Early lesions and development of primary hepatocellular carcinoma in man--association with hepatitis B viral infection

A retrospective study on the patterns of sequential fluctuation of serum alpha-fetoprotein level during progression from liver cirrhosis to hepatocellular carcinoma

The patterns of sequential fluctuation of serum alpha-fetoprotein levels were analysed in 218 patients with liver cirrhosis in whom the serum alpha-fetoprotein levels were regularly and serially measured for more than 1 year. In the group of patients with persistently abnormal high values (greater than 50 ng/mL) over a follow-up period of more than 1 year, the incidence of the subsequent development of hepatocellular carcinoma was statistically and significantly higher (44%) compared to the other groups which showed normal (less than 20 ng/mL) or low abnormal levels (21-50 ng/mL) (16%), and transient abnormal high levels (greater than 50 ng/mL for a period of less than 1 year, mostly within 5 months) or fluctuated repeatedly between normal and transient abnormal high levels (23%). Hepatocellular carcinoma developed in 48 patients more than 2 years after the diagnosis of liver cirrhosis, and the fluctuating patterns of serum alpha-fetoprotein levels were analysed in these patients. The serum alpha-fetoprotein levels in 10 of these 48 patients stayed below 50 ng/mL until about 2.0-10.0 months before the detection of hepatocellular carcinoma and then increased steadily until the time of hepatocellular carcinoma detection. In these 10 patients, the monthly increasing ratios were approximately 1.6-4.8 times the previous values.

Immunoelectron microscopic observation of alpha-fetoprotein synthesis in human non-malignant liver tissues using immunoperoxidase methods

Alpha-fetoprotein (AFP) synthesis in non-malignant liver tissue of 34 patients with chronic hepatitis or liver cirrhosis, some of whom also had hepatocellular carcinoma (HCC), was studied by light and ultrastructural immunohistochemistry using peroxidase-labeled anti-human AFP. Simultaneously, the serum level of AFP was measured in these patients by radioimmunoassay. AFP-positive cells were identified in non-malignant liver tissue of 7 patients with elevation of serum AFP. AFP was demonstrated in several hepatocytes which were clustered in hepatic lobules, and also in some bile ductular cells which were distributed in the periphery of portal tracts. In an immunoelectron microscopic study of AFP-positive hepatocytes, dense reaction products of anti-AFP were localized in the membranes and cisternae of rough endoplasmic reticulum (r-ER), perinuclear space (PNS) and Golgi apparatus. The prominent feature of AFP-positive hepatocytes was abundant r-ER encompassing many mitochondria. As to AFP-positive bile ductular cells, they had scanty cytoplasm and few intracytoplasmic organelles and were surrounded by basement membrane. AFP was focally localized in the r-ER of such bile ductular cells. These observations suggest that AFP can be produced by malignant and non-malignant liver cells and that in non-malignant liver tissues, AFP can be produced by two distinct cell types; bile ductular cells and hepatocytes themselves.

Alpha-fetoprotein-producing pancreatic carcinoma: case report and review of the Japanese literature

An autopsy was performed of a patient who succumbed to pancreatic carcinoma and in whom an unusually high level of serum alpha-fetoprotein (AFP) (84,000 ng/ml) was obtained. An immunohistochemical approach, utilizing the peroxidase-antiperoxidase method, proved that AFP was confined within pancreatic carcinomatous cells of the primary lesion and liver metastases. No AFP-positive cells were ever observed in the hepatocytes adjacent to the metastatic lesions in the liver. It may be inferred that, in this particular case, the carcinomatous cells themselves synthesize AFP. The sites of production of AFP in AFP-positive pancreatic carcinoma were discussed in a review of the literature.

Alpha-1-antitrypsin deficiency in adults

A clinicopathological examination was carried out on eight adult patients with alpha-1-antitrypsin (ATT) deficiency. Phenotyping confirmed five patients with PiMZ, two patients with PiZ-, and one patient with PiZZ. Cirrhosis was found in six of the patients, four of whom had a history of excessive ethanol consumption. Hepatitis B surface antigen was positive in two patients with cirrhosis. Dysplastic change was present in four patients, although no neoplasia in the liver was found in all patients. All patients had periodic acid-Schiff positive and diastase resistant inclusions of hepatocytes, which were identified as ATT by indirect immunoperoxidase stain. The possibility of the combined effects of ATT inclusions and such harmful stimuli such as alcohol or viral hepatitis infection may render the hepatocytes more susceptible to damage, and may contribute to development of cirrhosis.

