Hepatocellular carcinoma (a 28-year necropsy review)

Although primary liver carcinoma is one of the most common forms of malignancy in most parts of Africa and the Far East, recent reports indicate that the incidence of primary liver cancer has been increasing in Western countries. Our retrospective study is in agreement with this suggestion. From 28,311 autopsies performed at the Department of Pathology in Hradec Kralove from 1951 to 1978, 91 primary liver carcinomas were found. The increase was apparent in the period 1971 to 1978: 0.53% compared to 0.22% in the period 1951 to 1970. Of the 91 cases, 68 were in association with cirrhosis. In 6 of 17 liver samples, aflatoxin B1 was proved. Some authors suggest that the increase of liver cancer is related to the increase of cirrhosis. Other authors note a striking association of tumors with HBAg. The increase of cirrhosis has not been confirmed in our study. We assume that the carcinogenic mechanism is more complex and that the determinating factor might be an interaction of HB infection and some of the environmental carcinogenic factors, e.g., aflatoxin.