Hepatocellular carcinoma in Karachi.

The present study defines the clinical presentation and examines possible aetiological factors in the occurrence of hepatocellular carcinoma in Karachi, Pakistan. Histologically proven cases of hepatocellular carcinoma (n = 366) were seen over 16 years. The maximum frequency occurred in the age range 51-60 years (range: 8-98 years), and the male to female ratio was 2.5:1. The place of birth, place of longest stay and various addictions did not have any association with the occurrence of liver carcinoma. Only three cases had a history of liver cancer in their immediate relatives. The main presenting features were right hypochondrial mass (85%) and pain (79%). The liver size did not correlate with the duration of illness. alpha-Fetoprotein titres were more than 200 ng/mL in 62% of cases. Using a reverse passive haemagglutination assay method, HBsAg and anti-HBc positivity were 32% and 60%, respectively. Antigen figures rose to 60% when radio-immunoassay was used; 41% of cases were anti-delta positive (EIA). Aflatoxin contamination varied between 10% and 17% in various localities of Karachi, suggesting an association of liver cancer with HBsAg and aflatoxins. Histopathologically 73% were trabecular, and 2.5% were mixed hepatocholangiocarcinomas. Follow-up was available in 45% of cases. All except two (1.2%) died within 6 months.