title: Characteristic clinical features of hepatocellular carcinoma associated with Budd-Chiari syndrome: evidence of different carcinogenic process from hepatitis B virus-associated hepatocellular carcinoma.
abstract: OBJECTIVE
  Budd-Chiari syndrome (BCS) is a known risk factor for hepatocellular carcinoma (HCC). Considering the pathophysiological mechanism of BCS, BCS-associated HCC may have a different carcinogenic process to hepatitis B virus (HBV)-associated HCC, resulting in different characteristic clinical features.
  
  
  METHODS
  The clinical, radiological and histopathological characteristics of 15 HCCs associated with BCS were analysed and compared with 211 HBV-associated HCCs.
  
  
  RESULTS
  HCC associated with BCS showed a female predominance in contrast to a male predominance in HCC associated with HBV infection. Child classes of BCS-associated HCC patients were not different from the classes of HBV-associated HCC. BCS tended to be associated with the single nodular type of HCC. Only one BCS-associated HCC patient had portal vein invasion at the time of diagnosis, compared with 96 patients with HBV-associated HCC. No HCC patients with BCS showed biliary invasion, compared with 47 HBV-associated HCC patients. The median survival period of HCC patients associated with BCS was 58 months, which was much longer than the median survival period of 10 months in HBV-associated HCC. All of the three BCS-associated HCCs available for histological examination were well differentiated.
  
  
  CONCLUSIONS
  Patients with HCC associated with BCS seemed to survive for much longer periods than those with HBV due to the low invasiveness of the tumour. Such unique clinical features may be evidence of different carcinogenic processes in BCS-associated and HBV-associated HCC.
authors.affiliation: Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, South Korea.
authors.forename: Sang Hyo
authors.initials: SH
authors.lastname: Shin
authors.forename: Young-Hwa
authors.initials: YH
authors.lastname: Chung
authors.forename: Dong Dae
authors.initials: DD
authors.lastname: Suh
authors.forename: Jung Woo
authors.initials: JW
authors.lastname: Shin
authors.forename: Myoung Kuk
authors.initials: MK
authors.lastname: Jang
authors.forename: Soo Hyung
authors.initials: SH
authors.lastname: Ryu
authors.forename: Neung Hwa
authors.initials: NH
authors.lastname: Park
authors.forename: Han Chu
authors.initials: HC
authors.lastname: Lee
authors.forename: Yung Sang
authors.initials: YS
authors.lastname: Lee
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Suh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011859:Radiography; D012737:Sex Factors; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D000509:alpha-Fetoproteins