Abstract Hepatocellular carcinoma (HCC) rarely develops in patients with Crohn’s disease (CD) without cirrhosis. Focal hepatic glycogenosis (FHG), characterized by localized hepatocellular glycogen accumulation, has been proposed as a potential preneoplastic lesion, particularly in the setting of long-term azathioprine (AZA) therapy. We report two non-cirrhotic CD patients who developed HCC during prolonged AZA treatment; both exhibited FHG in their background livers. A review of the literature identified only 13 previously reported HCC cases in CD patients, most of which were associated with AZA use or FHG. These findings suggest a possible link between CD, AZA therapy, FHG, and hepatocarcinogenesis. Long-term AZA therapy in CD may be involved in the development of FHG and may contribute to HCC development, even in non-cirrhotic livers, underscoring the need for careful liver surveillance in CD patients receiving prolonged AZA treatment.
Fujii et al. (Fri,) studied this question.