Hepatitis B antigens and antibodies in serum from 41 cases of primary carcinoma of the liver. A study from Thailand.

Thirty-seven patients with hepatocellular carcinoma (HCC), one with cholangiocellular carcinoma (CCC), two with mixed HCC and CCC, and one with an anaplastic primary carcinoma of the liver, all from Bangkok, Thailand, were examined for the presence of hepatitis B virus infection markers in their blood. Of the patients with HCC, 70.6% had macronodular cirrhosis. Their serum was positive for hepatitis B surface antigen (HBsAg) in 64.9%, for hepatitis B core antibody (anti-HBc) in 97.3%, and for hepatitis B e antibody (anti-HBe) in 56.8% of the cases. The serum was positive for hepatitis B surface antibody (anti-HBs) in 53.9% of the HBsAg-negative and positive for hepatitis B e antigen (HBeAg) in 16.7% of the HBsAg-positive patients. The results of the study support the hypothesis of an etiological association between hepatitis B virus infection and HCC in Thailand.

Plasma cobalamin and transcobalamin in patients with primary carcinoma of the liver. A study from Thailand.

Of 37 patients with histologically verified hepatocellular carcinoma (HCC) from Bangkok, Thailand, 34 had raised values of plasma cobalamin, and 1 presented with a markedly increased value of plasma transcobalamin I (TC I). One patient with clinical malignancy of the liver, not proven histologically to be HCC, had a raised plasma cobalamin value and a markedly increased value of TC I. From our own studies and from studies in the literature we find circumstantial evidence that TC I occasionally is produced by the malignant liver cells in HCC.

Primary carcinoma of the liver. A histological study of 52 cases from Denmark.

Among 7763 autopsies performed in Greater Copenhagen in 1973, there were 309 cases of cirrhosis of the liver and 52 cases of primary carcinoma of the liver (PCL). Of the latter, 45 were hepatocellular carcinoma (HCC), 4 combined HCC and cholangiocarcinoma (CCC) and 3 CCC. HCC was found in 7.8 per cent of the cirrhotic livers and was in 57.1 per cent accompagnied by cirrhosis. The criteria of WHO, Peters (modified) and Anthony were used for classification. The degree of differentiation of the tumours was estimated using the criteria of WHO and Edmondson. The apparently small number of CCC may be due to the fact that this tumour is often overdiagnosed at the expense of HCC. The incidence of combined tumours is probably higher than generally assumed. The reticulin stain was found very valuable in HCC, both for descriptive and diagnostic purposes. In contrast to the situation in sub-Saharan Africa where hepatitis B virus is incriminated as the most important etiologic factor of HCC, it was found in the present study that alcoholism was a very essential cause of cirrhosis and thereby of HCC.

alpha 1-Acid glycoprotein, alpha 1-antitrypsin, and ceruloplasmin in human intestinal helminthiases.

alpha 1-acid glycoprotein, alpha 1-antitrypsin, and ceruloplasmin levels were followed in 150 children from the rural tropics after arrival in the temperate zone. It is postulated that multiple intestinal helminthiases, especially ancylostomiasis, cause an acute phase type of reaction which is enhanced by immunization with T.A.B.-cholera vaccine.

Primary carcinoma of the liver in Malawi: a review of 24 cases.

A consecutive series of 24 cases of primary carcinoma of the liver in Malawi has been investigated. Histologically, all were hepatocellular carcinomas (HCC). All patients were African Bantus, the average age was 42.7, and the sex ratio was men 3.5:women 1. The duration of symptoms attributable to HCC was about 5 months previous to admission to hospital and was in no case preceded by clinically manifest cirrhosis. The clinical picture was rather uniform with pain in the region of the liver, emaciation and nodular hepatomegaly as the most important features. One of the patients had repeated attacks of hypoglycaemic coma. Sera from 11 out of 13 patients contained alpha-feto-protein. Hepatitis-associated antigen and antibody in the serum were found in 7 and 6 out of 16 and 14 cases respectively. Serum B12 and serum unsaturated B12 binding capacity were moderately raised in most patients. The prognosis was poor, the average time of survival was 4.8 weeks after admission. The cause of death was most frequently hepatic coma. HCC in the African Bantu shows some different features from the same disease in the Western Hemisphere: The incidence is much higher; the patients are younger. The neoplasm commonly develops in a clinically latent cirrhosis. The latter is not caused by alcohol, but is presumably a sequel of hepatitis. It is possible that aflatoxin is the carcinogenic factor, acting more readily in a cirrhotic than in a normal liver.

A rare case of megaloblastic anaemia caused by disturbances in the plasma cobalamin binding proteins in a patient with hepatocellular carcinoma.

A patient with hepatocellular carcinoma, megaloblastic anaemia and increased concentration of serum cobalamin is described. Plasma TC I was increased to 10,000 times the normal concentration, thus explaining the increased concentration of serum cobalamin and a false Schilling test. The increase in plasma TC I in concurrence with undetectable amounts of plasma TC II was a likely explanation for the anaemia. The electron microscopic picture of the hepatocellular carcinoma was in accordance with TC I being produced by the tumour cells.