Question

A 55-year-old man from Southeast Asia is visiting his son in the U.S. for several months. While in the United States, he loses weight and starts to develop abdominal pain, anorexia, and ascites. His son takes him to the family doctor. On physical examination, ascites is present and his liver is enlarged. Interestingly, he is not jaundiced. Additional laboratory results are as follows:

TEST RESULTS REFERENCE RANGE
SGOT 134 IU/L 5-40 IU/L
SGPT 121 IU/L 5-35 IU/L
bilirubin (total) 2.8 mg/dL 0.2-1.5 mg/dL
alkaline phosphatase 113 U/L 20-70 U/L

A liver biopsy is done, and he is found to have hepatocellular carcinoma. Which of the following is most often associated with the development of hepatocellular carcinoma?

1. Clonorchiasis
2. Macadamia nuts
3. Aflatoxins
4. Arsenic
5. Opisthorchis viverrini

Answer 1

Both aflatoxins (3) and Opisthorchis viverrini (5) are associated with the development of hepatocellular carcinoma (HCC). Aflatoxins cause genetic mutations that increase cancer risk, while Opisthorchis viverrini infection leads to chronic biliary inflammation and increased likelihood of HCC.

Step-by-step explanation:

Factors Associated with the Development of Hepatocellular Carcinoma

The development of hepatocellular carcinoma (HCC) is most often associated with a variety of risk factors. The scenario described suggests the man has developed HCC without any signs of jaundice, which is a common symptom of liver disease. In this particular case, if we are to consider his region of origin (Southeast Asia) and look at the options provided, certain environmental risk factors are known to be prevalent.

Aflatoxins(3), which are toxins produced by certain species of Aspergillus fungi, often found in improperly stored food products, are one of the leading risks for developing HCC. Long-term exposure can lead to mutation in the TP53 tumor suppressor gene, among others, increasing the risk of liver cancer.

Furthermore, infections with certain parasites such as Opisthorchis viverrini(5), a liver fluke endemic to the region, are associated with chronic biliary inflammation and periductal fibrosis, which can also lead to an increased risk of cholangiocarcinoma, a type of HCC. Chronic infection with this parasite can significantly augment the likelihood of developing HCC.

In summary, among the given options, both aflatoxins exposure and Opisthorchis viverrini infection are significantly associated with the development of hepatocellular carcinoma, with aflatoxins being a widespread problem linked to food contamination, and Opisthorchis viverrini being specific to certain geographic regions, like Southeast Asia, where the man is from.