Clinical features and etiology of hepatocellular carcinoma arising in patients with membranous obstruction of the inferior vena cava: In reference tohepatitis viral infection

Background and Aims: Budd-Chiari syndrome (BCS) comprises hepatic vein thro mbosis and inferior vena cava (NC) obstruction known as membranous obstruct ion of the IVC (MOVC). The latter is frequently complicated by hepatocellul ar carcinoma (HCC). The etiology of MOVC-associated HCC in relation to hepa titis viral infection is not known. In this study, we investigated the clin ical features and etiology of HCC in MOVC. Methods: Membranous obstruction of NC and HCC were diagnosed and studied by using imaging techniques. Sera from patients with MOVC, complicated by HCC , were examined for hepatitis viral antigens and antibodies (hepatitis B su rface antigen (HBsAg), antibody to HBsAg (anti-HBs), antibody to hepatitis B core antigen (anti-HBc) and third generation antibody to hepatitis C viru s (anti-HCV)) and for hepatitis viral nucleic acids (hepatitis B virus (HBV )-DNA, hepatitis C virus (HCV)-RNA, hepatitis G virus (HGV)-RNA and TT viru s DNA). Results: We studied 12 patients with BCS who were seen between April 1968 a nd February 1999. All of them had MOVC. Hepatocellular carcinoma developed in three (25%) of them. There were no obvious differences in the clinical f eatures and imaging findings concerning MOVC between patients with and with out HCC. Hepatocellular carcinoma in these three patients showed no clear t rend in clinical features and imaging findings. Of the hepatitis viral mark ers examined, HBsAg, anti-HBc and HBV-DNA were positive in only one of thre e patients with HCC and all of the viral markers were negative in the other two patients. Conclusions: Chronic congestion in the liver, caused by an outflow block of hepatic veins and subsequent histopathologic change, must have led to HCC in two patients without any hepatitis viral markers. Patients with MOVC sho uld be followed closely as a high-risk group for HCC. (C) 2000 Blackwell Sc ience Asia Pty Ltd.