Pathobiology
Efforts have been made to elucidate the genetic pathways that are altered during hepatocarcinogenesis.[10] Among the candidate genes involved, the p53, PIKCA,andβ-catenin genes appear to be the most frequently mutated in patients with HCC.
Pathophysiology
Inflammation, necrosis, fibrosis, and ongoing regeneration characterize the cirrhotic liver and contribute to HCC development. In patients with HBV, in whom HCC can develop in livers that are not frankly cirrhotic, underlying fibrosis is usually present, with the suggestion of regeneration. By contrast, in patients with hepatitis C virus (HCV), HCC invariably presents, more or less, in the setting of cirrhosis. This difference may relate to the fact that HBV is a DNA virus that integrates in the host genome and produces HBV X protein that may play a key regulatory role in HCC development;[9] HCV is an RNA virus that replicates in the cytoplasm and does not integrate in the host DNA.
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