Extrahepatic manifestations of hepatitis B virus infection: Addison's disease and myelofibrosis in a patient with persistent hepatitis B surface antigenemia.

A 60-year-old white male patient was admitted to the hospital with acute abdominal pain, seemingly a self-limited ileus. He was found to be hepatitis B surface antigen (HBsAg)-positive. Previous dental treatment was suspected to be the initial source of the infection with hepatitis B virus. Five months later he was re-admitted with a diagnosis of adrenal insufficiency (Addison's disease) which responded well to steroids. Four years later he developed fever and leucocytosis. A bone marrow biopsy revealed myelofibrosis. He had several episodes of pyrexia during his lifetime. After a 12-year period the patient suffered a fatal myocardial infarction. At autopsy the adrenal glands were reduced to scarred remnants and HBsAg was found to be present in the residual adrenocortical cells by immunoflouresence methods. Bone marrow at autopsy revealed myelosclerosis as well HBsAg (via immunofluoresence). Hepatitis B virus was therefore closely correlated with the development of Addison's disease and myelofibrosis in this case.

Localization of hepatitis B virus in a primary testicular cancer.

An embryonal carcinoma of the testicle developed in a 29-year-old white man 3 months after recovery from hepatitis B surface antigen-positive hepatitis. Microscopic sections prepared with formalin-fixed tumor tissue were stained with anti-hepatitis B surface antibody and examined by fluorescent microscopy. Appropriate control procedures, including absorption techniques, were also performed. The carcinoma cells contained hepatitis B surface antigen; controls, including sections from normal testicles and three other testicular tumors, were negative. The result indicates that the hepatitis B virus in this case was localized in the tumor cells. The patient was alive and well 4 years after undergoing orchiectomy and chemotherapy.

The role of radiotherapy in the treatment of primary tumours of the frontal sinuses.

Three cases of primary frontal sinus carcinoma are described, all three in males. Radiotherapy for these tumours can be applied either combined with surgical treatment pre, or postoperatively using supervoltage radiation, or by itself. If applied alone, it may either be a palliative measure in inoperable cases, or a curative measure in radiosensitive tumours.