Hepatocellular carcinoma and schistosomiasis japonica. A clinicopathologic study of 59 autopsy cases of hepatocellular carcinoma associated with chronic schistosomiasis japonica.

The association between hepatocellular carcinoma (HCC) and chronic hepatic schistosomiasis (CS) was studied by reviewing, 4,886 autopsies in adults during the past 20 years. In 229 cases of CS, 59 (25.7%) also had HCC. Among cases without CS, 399 (8.5%) had HCC. The incidence of HCC in patients with CS was significantly higher than that of other autopsy cases (p less than 0.01). Serum HBsAg was positive in 25.7% of 35 HCC cases with CS examined for hepatitis B virus (HBV) markers and anti HBs was positive in 10 of the 12 HBsAg-negative cases associated with CS, and in 62.1% of the other HBsAg-negative cases examined. Thus, most of HCC cases, including those associated with CS, probably had HBV infection at one time. Morphological examination revealed varying degrees of non-schistosomal hepatic changes, including macronodular or mixed macro-and micronodular cirrhosis, superimposed on schistosomal fibrosis in about two-thirds of the cases of HCC associated with CS. Although conclusive evidence whether or not schistosomal infection had a direct role in hepatocarcinogenesis could not be obtained, it was predicted that the additional non-schistosomal factors, particularly HBV infection, might play a synergistic role.