Hello!

I think it's just a poll))? I agree with you. As it's known that hepatitis B markers are often detected in patients with HCC and role of HBV-DNA in hepatic carcinogenesis.  The positive results of serum HBc-antibody, HBe-antibody indicates the persistence of HBV in this case (If the patient didn't receive specific treatment). How long a patient has ascites?

Sincerely,

Dear Nobuhiro

It is right that the chronic HBV infection increase the risk of HCC development. OBIs are usually characterized by very low HBV DNA load in plasma (< 200 IU/mL). Detection of OBI requires assays of the highest sensitivity and specificity with a lower limit of HBV DNA detection of less than 10 IU/mL and < 0.1 ng/mL for HBsAg. In your case HBV-DNA was not detected. Is this does not disturb your defintition about occult HBV infection?

Marcellin.

 Dear Marcellin

Thanks for your valuable comment. I firmly believe this case holds true of the definition of occult HBV. 

From now on, I have to assess HBc-antibody and HBs-antibody although HBV-antigen is negative to reveal and follow-up patients with potential HBV infections.

Many thanks!

 Nobuhiro.

 Dear Dr Dzmitry

Thank you for giving me valuable advice. It's just to confirm my understanding of occult HBV. The ultrasonography performed a year ago revealed no HCC and acites.  He has not been considered to contract HBV up until now.  

Probably we need to assess  serum HBc-antibody and HBs-antibody in selected cases.

Sincerely,

Dear Nobuhiro.

I share your viewpoint. I wanted rightly to make you know that the direct mechanism of carcinogenesis in HBV-related HCC includes mutagenesis and changes in proliferation and differentiation caused by integration of HBV DNA into the host genome. as in your case the HBV DNA was not detected.

Marcellin.

Dear Nobuhiro,

I suggest you to not overlook the place of HBV-DNA in your diagnosis. HBV-DNA plays a role in the development of HBV-related HCC. I share your viewpoint about to assess HBc-antibody and HBs-antibody because it could be useful, but I have some doubts about your diagnosis. If HBV-DNA has not been detected, it may have another cause in addition to the presence of HBV which has just accelerated the HCC development to this patient.

Marcellin.

I agree with Marcellin's good comments. It might be interesting to know if the patient had been a regular consumer of alcohol since this could have contributed to the development of his cirrhosis - hence HCC.

Oliver James

Hello!

Did you do a liver biopsy? Was immunohistochemistry performed (ie, did it reveal the presence of any hepatitis B activity)?  

 Dear Cristóvão 

Unfortunately,  I didn't perform liver biopsy because of ascites above the liver surface and the use of anti-coagulant agents while in dialysis. I introduced this case to a surgeon. After this HCC is resected, I want to perform immunohistochemistry staining.  

Nobuhiro

Are you considering to resect this patient? Ascites may be caused by liver failure or carcinomatosis, both conditions may preclude surgical treatment. One good option is to perform a diagnostic laparoscopy to rule out dissemination of the HCC and the status of the liver (cirrhosis).

Do you have more images of the tumor? The location of the tumor seems favorable for laparoscopic liver resection. It may be in segment 6 rather than 7. We are doing laparoscopic resection even in Child B patients with good results. Laparoscopy itself decrease systemic inflammatory response that is responsible for postoperative complications in cirrhotic patients.

 Dear Dr Marcel

Thanks for your concern for my case. I'll attach another images. If you need more information, please feel free to ask me. 

Sincerely

Nobuhiro Takeuchi