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doctorF 04-27-2010 06:29 AM

HCC related with which Hep virus???
guys i hav a query: there was a question regading this patient with a history of viral hepatitis who complains of early satiety, upper abdominal pain and jaundice, now has a 10 lb weight loss over 3 mnths and reaveals a mass in the liver. which viral hepatitis is the cause... A B C D or E????

considering hapatocellular carcinoma i chose B but the qbank rx says Hep C.... isnt hep B related with HCC and hep C with cirrhosis.... which hep to choose in ur opinion if such a ques appears on boards exam????:rolleyes:

just_md 04-27-2010 08:18 AM

May be this will help
Goljan, p 380, C. 2. (2) - HCC rapidly incr in USA due to incr HCV infection

GNND85 04-27-2010 10:01 AM

Please tell
Hey doctorF,

What did USMLERx say in the explanation

ath.pantelis 04-27-2010 02:16 PM

I remember myself having mistaken a similar question during my preparation, based on the fact that epidemiologically an individual is most probable to be infected by HBV rather than HCV. This is not a correct working hypothesis, though...

First of all, any cause that leads to cirrhosis may lead to HCC as well (including viruses, hemochromatosis, Wilson's disease, alcohol etc). HCC is in a way the natural course of a continuous process of inflammation and tissue regeneration, which statistically may lead to the arising of a clone of cells capable of not undergoing normal apoptosis (or not staying in the G0 phase of the cell cycle, as resting liver cells normally do). So, this would not be a criterion to tell HBV & HCV infections apart.

Another important point is that HCV classically presents with waxing & waning transaminase levels but subliminal symptomatology. Arthralgias, myalgias, cryoglobulinemia & glomerulonephritis may all be present, but these are constitutional, non-specific symptoms.

Following the above data, a case of HCV may evolve subclinically and well evade diagnosis until it presents as HCC. On the contrary, HBV should typically undergo the "stage of clinically evident cirrhosis", before it manifests as HCC.

Another reason could be that HBV causes chronic infection only in approx. 5-10% of infected patients, versus >80% related to HCV. On statistical grounds again, among those 5-10% patients few will develop HCC, which is not the case for the 80% of HCV patients.

Hope this helps...

doctorF 04-27-2010 10:05 PM

wow!! thanks ath.

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