In situ detection of hepatitis B, C, and G virus nucleic acids in human hepatocellular carcinoma tissues from different geographic regions.

We performed a retrospective study to determine the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and hepatitis G virus (HGV) genomes in formalin-fixed, paraffin-embedded liver tissues from hepatocellular carcinoma (HCC) patients in various geographic areas. The prevalence of each hepatitis virus in the liver tissues that have both carcinoma and noncarcinoma regions was different among the countries. HCV was the most prevalent in Japan (75 of 122 [61.5%]), Spain (9 of 15 [60%]), and the United States (27 of 65 [41.5%]); HBV was the most prevalent in Korea (45 of 55 [82%]) and among Japanese Americans in Hawaii (4 of 8 [50%]). Genotype II/1b was the most common genotype of HCV encountered in HCCs in these countries. In contrast, HGV RNA was undetectable in all tested HCCs. "Cryptogenic HCC," defined as HCC of unknown etiology, was seen 4 (3%) and 4 (6.2%) of Japanese and American patients, respectively, but this was not found in other countries. Interestingly, patients with HCC related to primary biliary cirrhosis (4.6%), who were excluded from analysis as hepatitis virus infections, were present only in the United States, but not in other countries. This study suggests that HCV, particularly genotype II/1b, and HBV may play an important role in hepatocarcinogenesis in these countries. There was no evidence of any relation between HGV infection and development of HCC.

Results of 90 consecutive hepatectomies for hepatocellular carcinoma: a multivariate analysis of survival.

The surgical results and postoperative management of 90 patients with hepatocellular carcinoma (HCC) who underwent hepatectomy were reviewed, and clinical factors relating to HCC were analyzed to determine what type of HCC responds best to hepatectomy. The patients consisted of 69 men and 21 women. Serum anti-hepatitis C virus was positive in 76.9% of patients and hepatitis B surface antigen was positive in 18.9%. The operative procedures consisted of right lobectomy in six patients, left lobectomy in seven, right hepatic segmentectomy in eight, left lateral segmentectomy in 13, two adjoining subsegmentectomy in 17, subsegmentectomy in 29, and partial hepatectomy in 10. Liver cirrhosis was confirmed histopathologically in 63 patients. There were two operative deaths and two other in-hospital deaths. During the follow-up period, HCC recurred in 64 of the remaining 86 patients at the following sites: liver in 56 patients (87.5%), bones in four (6.3%), lymph nodes in three (4.7%), and lung in one (1.6%). Transcatheter arterial chemoembolization was performed in 22 of the patients with recurrence, transcatheter arterial chemoembolization in combination with percutaneous ethanol injection was performed in 14, hepatectomy was performed in six, and irradiation with Linac x-rays was performed in eight. The cumulative 3- and 5-year survival rates were 63.8% and 37.8%, respectively. Univariate and multivariate analyses of factors influencing survival disclosed that having a single HCC nodule of up to a maximal diameter of 4.0 cm, an absence of intrahepatic metastasis, and a functional liver reserve estimated as clinical stage I contributed significantly and independently to increasing the survival rate.

Hepatitis C and B virus infections in hepatocellular carcinoma. Analysis of direct detection of viral genome in paraffin embedded tissues.

BACKGROUND: Although there have been many seroepidemiologic studies on hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC) occurrence, the actual role of HCV in hepatocarcinogenesis is unknown. METHODS: We have previously reported on a highly sensitive method of detecting and identifying sequences of RNA genome in formalin fixed, paraffin embedded (FFPE) tissue by polymerase chain reaction (PCR) assay. Using this method, we carried out a retrospective study to determine the prevalence of HCV and hepatitis B virus (HBV) genomes in FFPE specimens from 102 Japanese patients with HCC. RESULTS: HCV-RNA was detected by nested PCR reverse transcription (RT) in 64 of the 102 patients (62.7%), and 78.1% (50/64) of those HCV-RNA-positive patients had HCV genotype II. HCV-RNA was present in 54 of 70 (77.1%) anti-HCV-positive patients, and also in 5 of 20 (25%) anti-HCV-negative patients. HBV-DNA was detected by nested PCR in FFPE liver specimens from 21 of 102 (20.6%) patients. HBV-DNA positivity was consistent with seropositivity for serum HBV markers in 17 of these 21 patients (80.9%). HBV-DNA was present in FFPE samples from 2 patients who were seronegative for HBV markers, and in 1 patient who was seropositive for anti-HBs. Double infection of these two viruses was found in 6 patients (5.9%). Three patients (2.9%) were negative for both hepatic viral genomes and serum viral markers. CONCLUSIONS: The precise prevalence of HCV and/or HBV infection among HCC patients can be determined by studying routinely-processed FFPE HCC samples preserved for up to 11 years using the technique of nested PCR. HCV-RNA was detected in the majority of our HCC cases; type II was the most common genotype of HCV encountered. The incidence of HCV-associated HCC was three times greater than that of HBV. Thus, the hepatitis virus infection most frequently associated, and probably ectologically implicated, with HCC in Japanese people is HCV infection.

[A case report of left ventricular-right atrial communication with tricuspid regurgitation due to infective endocarditis].

A case of 58-year-old man with a left ventricular-right atrial communication with tricuspid regurgitation due to infective endocarditis was reported. Surgical treatment was performed following intensive chemotherapy. The communication was found in the center of a vegetation on the septal leaflet. Closure of the communication and replacement of the tricuspid valve were done successfully. His postoperative course was uneventful.