Resected Hepatocellular Carcinoma in a Patient with Crohn's Disease on Azathioprine

Valérie Heron, Kyle Joshua Fortinsky, Gillian Spiegle, Nir Hilzenrat, Andrew Szilagyi

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Hepatocellular carcinoma rarely occurs in patients without underlying cirrhosis or liver disease. While inflammatory bowel disease has been linked to certain forms of liver disease, hepatocellular carcinoma is exceedingly rare in these patients. We report the twelfth case of hepatocellular carcinoma in a patient with Crohn's disease. The patient is a 61-year-old with longstanding Crohn's disease who was treated with azathioprine and was found to have elevated liver enzymes and a new 3-cm liver mass on ultrasound. A complete workup for underlying liver disease was unremarkable and liver biopsy revealed hepatocellular carcinoma. The patient underwent a hepatic resection, and there is no evidence of recurrence at the 11-month follow-up. The resection specimen showed no evidence of cancer despite the initial biopsy revealing hepatocellular carcinoma. This case represents the third biopsy-proven complete spontaneous regression of hepatocellular carcinoma. Although large studies have failed to show a definite link between azathioprine and hepatocellular carcinoma, the relationship remains concerning given the multiple case reports suggesting a possible association. Clinicians should exercise a high degree of suspicion in patients with Crohn's disease who present with elevated liver enzymes, especially those on azathioprine therapy.

Original languageEnglish
Pages (from-to)50-56
Number of pages7
JournalCase Reports in Gastroenterology
Issue number1
StatePublished - 1 Jan 2016
Externally publishedYes


  • Azathioprine
  • Crohn's disease
  • Hepatocellular carcinoma
  • Spontaneous regression

ASJC Scopus subject areas

  • Gastroenterology


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