Ruptured hepatocellular carcinoma following administration of Lenvatinib: an autopsy case

Lenvatinib was prescribed to a 71-year-old man with hepatocellular carcinoma (210mm, largest dimension) and portal vein tumor thrombosis. However, this treatment was discontinued 8 days later due to prolongation of prothrombin time and an increase in AST and LDH levels. Rupture of the hepatocellular carcinoma occurred 4 days after discontinuing Lenvatinib and the patient died. Autopsy findings showed a moderately differenti-ated hepatocellular carcinoma with diffuse hemorrhagic necrosis. Immunohistochemistry revealed diffuse FGF 19 protein expression in the nuclei of tumor cells, whereas some of the nuclei and cytoplasm of the hepatocytes in non-tumorous tissue were only slightly stained. The risk of hepatocellular carcinoma rupture should always be considered even after stopping short-term chemotherapy with Lenvatinib.