Background: Viral hepatitis, particularly hepatitis B (HBV) and hepatitis C (HCV), is highly prevalent in Mongolia. Moreover, Mongolia has the highest prevalence of hepatitis delta virus (HDV) globally, with over 60% of HBV-infected individuals also co-infected with HDV. Since HBV/HDV infections accelerate liver disease progression more compared to HBV infection alone, urgent national health measures are required.Method: This study presents a clinicopathological analysis of 49 hepatocellular carcinoma cases surgically resected at the Mongolia–Japan Hospital of the Mongolian National University of Medical Sciences.Results: HBV infection was found in 27 (55.1%) cases of all HCC cases. Immunohistochemical staining of the liver revealed that 14 (28.6%) cases were HDV antigen-positive in the HCC cases. HDV-positive cases exhibited significantly higher inflammatory activity compared to HDV-negative cases, with lymphocytic infiltrates predominantly composed of CD4-positive cells. Furthermore, HDV-positive cells were spatially distinct from HBs antigen-positive cells, suggesting that HDV-infected cells may interfere with HBV replication. No significant differences in fibrosis or in tumor characteristics were observed between the HDV-positive and negative cases. Early diagnosis of HBV/HDV infections is essential for appropriate treatment and to prevent further domestic transmission of the virus. However, routine testing for HDV infection is rarely conducted in Mongolia. Since HDV-positive cells are morphologically indistinguishable from surrounding HDV-negative cells, routine histopathological analysis may not be sufficient enough to detect HDV infection.Conclusions: Based on this clinicopathological study, CD4 and CD8 immunostaining can be considered an adjunctive diagnostic tool in cases with significant lymphocytic infiltration and hepatocellular damage. Additionally, HDV screening using blood and tissue samples may be recommended to ensure accurate diagnosis.
背景：病毒性肝炎，特别是乙型肝炎（HBV）和丙型肝炎（HCV），在蒙古国高度流行。此外，蒙古国是全球丁型肝炎病毒（HDV）感染率最高的国家，超过60%的HBV感染者同时合并HDV感染。由于HBV/HDV合并感染比单纯HBV感染更快地加速肝脏疾病进展，因此迫切需要采取国家层面的卫生措施。 方法：本研究对蒙古国医科大学蒙日医院手术切除的49例肝细胞癌病例进行了临床病理学分析。 结果：在所有肝细胞癌病例中，发现27例（55.1%）存在HBV感染。肝脏免疫组织化学染色显示，在肝细胞癌病例中，有14例（28.6%）为HDV抗原阳性。与HDV阴性病例相比，HDV阳性病例表现出显著更高的炎症活动度，淋巴细胞浸润主要由CD4阳性细胞组成。此外，HDV阳性细胞在空间分布上与HBs抗原阳性细胞不同，这表明HDV感染细胞可能干扰HBV的复制。在纤维化程度或肿瘤特征方面，HDV阳性与阴性病例之间未观察到显著差异。早期诊断HBV/HDV感染对于进行适当治疗和防止病毒在国内进一步传播至关重要。然而，蒙古国很少进行HDV感染的常规检测。由于HDV阳性细胞在形态学上与周围HDV阴性细胞无法区分，常规组织病理学分析可能不足以检测HDV感染。 结论：基于这项临床病理学研究，在存在显著淋巴细胞浸润和肝细胞损伤的病例中，CD4和CD8免疫染色可被视为一种辅助诊断工具。此外，建议使用血液和组织样本进行HDV筛查，以确保诊断的准确性。
肿瘤(癌症)患者之家