Gastroenterology

Gastroenterology

Volume 97, Issue 1, July 1989, Pages 140-146
Gastroenterology

Hepatocellular carcinoma without cirrhosis in Japanese patients

https://doi.org/10.1016/0016-5085(89)91427-3Get rights and content

Abstract

Hepatocellular carcinoma is closely associated with cirrhosis, but it also develops, although much less frequently, in a noncirrhotic liver. It is suspected, without supporting evidence, that hepatocellular carcinoma has a different etiology when associated and not associated with chronic liver disease. In this study, 66 noncirrhotic cases found among 618 autopsies for hepatocellular carcinoma (10.7%) were analyzed retrospectively. The noncirrhotic liver was histologically unremarkable in 3 cases and in the histologically evaluable 56 cases it had fibrosis of varying degrees or mild cellular infiltrate, or both, in the portal tract. There was one liver that had portal venous changes compatible with those in idiopathic portal hypertension (Banti's syndrome). In these noncirrhotic livers, the parenchymal cells were generally unremarkable except for liver cell dysplasia that was seen in 26.8%. Serum hepatitis B surface antigen was positive in only 7.4% in conrast to 26.6% in cirrhotic cases. Three histologically unremarkable cases had no clinical or histologic evidence of chronic liver disease; two involved painter-plasterers and one a farmer. The liver weight in these cases ranged from 4400 to 6180 g. In contrast, the average liver weight in cirrhotic cases was 1998 g. Noncirrhotic patients when compared with cirrhotic patients had better liver function tests and much less frequent varices. It was concluded that ~11% of hepatocellular carcinoma cases in Japan are noncirrhotic, the majority having some histologic changes in the portal tracts suggestive of past or ongoing chronic liver disease, and that there are rare cases that have no histologic changes in the liver.

References (25)

  • M Arakawa et al.

    Emergence of malignant lesions within an adenomatous hyperplastic nodule in a cirrhotic liver

    Gastroenterology

    (1986)
  • H Popper

    Viral versus chemical hepatocarcinogenesis

    J Hepatol

    (1988)
  • RNM McSween

    A clinicopathological review of 100 cases of primary malignant tumors of the liver

    J Clin Pathol

    (1974)
  • HA Edmondson

    Tumor of the liver and intrahepatic bile ducts

    (1958)
  • T Shikata

    Primary liver carcinoma and liver cirrhosis

  • SJ Van Rensburg et al.

    Hepatocellular carcinoma and dietary aflatoxin in Mozambique and Transkai

    Br J Cancer

    (1985)
  • C Berman

    Primary carcinoma of the liver

    (1951)
  • PE Steiner

    Cancer of the liver and cirrhosis in trans-Saharan Africa and the United States of America

    Cancer

    (1960)
  • C Brechot et al.

    Presence of integrated hepatitis B virus DNA sequences in cellular DNA of human hepatocellular carcinoma

    Nature

    (1980)
  • AD Shafritz et al.

    Identification of integrated hepatitis B virus DNA sequences in human hepatocellular carcinoma

    Hepatology

    (1981)
  • AA Hirata et al.

    Hepatitis B virus antigen detection by reversed passive hemagglutination

  • RG Knodell et al.

    Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis

    Hepatology

    (1981)
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