Go Akagi

Liver cell dysplasia and hepatitis B surface antigen in liver cirrhosis and hepatocellular carcinoma

Liver tissues of 223 autopsy cases of cirrhosis and hepatocellular carcinoma were examined for liver cell dysplasia in relation to hepatitis B surface antigen (HBsAg) detected with orcein stain. Liver cell dysplasia was found in 94 cases (42.2%): 37 were from cases of cirrhosis only, and 53 were from cases of cirrhosis with hepatocellular carcinoma. There was a significant difference in the overall incidence of HBsAg in cases with and without dysplasia (70.2%:32.6%). A similar difference was found in all groups, i.e., those with cirrhosis, cirrhosis with hepatocellular carcinoma, and hepatocellular carcinoma only, in which none of 11 cases of HBsAg negative had dysplasia. A good correlation was seen between the semiquantitative grade of dysplasia and the incidence of HBsAg. These findings suggest a close relationship of HBsAg with liver cell dysplasia.

Hepatitis B antigen in the liver in hepatocellular carcinoma in Shikoku, Japan.

An analysis of 105 autopsy cases (77 male, 28 female) of hepatocellular carcinoma (HCC) showed that 90 cases (85.7%) were associated with liver cirrhosis, of which 75 cases (83.3%) were of the macronodular type. Hepatitis B surface antigen (HBsAg) was detected with orcein stain in the hepatic tissue in 58 cases (55.2%). The incidence of HBsAg in cases of HCC patients with cirrhosis (58.9%) was higher, but not significantly, than that in those without cirrhosis (33.3%). The mean age of HBsAg‐positive cases was five years less than that of HBsAg‐negative cases, the age distributions therefore being significantly different.

CARCINOMA ASOCIATED WITH IDIOPATHIC CHOLEDOCHUS CYST

Clinical and autopsy findings of a rare condition, carcinoma arising in the wall of an idiopathic choledochus cyst, are reported. Endogeneous carcinogen which is likely to be present in the bile, and coexisting chronic inflammation in the wall of the cyst are assumed to be significant causative factors for the development of carcinoma. The possibility of dysontogenetic development of carcinoma was also discussed.

An elevated type of gastric ulcer scar

Some healing gastric ulcers leave an elevated scar that is indistinguishable from early gastric cancer type lla during short term observation. We have followed 9 patients with elevated ulcer scars by radiography, endoscopy, and biopsy. The appearance is that of mucosal folds converging to an elevated center and resembles early gastric cancer. Histologic sections reveal penetration of the muscularis mucosae and submucosal fibrosis; the central elevation consists of hyperplastic pyloric glands with cystic dilatation.

Comparative Study of Hepatocellular Carcinoma in Shikoku, Japan: a Study of 198 Autopsy Cases in Tokushima and Ehime Prefectures

A total of 198 cases with hepatocellular carcinoma (HCC) autopsied in two different areas in Shikoku, Tokushima and Ehime, was examined clinicopathologically. The incidence of HBsAg‐positives in overall HCC cases was 49.0%, being higher in Tokushima (52.4%) than in Ehime (43.1%). The difference seemed to be caused by the high incidence in female cases in Tokushima (46.7% in Tokushima vs. 23.1% in Ehime). The mean age of HCC cases with HBsAg (53.9 years) is younger than that of cases without HBsAg (58.8 years). The incidence of HBsAg‐positive HCC cases in Shikoku decreased step by step toward older age groups from 63.4% in 41–50, 59.5% in 51–60, 34.6% in 61–70, to 15.8% in over‐71 age groups, and has been decreasing gradually with the passage of time from 57.1% in 1960–1971, 50.0% in 1972–1976, to 40.8% in 1977–1981. The incidences of HBsAg‐negatives in all autopsy cases increased from 2.0% in 1960–1971 to 3.3% in 1977–1981 (P< 0.05) although the incidences of HBsAg‐positives showed almost the same level. Both in Tokushima and Ehime, the incidences of HCC associated with cirrhosis and HCC with HBsAg were smaller in grade IV cases, and the incidence of HBsAg‐positive HCC was high in cases with macronodular type of cirrhosis.