product and the level of HepG2 total RNA spiked. The assay is sensitive down to a detection level of one HepG2 cell. Alb mRNA was detected in 50% of 18 normal subjects and afp mRNA in only two normal subjects. The alb mRNA cut-off level for the normal was exceeded by seven normal subjects and 34 out of 64 HCC patients, and that for afp mRNA was exceeded by six HCC patients but none of the normal subjects. The level of alb mRNA detected was not linearly proportional to the amount of afp mRNA detected in peripheral blood of the same patients, suggesting heterogeneous expression of alb and afp genes in different circulating tumour cells. In addition, no significant linear association between the levels of afp mRNA and serum AFP was observed. Semiquantification of both mRNA markers for HCC cell detection may prove useful in prediction of metastases.

Hepatocellular carcinoma is a recognized complication of hepatic cirrhosis, most commonly associated with alcohol excess, haemochromatosis and chronic hepatitis B infection. Long‐standing hepatic venous congestion may cause cirrhosis. A search of the literature has not revealed a case of hepatocellular carcinoma complicating cardiac cirrhosis. A case is described and the association is discussed.

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