Diagnostic and prognostic characteristics of 121 North American patients with hepatocellular carcinoma seen in one metropolitan area over a 6-year period were assessed using multivariate analysis. Presenting symptoms commonly included abdominal pain (53%) or mass (34%), anorexia (31%), and ascites (20%); however, the ability to make an early diagnosis was complicated by a variety of unusual symptoms accounting for 25% of presentations. While cirrhosis (63%) and hepatitis B surface antigen (HBsAg) positivity (52%) were common associated findings, the majority of patients (67%) had no prior diagnosis of liver disease. Despite the vascular nature of these malignancies, percutaneous biopsy procedures performed in 66 patients provided diagnostic material in over 85% of cases with little morbidity. Histologic diagnosis was made by blind percutaneous biopsy (41 done, 83% positive), peritoneoscopy with directed percutaneous biopsy (25 done, 88% positive), laparotomy (42 done, 98% positive), or autopsy (19). Percutaneous hepatic biopsy procedures were associated with no mortality and rare bleeding (three cases). Overall median survival was only 18 weeks; multivariate analysis indicated increased bilirubin or presence of pulmonary metastases adversely influenced outcome. Unexpectedly, patients younger than 45 years of age had a significantly (P less than 0.01) greater survival (median, 40 versus 9 weeks) than did older patients with this disease. We conclude: (1) hepatocellular carcinoma can be rapidly and safely diagnosed using percutaneous biopsy procedures; (2) North American patients with hepatocellular carcinoma younger than 45 years of age have a more favorable prognosis.

Hepatocellular carcinoma. Diagnostic and prognostic features in North American patients.

Fibrolamellar carcinoma of the liver: An immunohistochemical study of nineteen cases and a review of the literature

Serum ferritin concentrations were found to be raised, often considerably, in 58 of 76 black patients with primary liver cancer (PLC). No correlation could be demonstrated between the serum ferritin concentration and several other measurements, including the following: hepatic iron stores measured chemically, the size of the tumour, serum transaminase values, and the presence or absence of cirrhosis in the non-tumorous liver. There was, however, a negative correlation between serum ferritin and alpha-foetoprotein concentrations. Ferritin was purified from PLC tissue obtained from three patients at necropsy and the distribution of isoferritins was determined by isoelectric focusing. Acidic isoferritins similar to those previously found in PLC tissue were obtained. Their acidic nature was confirmed chromatographically using DEAE cellulose. Because the serum ferritin in patients with PLC probably consists of a mixture of normal and acidic isoferritins, it is likely that the serum assay used in the present study underestimated the actual concentrations present. With the development of an assay which utlises a specific antibody against acidic PLC isoferritins, serum ferritin may prove to be a second marker for PLC.

https://gut.bmj.com/content/gutjnl/19/4/294.full.pdf

Serum and tumour ferritins in primary liver cancer.

Histologic growth pattern of hepatocellular carcinoma: Relationship to orcein(hepatitis B surface antigen)-positive cells in cancer tissue

https://www.journal-of-hepatology.eu/article/S0168-8278(87)80030-2/pdf

Childhood hepatocellular carcinoma develops exclusively in hepatitis B surface antigen carriers in three decades in Taiwan. Report of 51 cases strongly associated with rapid development of liver cirrhosis.

Hepatitis-B antigen (HBAg) was found in the serum of 30 of 75 (40%) Bantu patients with primary liver cancer (PLC), but in only 7% of 18,377 apparently healthy rural Bantu, confirming an association between this tumor and persistence of the hepatitis-B virus. No relationship could be demonstrated between hepatitis-B antigenemia and alpha-fetoprotein, which was present in 77% of the patients. HBAg was not more common in the younger patients. In 60% of the patients, PLC coexisted with „posthepatitic” or postnecrotic cirrhosis. HBAg was found in 45.6% of the patients with cirrhosis, but also in 31% of those without, an insignificant difference. Our findings may be interpreted as meaning that persistence of the hepatitis-B virus is the cause or result of PLC, or that some immunologic defect is responsible for both. If the former, the virus must be directly oncogenic, in addition to having the potential to induce neoplasia indirectly via chronic parenchymal liver disease.

https://acsjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/1097-0142%28197409%2934%3A3%3C539%3A%3AAID-CNCR2820340310%3E3.0.CO%3B2-3

I. Bersohn

Papers

Hepatitis-B antigen and cirrhosis in Bantu patients with primary liver cancer.