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Boortalary et al. Hepatoma Res 2020;6:48 Hepatoma Research
DOI: 10.20517/2394-5079.2020.38

Case Report Open Access

Long-term survival of occult hepatitis B associated
hepatocellular carcinoma following surgery and
antiviral therapy

Tina Boortalary , Ernest Rosato , Christopher Roth , Xiangdong David Ren , Selena Y. Lin , Hie-Won Hann 6
3
2
1
5
4
1 Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
2 Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
3 Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA.
4 Reniguard Life Sciences Inc., Malvern, PA 19355, USA.
5 JBS Science, Inc., Doylestown, PA 18902, USA.
6 Division of Liver Disease Prevention Center, Division of Gastroenterology and Hepatology, Thomas Jefferson University
Hospital, Philadelphia, PA 19107, USA.
Correspondence to: Hie-Won Hann, MD, FAASLD, Department of Medicine, Division of Gastroenterology and Hepatology,
Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. E-mail: hie-won.hann@jefferson.edu
How to cite this article: Boortalary T, Rosato E, Roth C, Ren XD, Lin SY, Hann HW. Long-term survival of occult hepatitis B
associated hepatocellular carcinoma following surgery and antiviral therapy. Hepatoma Res 2020;6:48.
http://dx.doi.org/10.20517/2394-5079.2020.38
Received: 15 Apr 2020 First Decision: 18 May 2020 Revised: 27 May 2020 Accepted: 29 May 2020 Published: 7 Aug 2020
Academic Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
Occult hepatitis B infection (OBI) is characterized by absent hepatitis B surface antigen (HBsAg), low or
undetectable serum hepatitis B viral DNA (HBV-DNA), and detectable DNA in the liver. There is debate over
whether OBI increases the risk of hepatocellular carcinoma (HCC). We present a patient with negative HBsAg and
a large HCC tumor who underwent a large right hepatic lobectomy. Initially, the etiology of HCC was unknown,
but through more sensitive molecular testing, it was believed to be due to OBI. In this case report, we discuss the
patient’s clinical course, the effect of antiviral therapy, mechanism of carcinogenesis in OBI, and the need for more
rigorous HBV DNA assay testing for the detection of OBI.

Keywords: Occult hepatitis B infection, OBI-associated HCC, HBsAg negative HCC

INTRODUCTION
[1]
Hepatitis B virus (HBV) has caused over 50 percent of hepatocellular carcinoma (HCC) cases worldwide .
The prognosis for HCC is generally poor especially when patients present with multifocal disease. Radical
liver resection is usually ineffective as new tumors can present in the remnant liver. High levels of HBV-DNA
are believed to increase the risk for HCC and sensitive molecular testing has identified OBI as a risk factor in

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