Published online Oct 6, 2021. doi: 10.12998/wjcc.v9.i28.8492
Peer-review started: April 1, 2021
First decision: May 27, 2021
Revised: May 28, 2021
Accepted: August 11, 2021
Article in press: August 11, 2021
Published online: October 6, 2021
Processing time: 180 Days and 3.9 Hours
Hepatocellular carcinoma (HCC) may be caused by hepatitis B virus (HBV) infection. Post-infection recovery-associated changes of HBV indicators include decreased hepatitis B surface antigen (HBsAg) level and increased anti-HBsAg antibody titer. Testing to detect HBV DNA is conducted rarely but could detect latent HBV infection persisting after acute infection and prompt administration of treatments to clear HBV and prevent subsequent HBV-induced HCC deve
A 57-year-old male patient with abdominal pain who was diagnosed with primary HCC presented with an extremely high level (over 2000 ng/mL) of serum alpha-fetoprotein. Abdominal B-ultrasonography and computed tomography scan results indicated focal liver lesion and mild splenomegaly. Assessments of serological markers revealed a high titer of antibodies against hepatitis B core antigen (anti-HBcAg antibodies), an extremely high titer (1000 mIU/mL) of hepatitis B surface antibodies (anti-HBsAg antibodies, anti-HBs) and absence of detectible HBsAg. Medical records indicated that the patient had reported no history of HBV vaccination, infection or hepatitis. Therefore, to rule out latent HBV infection in this patient, a serum sample was collected then tested to detect HBV DNA, yielding a positive result. Based on the aforementioned information, the final diagnosis was HCC associated with hepatitis B in a compensated stage of liver dysfunction and the patient was hospitalized for surgical treatment.
A rare HCC case with high serum anti-HBsAg antibody titer and detectable HBV DNA resulted from untreated latent HBV infection.
Core Tip: Generally, hepatitis B surface antigen turning negative and the occurrence of hepatitis B surface antibody have been regarded as indicators of virus clearance and clinical recovery in hepatitis B patients. Here, we present a case of hepatis B virus (HBV) infection-associated hepatocellular carcinoma with extreme high titer of hepatitis B surface antibodies, up to 30396 mIU/mL, and failure to eliminate HBV. This case provides details of a diagnostic process for HBV infection-associated hepatocellular carcinoma that should be considered in patients with highly elevated titer of anti-HBs.