Published online Jul 27, 2022. doi: 10.4254/wjh.v14.i7.1512
Peer-review started: March 29, 2022
First decision: May 12, 2022
Revised: May 25, 2022
Accepted: June 27, 2022
Article in press: June 27, 2022
Published online: July 27, 2022
Processing time: 120 Days and 1.7 Hours
Hepatitis B virus (HBV) is a known carcinogen that may be involved in pancreatic cancer development. Detection of HBV biomarkers [especially expression of HBV regulatory X protein (HBx)] within the tumor tissue may provide direct support for this. However, there is still a lack of such reports, particularly in non-endemic regions for HBV infection. Here we present two cases of patients with pancreatic ductal adenocarcinoma, without a history of viral hepatitis, in whom the markers of HBV infection were detected in blood and in the resected pancreatic tissue.
The results of examination of two patients with pancreatic cancer, who gave informed consent for participation and publication, were the source for this study. Besides standards of care, special examination to reveal occult HBV infection was performed. This included blood tests for HBsAg, anti-HBc, anti-HBs, HBV DNA, and pancreatic tissue examinations with polymerase chain reaction for HBV DNA, pregenomic HBV RNA (pgRNA HBV), and covalently closed circular DNA HBV (cccDNA) and immunohistochemistry staining for HBxAg and Ki-67. Both subjects were operated on due to pancreatic ductal adenocarcinoma and serum HBsAg was not detected. However, in both of them anti-HBc antibodies were detected in blood, although HBV DNA was not found. Examination of the resected pancreatic tissue gave positive results for HBV DNA, expression of HBx, and active cellular proliferation by Ki-67 index in both cases. However, HBV pgRNA and cccDNA were detected only in case 1.
These cases may reflect potential involvement of HBV infection in the development of pancreatic cancer.
Core Tip: Hepatitis B virus (HBV) is a known carcinogen that may be involved in pancreatic cancer development. Detection of HBV biomarkers (especially expression of HBV regulatory X protein) within the tumor tissue may provide direct support for this. However, there is still a lack of such reports, particularly in non-endemic regions for HBV infection. We present two cases of HBsAg-negative patients with pancreatic ductal adenocarcinoma, in whom the markers of HBV were detected in blood and in the tumor tissue. This reflects potential role of the virus in the etiology and pathogenesis of pancreatic ductal adenocarcinoma.