Case Report
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World J Gastroenterol. Feb 28, 2014; 20(8): 2113-2116
Published online Feb 28, 2014. doi: 10.3748/wjg.v20.i8.2113
Pleomorphic hepatocellular carcinoma following consumption of hypericum perforatum in alcoholic cirrhosis
Evangeli S Lampri, Elli Ioachim, Haralampos Harissis, Eufemia Balasi, Antigoni Mitselou, Vasiliki Malamou-Mitsi
Evangeli S Lampri, Vasiliki Malamou-Mitsi, Department of Pathology, Ioannina University Medical School, 45110 Ioannina, Greece
Elli Ioachim, Eufemia Balasi, Department of Pathology, G. Hatzikosta General Hospital, 45001 Ioannina, Greece
Haralampos Harissis, Department of Surgery, Ioannina University Medical School, 45110 Ioannina, Greece
Antigoni Mitselou, Department of Forensic Pathology, Ioannina University Medical School, 45110 Ioannina, Greece
Author contributions: Lampri ES and Ioachim E designed the study; Harisis H was the attending doctor and performed the surgical operation; Malamou-Mitsi V performed the cytological examination; Lampri ES, Ioachim E, Malamou-Mitsi V, Balasi E and Mitselou A performed the pathological examinations; Ioachim E organized the case report; Lampri E wrote the manuscript.
Correspondence to: Evangeli S Lampri, MD, Department of Pathology, Ioannina University Medical School, Leoforos Stavrou Niarxou, PO Box 1186, 45110 Ioannina, Greece. evangeli.lampri@gmail.com
Telephone: +30-265-1080428 Fax: +30-265-1080428
Received: April 23, 2013
Revised: June 6, 2013
Accepted: July 17, 2013
Published online: February 28, 2014
Processing time: 309 Days and 6.9 Hours
Abstract

Hepatocellular carcinoma (HCC) often develops in patients with underlying liver disease, yet HCC with syncytial giant cells (SGCs) is extremely rare. Herein, we report a 55-year-old man with a 6-year history of alcoholic cirrhosis who during his regular checkup presented with marked elevation of alpha-fetoprotein. Clinical examination and imaging analyses revealed a tumor-like lesion in segment 4 of the liver, which was removed by limited wedge resection. Histological analysis by hematoxylin and eosin staining indicated pleomorphic and atypical nodules, with some SGCs, embedded within the boundaries of the neoplastic lesion. The adjacent liver parenchyma showed microvesicular steatosis, pericellular fibrosis, and moderate hemosiderin accumulation (grade 2, as determined by Prussian blue iron stain) in hepatocytes and Kupffer cells but no copper accumulation (as determined by orcein stain). Immunohistochemical analysis showed hepatocyte antigen-positive staining for the neoplastic cells and SGCs. The diagnosis was made for cirrhosis-related HCC with SGCs. The previous reports of pleomorphic HCC have featured osteoclast-like (i.e., mesenchymal type) giant cells, making this case of epithelial type giant cells very rare. The patient’s 6-month history of hypericum perforatum/St John’s wort self-medication may have prompted the cirrhosis or HCC progression or the unusual SGC manifestation.

Keywords: Hepatocellular carcinoma; Giant cell carcinoma; Hypericum perforatum; St John’s wort; Syncytial giant cell; Pleomorphic liver tumor; Alcoholic cirrhosis

Core tip: This case report describes the clinicopathological-based finding of an unusual hepatocellular carcinoma (HCC) with syncytial giant cells (SGCs) in a 55-year-old man with a 6-year history of alcoholic cirrhosis. Unlike the previous case reports of these rare tumor types that have demonstrated the mesenchymal and non-neoplastic nature of the giant cells, the current case showed an epithelial and hepatocyte-originated neoplasmic nature. An intriguing feature of case is the patient’s 6-month history of hypericum perforatum/St John’s wort self-medication, which may have prompted the cirrhosis or HCC progression or the unusual SGC manifestation.