Metabolic-associated steatotic liver disease: A natural history from steatosis to hepatocellular carcinoma and liver transplantation: A case report

This case report follows a 67-year-old male with diabetes (T2DM) and Metabolic- Associated Steatotic Liver Disease (MASLD) over a two-decade. The patient progressed from hepatic steatosis to steatohepatitis (MASH) and cirrhosis from 2006 to 2009. Hepatocellular Carcinoma (HCC) was found via CT scan in 2012, leading to a Liver Transplantation (LT) in 2014. Explanted liver showed cirrhosis and five macro nodules. Histopathological evaluation identified well-differentiated HCCs with a trabecular and pseudo-acinar pattern and cholestasis. Unsuspected areas had small well-differentiated HCCs forming nodules or infiltrating non-neoplastic hepatocyte plates within cirrhotic nodules. The tumor was classified as an HCC of the diffuse/cirrhotomimetic type. Despite exceeding Milan criteria, the patient has 10 years of recurrence-free survival after LT. In conclusion, this case illustrates the natural history of MASLD form steatosis, MASH to cirrhosis and HCC and highlights successful outcomes in certain HCC types. A decade post-liver transplantation, the patient leads a normal life without any recurrence of HCC.