a prevalence
of 6%-35%. Its pathological spectrum ranges from simple steatosis (non-alcoholic fatty liver) to different degrees of
inflammation and liver cell damage [non-alcoholic steatohepatitis (NASH)]. NASH has gained attention in recent years
because of its association with hepatocellular carcinoma (HCC). Although the occurrence of HCC is more frequent in the
presence of cirrhosis, studies have shown that hepatic carcinogenesis may also develop in the context of NASH without
association with advanced fibrosis, as well as from simple steatosis. Evidence of the onset of HCC in the absence of
cirrhosis is of concern, since recent surveillance and screening guidelines for liver cancer do not include this population
subgroup. Therefore, it is imperative that new effective screening and monitoring measures for HCC, or even the
reformulation of these recommendations, be taken to handle these patients considered to be at high risk. The present
paper aims to review the literature on the occurrence of HCC in patients with NASH with or without cirrhosis. In addition,
we report a case showing the development of HCC in a patients with NASH without cirrhosis.

Keywords: Non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma

INTRODUCTION
Non-alcoholic fatty liver disease (NAFLD) is the leading cause of liver disease in the world and its
pathological spectrum ranges from simple steatosis [non-alcoholic fatty live (NAFL)] to various degrees of
[1-4]
inflammation and liver cell damage, a condition known as non-alcoholic steatohepatitis (NASH) . The

© The Author(s) 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0
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