Familial hepatocellular carcinoma in an endemic area of Thailand

Hepatocellular carcinoma (HCC), while rare in the United States and other western countries, represents a major cause of death in certain areas of the world, including southeast Asia. While the etiology of HCC remains enigmatic, it is of interest that hepatitis-B viral infection (HBV) has occurred in significant excess in those geographic regions endemic for HCC. Only limited attention has been given to the role of primary genetic factors in HCC, but scattered anecdotal reports have identified familial aggregations of this disease. We report a family in which histologically verified HCC was found in a mother and two of her four sons, all of whom were concordant for HBV infection. We also briefly discuss two additional familial aggregations of HCC from Costa Rica. We propose that greater attention to be given to the role of primary genetic factors in HCC and that appropriate consideration be given to interaction with other environmental factors, such as aflatoxin exposures, nitrosamines, and HBV infection. While our observations document familial clustering of HCC with concordance for HBV, we caution that support of a genetic hypothesis will require more extensive investigation.