Morphologic studies of the liver cell dysplasia

Light and electron microscopic changes in human liver cells which were considered to be precancerous lesions, were studied. In our micrometrical examination, dysplastic liver cells were classified into two types: large and small dysplastic cell. Each type had nuclear pleomorphism and multinucleation; however, the nucleocytoplasmic ratio of the large dysplastic cell remained normal. Electron microscopically, the large dysplastic cell had some features of regenerative cells. The nucleocytoplasmic ratio of the small dysplastic cell was between that of normal hepatocytes and liver cancer cells. The difference in the incidence of the small and large dysplastic cells in normal livers and cirrhotic livers having hepatocellular carcinoma was statistically significant. In addition, the small dysplastic cell had more of a tendency to produce a small round focus. It was morphologically suggested that the more important candidate for the precancerous cell in the liver was the small dysplastic cell.

Hepatitis B virus antigens in liver tissue in hepatocellular carcinoma and advanced chronic liver disease-relationship to liver cell dysplasia

Hepatitis B surface (HBs) and core (HBc) antigens (Ag) were studied in liver tissue in HBsAg seropositive patients with chronic liver disease complicated (n = 32) and not complicated (n = 36) by hepatocellular carcinoma. Both groups were matched by age, sex and underlying disease. There was no qualitative and quantitative difference in tissue HBsAg between the two groups. However, HBcAg was significantly less in quantity in hepatocytes of patients with hepatocellular carcinoma compared to chronic liver disease without cancer. Serum hepatitis B e antigen tested by radioimmunoassay was also less frequently positive in patients with hepatocellular carcinoma. These findings seem to suggest that hepatitis B virus replication becomes less active in the process of hepatocarcinogenesis. The relationship between intrahepatic hepatitis B antigens and liver cell dysplasia was also studied. In hepatocellular carcinoma, tissue hepatitis B antigens often coexisted in the same liver having liver cell dysplasia, but no such association was observed in chronic liver disease without cancer. However, no indication was obtained that the dysplastic cells harbor HBsAg more frequently than non-dysplastic cells.

An autopsy study of hepatocellular carcinoma in Hong Kong

Two hundred and eighty-seven autopsy cases of hepatocellular carcinoma (HCC) in Chinese were reviewed. The analyses included histological study of the tumour and of the non-cancerous liver tissue, the cause of death and metastases. Bleeding of oesophageal varices was more frequent but rupture of tumour less common in cases associated with cirrhosis than in those without cirrhosis. There was a significantly higher incidence of bilobar involvement by tumour in the clear cell type of HCC and in cases unassociated with cirrhosis compared to other histological types of HCC and HCC with cirrhosis, possibly because of longer survival of the former groups. A strong association was found between cirrhosis and hepatic fibrosis with HCC and hepatitis B surface antigen (HBsAg), suggesting an oncogenic effect of chronic persistent hepatitis B virus (HBV) infection on hepatocytes.

An appraisal of the relationship between primary hepatocellular carcinoma and hepatitis B virus

The association between hepatitis B virus infection and primary hepatocellular carcinoma is reviewed. On the basis of serological and tissue examination there is a close link between virus infection and the tumour. While there is evidence to favour an oncogenic role for virus this is not conclusive, and other possible explanations for the relationship are discussed.

Relationship of hepatitis B surface antigen to serum alpha-fetoprotein in nonmalignant diseases of the liver

Serum alpha-fetoprotein (AFP) levels were measured by radioimmunoassay in 89 healthy adult Chinese, 170 patients with histologically verified non-malignant liver diseases, and 14 hepatitis B surface antigen (HBsAg) carriers with normal liver histology. In 97% of the healthy adults, AFP levels were under 20 ng/ml, which is then regarded as the normal upper limit. Cases with supranormally elevated AFP levels ranged from 15-51% in chronic hepatic disorders and were 33% in acute hepatitis. None of the healthy HBsAg carriers had abnormal AFP level. HBs antigenemia was found to be related to AFP elevation in chronic active hepatitis, cirrhosis, and acute hepatitis but not in chronic persistent hepatitis and healthy HBsAg carriers. The correlation could be demonstrated only when the sensitive third generation test was employed to define seropositivity of HBsAg. Events after hepatic injury induced by hepatitis B virus, rather than the HBs antigenemia itself, are probably responsible for the association. Whether the association of HBsAg and elevated serum AFP in these nonmalignant hepatic disorders contributes to the higher risk of subsequent development of hepatocarcinoma in Taiwan is unknown and requires further long-term longitudinal study.