Over a 25-year period, investigators (DB Mogul et al. JPGN 2018; 67: 437-440) from 4 medical centers identified 8 patients (8-17 years) with hepatocellular carcinoma (HCC) associated with hepatitis B virus (HBV).

The authors indicate that all of the cases were thought to have acquired HBV via vertical transmission.

Key features:

• 3 were asymptomatic; 50% reported abdominal pain
• Only 1 case presented to a hepatologist
• 4 patients had ALT values <1.5 times the upper limit of normal
• Among those with documented HBeAg (n=3), all were negative and all were positive for anti-HBeAb
• Alphafetoprotein was elevated in 3 patients, normal in 2 patients and not documented in 3 patients.

My take: HCC rarely occurs in children with HBV.  The most effective way to reduce HCC is through prevention, particularly vaccination.  The role of regular imaging which could detect tumors earlier remains unclear (in the absence of a risk factor like cirrhosis); in this series, only one patient presented to a hepatologist.

Related blog posts:

• HBV Vaccination Prevents Cancer  In Taiwan: HCC incidence per 105 person-years was 0.92 in the unvaccinated cohort and 0.23 in the vaccinated birth cohorts. 
• Increasing Incidence of Hepatocellular Carcinoma in the U.S.
• Causes of Death with Hepatitis B in U.S.
• Do antivirals lower the risk of Hepatocellular Carcinoma in HBV?

Lake Agnes, Banff