A high incidence of primary hepatocelluar carcinoma in the Orient and Africa has been reported. It is also seen frequently in Saudi Arabia. In a series of 54 consecutive patients diagnosed histologically, the male to female ratio was 10:1--the highest reported. The peak age was between 40-60 years and the mean survival was eight months. This is in contrast to hepatocelluar carcinoma in Africa where the age is between 25-35 years and the disease runs a quick downhill course simulating an abscess. Macronodular cirrhosis was diagnosed histologically or suggested clinically in 80% of the cases. Serum was positive for HBsAg in 55% of the patients, compared with 8% in healthy blood donors. These figures are as significant as reports from high incidence areas and point strongly to a possible causal relationship between HBV infection and the development of primary hepatocellular carcinoma.
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