Orcein-positive hepatitis B surface antigen and liver carcinoma: their association in an Eastern US population

We retrospectively examined the association of hepatitis B infection and hepatocellular carcinoma (HCC) in a US East Coast population using orcein staining of fixed liver tissue. Hepatitis B surface antigen (HBsAg) was present in non-neoplastic hepatocytes in eight of 53 cases of HCC, but in no cases of cholangiocarcinoma or metastatic tumor. In five of the eight positive cases, macronodular cirrhosis was present; in three positive cases, cirrhosis was absent. The rate of positivity in livers with both HCC and macronodular cirrhosis was 28%, compared with 4.7% in livers with macronodular cirrhosis but no carcinoma. The low, but significant association of HBsAg and HCC, both in the presence and absence of cirrhosis, suggests that HCC may develop in a subset of patients in the United States as a result of infection with hepatitis B virus.