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Case report
Abernethy malformation and hepatocellular carcinoma: a serious consequence of a rare disease
  1. Manuel Jaklitsch1,2,
  2. Mafalda Sobral2,
  3. Ana Maria Carvalho3 and
  4. Hugo Pinto Marques2,4
  1. 1Institut Hépato-Biliaire Henri Bismuth, Villejuif, France
  2. 2Centro Hepato-Bilio-Pancreático e de Transplantação, Hospital Curry Cabral, Lisboa, Portugal
  3. 3Pathology, Hospital Curry Cabral, Lisboa, Portugal
  4. 4Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal
  1. Correspondence to Dr Manuel Jaklitsch; manuel.jaklitsch{at}


Congenital portosystemic shunts (CPSS) are a rare vascular consequence of embryogenetic vascular alterations or the persistence of the fetal circulation elements, first described by John Abernethy in 1793 and classified by Morgan and Superina, into complete and partial portosystemic shunts. Its prevalence to this day has not been defined. We present a patient series of a 44-year-old and 47-year-old man and woman, with this rare congenital malformation and underlining hepatocellular carcinoma (HCC) treatment strategies. Over half of the individuals with CPSS have benign or malignant liver tumours, ranging from nodular regenerative hyperplasia, focal nodular hyperplasia, adenomas, HCC and hepatoblastomas. Additionally, it is known that half of individuals with Abernethy malformation type Ib will develop one or multiple types of tumours. There seems to be a direct association with tumorigenesis and CPSS, which is the primary consequence of absent portal flow. Surgery is the treatment of choice, either as a curative resection or orthotopic liver transplantation if recommended as per the criteria, in which replacing the hepatic parenchyma in the setting of an Abernathy malformation will correct the underlining hyper-arterialisation.

  • hepatic cancer
  • portal vein
  • surgical oncology
  • transplantation

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  • Contributors MJ, MS: collection of data and writing, formatting. AMC: collection of data/pathology department. HPM: editing and reviewing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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