HBsAg, chronic lymphoproliferative disorders, and cirrhosis of liver

This study reports the incidence of HBsAg in a series of chronic lymphoproliferative disorders in which a high incidence of cirrhoses had been previously observed. Twenty-three cases were collected from the necropsy records. The type of lymphoma was reviewed in the light of the new functional classifications of non-Hodgkin malignant lymphomas introduced by Lennert and Lukes. The presence of HBsAg in the liver was investigated by the indirect immunofluorescence technique. Eleven cases showed plasmocytoid features and were considered as immunocytomas. Seven cases showed cirrhosis of the liver; six of them belonged to the immunocytoma group. Four cases were positive for HBsAg. Three of them were found among the group combining cirrhosis and immunocytoma. They presented the abundant nodular distribution of HBsAg typical of inactive cirrhosis.A parallel is drawn between the often reported association of Waldenström's syndrome and cirrhosis and the association of immunocytoma and cirrhosis observed in this study. The analogy is all the more justified since most of the lymphomas associated with Waldenström's syndrome happen to be immunocytomas. Therefore the association between HB virus infection and cirrhosis on the one hand and chronic lymphoproliferative disorders on the other may not be purely coincidental. A chronic antigenic stimulus such as persisting HBsAg could trigger the proliferation of a malignant lymphoid clone.