Clinical aspects of cryptogenic hepatocellular carcinoma

Clinical features of hepatocellular carcinoma in 22 patients without serum HBsAg, HBV DNA, anti-HCV antibody and HCV RNA were characterized and possible pathogenic factors for this cryptogenic hepatocellular carcinoma were prospectively assessed. Twenty-two patients were selected from 434 patients with hepatocellular carcinoma (HCC) who were treated at the Second Department of Internal Medicine, Kurume University Hospital between January 1994 and December 1996. Serum samples collected from these patients were all negative for HBsAg, HBV DNA, anti-HCV antibody, and HCV RNA. Patients were evaluated based on past history, present illness, history of habitual alcohol consumption, results of the serological and biochemical laboratory tests at diagnosis of HCC, Anti-HBc antibody, autoantibodies, GBV-C/HGV RNA, and histopathologic findings of non-cancerous portion of the liver were also evaluated. Among 22 patients with non-B non-C HCC, 16 patients (72.7%) had a history of alcoholic liver disease, 6 patients had an infection of schistosomiasis Japonica, and 1 patient had Budd-Chiari syndrome. Nine patients (40.9%) were positive for anti-HBc antibody, but their titers were low in all cases. Among 22 patients, positive for auto antibody, 7 patients (31.8%) were positive for anti-nuclear antibody, and 17 patients (77.3%) were positive for anti-smooth muscle antibody. Only 1 patient was positive for GBV-C/HGV RNA. Histopathologic examination was performed in 3 cases for non-cancerous portions of the liver. Liver cirrhosis and liver with passive congestive fibrosis were diagnosed in 2 cases each. The remaining one case showed normal feature of the liver. In conclusion, the majority of the 22 patients with non-B non-C HCC had a history of alcoholic liver disease. Many were also positive for auto antibodies. These results suggest that patients with alcoholic liver disease or hepatic disease with autoantibodies may be defined as the high-risk group of developing non-B non-C HCC and should be periodically underwent a complete medical examination.