Synchronous hepatocellular carcinoma and nasopharyngeal carcinoma in a patient with chronic hepatitis B: A case report and literature review

Rationale: Synchronous double primary cancers involving hepatocellular carcinoma (HCC) and nasopharyngeal carcinoma (NPC) are exceptionally rare. Chronic hepatitis B virus (HBV) infection is an established cause of HCC, whereas Epstein–Barr virus (EBV) infection is the major etiological factor for NPC. We report a patient with synchronous HCC and NPC and review the relevant literature. Patient concerns: A 63-year-old Chinese man with chronic HBV presented with a liver mass detected on routine screening. He reported nasal obstruction. Diagnoses: Contrast-enhanced imaging showed a 46 × 59 mm hepatic lesion with portal vein tumor thrombus and a 41 × 29 mm nasopharyngeal mass with bilateral cervical lymphadenopathy. Biopsies confirmed moderately differentiated HCC and EBV-associated non-keratinizing NPC. Final diagnoses were HCC Barcelona Clinic Liver Cancer Stage C (CNLC IIIa, Child-Pugh A) and NPC T3N2M0 Stage III (AJCC 8th edition). Interventions: He received hepatic arterial infusion chemotherapy (HAIC, mFOLFOX) combined with tislelizumab and donafenib; radiotherapy for NPC was deferred after shared decision-making. Entecavir was continued. Outcomes: At 19-month follow-up, both tumors remained controlled; the NPC met radiographic complete response criteria. Lessons: Synchronous HCC and EBV-associated NPC were controlled during treatment with a tislelizumab-containing multimodality regimen, and the NPC achieved a radiographic complete response. The contribution of each treatment component cannot be determined from a single case, and definitive radiotherapy remains the standard of care for locoregionally advanced NPC. Multidisciplinary management and close monitoring are essential.