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HBV-DNA-related hepatocellular carcinoma occurring in childhood. Report of three cases
R Giacchino1, C Navone, F Facco
1I Department of Infectious Diseases, University of Genova, Italy.
Insights
Hepatocellular carcinoma (HCC) is rare in children with chronic Hepatitis B virus (HBV) infection. This study observed three pediatric cases of HCC developing 6-11 years after perinatal HBV infection in Italy.
Area of Science:
- Hepatology
- Pediatric Oncology
- Virology
Background:
- Chronic Hepatitis B virus (HBV) infection is a significant global health concern.
- Hepatocellular carcinoma (HCC) is a rare but severe complication of chronic HBV infection, particularly in children.
- Understanding the long-term risks of HCC in pediatric HBV carriers is crucial for effective management.
Observation:
- A longitudinal study followed 325 chronically HBV-infected children over 18 years.
- Three children, all born in a high-endemic HBV region of southern Italy, developed HCC.
- These cases involved perinatal infection, acute hepatitis, and chronic carriage.
Findings:
- HCC developed between 6 and 11 years post-infection.
- Two patients had cirrhosis and were HBsAg positive; one had seroconverted to HBsAb but showed HBV-DNA integration without cirrhosis.
- HBV antigens were not expressed in the tissue of the non-cirrhotic HCC case.
Implications:
- This study highlights the potential for HCC development in chronically infected children, even in the absence of cirrhosis.
- The findings suggest similarities between Italian pediatric HCC cases and those observed in the Far East.
- Early detection and monitoring strategies for pediatric HBV carriers may need to be refined.
Abstract:
In a series of 325 HBV chronically infected children observed over an 18-year period, three developed HCC. These three children were born in southern Italy, a region characterized by a high endemic HBV infection rate; each had been infected perinatally, developed an acute hepatitis, and became a chronic carrier. Two of the three with cirrhosis were HBsAg positive at the time their HCC was detected. The remaining case had seroconverted to HBsAb but HBV-DNA integration could be demonstrated in the absence of cirrhosis; moreover HBV antigens were not expressed in the tissue of this case. The interval between HBV infection and HCC appearance in these three cases ranged from six to 11 years. A similarity between these three Italian cases and the majority of HCC arising in chronically infected children in the Far East is noted.