Intracytoplasmic Hepatitis B Surface Antigen and fiver Cell Dysplasia in 107 Autopsy Cases of Primary Carcinoma and Cirrhosis of the Livers in Kansai District of Japan

Abstract

Formalin-fixed liver tissues of 107 autopsy cases of 81 primary carcinoma (65 HCC,12 CC and 4 MIX) and 26 cirrhosis alone of the liver were investigated by gross examinations on their whole slice preparations and by microscopic observations on the sections from each hepatic lobe and the other some portions with the histopathologic techniques including orcein stain and victoria blue stain for HBsAg. In addition, immunohistochemical techniques for HBsAg were applied to the sections containing victoria blue-positive hepatocytes.
The distribution of gross typing of the malignant tum ors was somewhat different from other Japanese papers, and that of microscopic grading of them was similar to Edmondson's. High combination of liver cirrhosis to HCC was noted, and most of the cirrhosis were posthepatitic type. On gross examinations of whole slice preparations, a minute HCC was found from 3livers previously diagnosed as posthepatitic cirrhosis alone.
Both orcein and victoria blue stains exhibited a lmost the same specificity, but the latter revealed more clearly and easily the positive finding for the viral matrix. The specificity and sensitivity of victoria blue stain were proved to be almost the same as those of the immunohistochemical methods, and indirect immunoperoxidase methods were superior to immunofluorescence mothods because of the precise cytological background.
LCD was characteristic in the cirrhotic livers, particu larly those with HCC. Cirrhotic livers without LCD were found in the younger autopsy cases than those with LCD, but there was lack of significant correlation in the mean autopsy ages between liver cirrhosis alone having LCD and liver cirrhosis with HCC having LCD. LCD occurred significantly more frequently in the younger patients detecting HBsAg in the livers than the older ones. Sex difference in LCD frequency was similar to Anthony's but not to Sakurai's. But, it is uncertain whether LCD itself would give more chances in developing of HCC in male than in female. LCD was detected more frequently in posthepatitic type out of the group composed of 11 A,59 B and 4 F types of liver cirrhosis. It has to be mentioned that HBsAg hardly be seen in the area of LCD.
The incidence of VB (+) hc was significantly higher in cases with liver cirrh osis than without, but there was no difference in the frequencies between cases with HCC and without. HBsAg was more detected in the livers with LCD than without, but the antigen could not be found in more than 60% of the livers with LCD. From the difference of mean autopsy ages, HCC in younger patients seemed to be influenced more by the viral factor than in older ones. In the present materials, there were 3 HCC having HBsAg-positive inclusions in the tumor cellls themselves.
In conclusion, LCD would be somewhat different premalignant state from the Anthony's speculation, and persistence of the viral factor might play some roles in human hepatocarcinogenesis although it is unknown whether the virus is an initiator of HCC. HBsAg-positivity in tumor cells might be accepted that the viral antigen was linked to this carcinogenesis, although it was detected in a minority of tumor cells.
Acknowledgements: I would like to express my deepest appreciation to prof. S. Morii, Kansai Medical University, for his thoughtful supports and helps, and to Dr. S. Takaoka of Department of Pathology, Kansai Medical University, for his collaberation on immunohistochemical techniques. This study was supported in part by a Grant of Takeda Pharma. Co. (1979).