Supplementary Material for: A Case of Hepatocellular Carcinoma after Treatment for Chronic Myeloid Leukemia in a Patient Without Liver Disease

Introduction: Chronic myeloid leukemia (CML) is a myeloproliferative disease caused by the reciprocal translocation of chromosomes 9 and 22, which leads to a chimeric gene product known as BCR-ABL. Some studies have shown a higher incidence of secondary malignancies than the one seen in the general population in patients with CML. Hepatocellular carcinoma (HCC) is rarely reported in association with CML and/or CML related treatment. Case Presentation: We describe a case of a patient with no history of liver disease and CML on imatinib for ten years, who presented with worsening right upper quadrant abdominal pain. Imaging revealed a large hepatic mass highly suspicious of malignancy that later was confirmed to be HCC after biopsy. The patient was bracketed with advanced stage HCC (BCLC stage C) and given her advanced age and poor performance status; palliative care was offered. Conclusion: Patients with CML have a common association with secondary malignancies. This is the first case report based on our extensive review of available literature that HCC was diagnosed in a patient with CML on treatment with imatinib without any clear or usual underlying cause.