Hepatocellular carcinoma without cirrhosis in the West: epidemiological factors and histopathology of the non-tumorous liver

Background/Aim: In the West, hepatocellular carcinoma rarely occurs in pati ents without cirrhosis. In these patients, epidemiological factors and the histopathology of the non-neoplastic liver are not well known. The aim of t his study was to clarify these points. Methods: We studied 30 patients (26 men, 28-87 years) with hepatocellular c arcinoma and histologically-proven non-cirrhotic livers. Serological marker s of HBV and HCV infection, as well as alcohol and tobacco consumption were evaluated. Pathological changes in the non-tumorous liver (fibrosis, infla mmation, steatosis, alcoholic hepatitis lesions, iron overload, and large c ell dysplasia) mere systematically assessed using semi-quantitative scores. Results: Twenty patients had alcohol intake greater than or equal to 30 g/d and 16 mere smokers. Serological HBV or HCV markers mere positive in 10 pa tients. Only four patients had no exposure to alcohol or tobacco and no ser ological markers of HBV or HCV Histological examination shelved that all li vers had pathological changes. Seventeen patients (57%) had clearly-identif ied chronic liver disease: chronic hepatitis (n=10) or alcoholic liver dise ase (n=7). Non-specific and moderate pathological changes mere observed in the 13 other patients (43%), with different degrees of fibrosis, activity s teatosis, and iron overload. Large cell dysplasia was present in 12 patient s (40%). Conclusions: In our study, all patients with hepatocellular carcinoma and n on-cirrhotic livers had non-tumorous pathological liver changes, especially iron overload and large cell dysplasia. These results suggest that hepatoc ellular carcinoma originates from an abnormal histological background, even in non-cirrhotic liver.