Hepatocellular carcinoma and hepatic cirrhosis in the west of Scotland: a 25-year necropsy review.

Abstract

SUMMARY A two-fold increase in the incidence of hepatocellular carcinoma in the west of Scotland is reported on the basis of a 25-year retrospective necropsy review (313 cases). This increase is not accompanied by a corresponding increase in the incidence of hepatic cirrhosis. The relationship between hepatocellular carcinoma and hepatic cirrhosis is discussed in the light of these findings.Primary hepatocellular carcinoma (PHC) is a very common tumour in some parts of the world, notably Africa and south-east Asia, but has hitherto been regarded as relatively uncommon in Europe and the Americas. However, recent reports from the west of Scotland have suggested that the incidence of this tumour is increasing (Manderson et al., 1968;MacSween, 1974) and this trend has also been reported in Europe and North America (MacDonald, 1957;Glenert, 1961;Patton and Horn, 1964;Ohlsson and Norden, 1965) as well as in other parts of the United Kingdom (Elkington et al., 1963;Stone et al., 1968).We have undertaken a retrospective review of the necropsy records of the five major Glasgow teaching general hospitals over the 25-year period 1950-74 and report a twofold increase in the incidence of hepatocellular carcinoma. In three of these hospitals we have compared the incidence of this tumour with the incidence of hepatic cirrhosis in the same adult necropsy population over the same 25-year period.Stobhill Hospital) over the 25-year period 1950-74 have included 313 cases of histologically proven hepatocellular carcinoma from a total of 58 074 adult necropsies (total necropsy incidence 0 54%). During this period the necropsy incidence of this tumour has risen steadily to twice its original level (1950-54 incidence 0 34 %; 1970-74 incidence 0 73 %) and this trend is similar in both sexes (male 0 27% and 0 56o%; female 007 % and 0 16%) (Fig.

Screening for hemochromatosis by measuring ferritin levels: a more effective approach

“…23 None of these values, of course, has been corrected for the incidence of cirrhosis in the general population, a number that is difficult to ascertain, but that is certainly not negligible. [24][25][26] Our finding of one male with cirrhosis among 75 male C282Y homozygotes studied is consistent with the other findings, although in the absence of routine liver biopsies in our study, we cannot exclude the possibility that silent cirrhosis may have been present in other patients. Notably, the cirrhotic patient we did detect had a serum ferritin level of 4891 g/L.…”

Microsatellite instability and loss of heterozygosity at DNA mismatch repair gene loci occurs during hepatic carcinogenesis

“…In large necropsy series, HCCs are present in approximately 17% of patients with cirrhosis, while for noncirrhotic patients, the prevalence is between 0.11% and 0.30%. 43,44 Because of the relative prevalence of cirrhosis in these necropsy series, HCC is approximately three times more likely to be found in conjunction with cirrhosis than without cirrhosis, although clearly it does occur in both settings. Part of the reason for the relative excess of noncirrhotic patients in our study population is likely to be due to where tissues were obtained for study.…”

Pedunculated primary hepatocellular carcinoma

“…Most cases of primary hepatocellular carcinoma (PHCC) are well advanced at the time of diagnosis [5,9,13,17,19] such that rates of resectability in various series range from 3 to 24% [13,14,16,19]. Of the resectable PHCC, the pedunculated lesions are only rarely reported.…”