title: Common clinicopathological features of the patients with chronic hepatitis B virus infection who developed hepatocellular carcinoma after seroconversion to anti-HBs--a consideration of the pathogenesis of HBV-induced hepatocellular carcinoma and a strategy to inhibit it.
abstract: OBJECTIVE
  The incidence of hepatocellular carcinoma among patients who have seroconverted to anti-hepatitis B surface antigen (anti-HBs) remains controversial.
  
  
  METHODS
  We report four patients with chronic hepatitis B virus (HBV) infection who had cleared HBsAg and had developed anti-HBs at a later time, but who developed hepatocellular carcinoma (HCC) eventually.
  
  
  RESULTS
  The common clinicopathological characteristics of the four patients were: An established diagnosis of precirrhosis or liver cirrhosis more than a decade previously, a long-standing normalization or stabilization at a low level of ALT values due to undetectable HBV DNA by the Amplicore Monitor assay, and a marked reduction of the fibrosis level in the non-tumorous liver obtained at HCC surgery or autopsy compared to the previous histology more than a decade previously. There was no fibrosis in the needle biopsy specimen from one patient.
  
  
  CONCLUSIONS
  Our findings suggest that HCC due to HBV can occur in the serologically-cured stage if progression to pre-cirrhosis or cirrhosis already has occurred, where the fibrosis level has improved considerably because of the long-term absence of active HBV viremia and inflammation. Active medical intervention to prevent liver cirrhosis for chronic hepatitis B may have an important role in the inhibition of HCC in patients with chronic hepatitis B.
authors.affiliation: Internal Medicine, Nippon Dental University, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Tsuboi
authors.forename: Shogo
authors.initials: S
authors.lastname: Ohkoshi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.forename: Kenta
authors.initials: K
authors.lastname: Suzuki
authors.forename: Syun-suke
authors.initials: SS
authors.lastname: Tsubata
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ishihara
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ichida
authors.forename: So-ichi
authors.initials: S
authors.lastname: Sugitani
authors.forename: Ko-ichi
authors.initials: K
authors.lastname: Shibazaki
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyagi
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000209:etiology* / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000150:complications* / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged
chemical_list: D006514:Hepatitis B Surface Antigens