PT  - JOURNAL ARTICLE
AU  - Kohtaro Ooka
AU  - Ifeyinwa Onyiuke
AU  - Xuchen Zhang
AU  - Tamar Hamosh Taddei
TI  - Protective altruistic phlebotomy: hereditary haemochromatosis presenting as hepatocellular carcinoma in a non-cirrhotic 83-year-old man
AID  - 10.1136/bcr-2016-216649
DP  - 2016 Sep 02
TA  - BMJ Case Reports
PG  - bcr2016216649
VI  - 2016
4099  - http://casereports.bmj.com/content/2016/bcr-2016-216649.short
4100  - http://casereports.bmj.com/content/2016/bcr-2016-216649.full
AB  - Hereditary haemochromatosis is a multisystem disorder of iron metabolism. Hepatic manifestations include hepatomegaly, cirrhosis and hepatocellular carcinoma. Hepatocellular carcinoma is almost always preceded by cirrhosis. We present a case of an 83-year-old man without history of liver disease or iron overload who presented with abdominal pain. Workup revealed mildly elevated transaminases, ferritin of 3996 and a solitary liver tumour. Biopsy was consistent with hepatocellular carcinoma in a background of haemosiderosis without cirrhosis. He was diagnosed with hereditary haemochromatosis and hepatocellular carcinoma. He underwent a partial hepatectomy and was started on routine phlebotomy and surveillance imaging. He has improved and has not had signs of recurrence or new complications of haemochromatosis. We suggest a possible reason for his unique and late presentation.