Annals of African Medicine Annals of African Medicine Society ISSN: 1596-3519 Vol. 5, Num. 3, 2006, pp. 163-163

Annals of African Medicine, Vol. 5, No. 3, 2006, pp. 163

LETTER TO THE EDITOR

Maternal Mortality following Primary Liver Cell Cancer in Pregnancy in a Nigerian

O. U. J. Umeora, V. E. Egwatu and C. O. U. Esike

Department of Obstetrics and Gynaecology, Ebonyi State University Teaching Hospital, P.O. Box 980, Abakaliki 480001, Ebonyi State, Nigeria., E-mail: oujair@yahoo.com

Code Number: am06038

A 40-year-old Nigerian woman, gravida 4 para ³⁺⁰, presented in October 2001, when 32 weeks pregnant with 10 months history of abdominal mass and 2 months complaint of weakness, weight loss and jaundice. She did not take alcohol and had never used the contraceptive pills. She was cachectic, jaundiced and had bilateral pitting pedal oedema. Her pulse rate was 92 beats per minute and blood pressure ¹²⁰/₈₀mmHg. A hard, nodular and non-tender liver was 6 cm palpable below the right costal margin. There was moderate splenomegaly. The uterine size was compatible with a gestation of 30 weeks. There was no ascistes.

Haemoglobin estimation was 10.2g/dl, white cell count 39 x 10⁹/l, with neutrophilia, and erythrocyte sedimentation rate 165mm in the first hour. Liver function tests showed total serum bilirubin of 38.8mmol/l, conjugated serum bilirubin of 24.6 mmol/l, and moderately raised liver enzymes. The serum was negative to alpha-fetoprotein. Fasting blood sugar and serum electrolytes were essentially normal. The urine contained some bilirubin and protein but no sugar. Ultrasound examination of the abdomen showed a viable 33 week fetus, and a 6.5 x 3.2 cm echogenic mass in the left lobe of the liver.

Histology of liver specimen obtained by needle biopsy confirmed hepatocellular carcinoma. Five days after admission, she developed hepatic encephalopathy and died. The relation declined consent for perimortem caesarean section and autopsy.

Hepatocellular cancer comprises 90% of all primary liver cell cancer worldwide.¹  There is high prevalence of Hepatitis B virus carrier in Eastern Asia and sub-Saharan Africa (5-10%)¹ and this has been implicated as a major causative factor. The HBV carrier-status of the patient was not known. Other aetiological factors like alcoholism and prolonged oral contraceptive usage² which are linked to liver cirrhosis, were not contributory.

Though primary liver cancer in pregnancy is very rare,² positive association has been previously established^3,4 with risk increasing proportionately with parity^4.  Estrogens  stimulate hepatic growth, alter liver metabolism and  endogenous hormones may contribute to liver cancer development.⁴   Estrogen levels rise enormously in pregnancy.

Our patient presented with the classical features of primary liver cancer. Diagnosis was made on clinical and ultrasound findings and confirmed on histological examination of the liver biopsy specimen.

Prognosis of primary liver cancer in pregnancy is very poor. Maternal and fetal losses have remained almost 100% in reported cases.

References

1. Trichopoulos D. Etiology of primary liver cancer and the role of steroidal hormones (editorial). Cancer Cases and Controls 1992; 3:3-5
2. Egwuatu VE. Primary hepatocarcinoma in pregnancy. Trans Royal Soc Trop Med Hyg 1980; 74:793-794
3. La vecchia C, Altieri A, Franceschi S, Tavani A. Oral contraceptives and cancer: an update. Drug Safety 2001; 24:741-754
4. Hsing AW, McLaughin JK, Hoover RN, Co Chien HT, Blot WJ ,  Fraumeni JF (Jr). Parity and primary liver cancer among young women.  J Natl Cancer Inst 1992; 84:1118-1119

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