Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 27, 2022; 14(7): 1512-1519
Published online Jul 27, 2022. doi: 10.4254/wjh.v14.i7.1512
Hepatitis B virus markers in hepatitis B surface antigen negative patients with pancreatic cancer: Two case reports
Sergey Batskikh, Sergey Morozov, Dmitry Kostyushev
Sergey Batskikh, Department of Hepatology, Moscow Clinical Research Center named after A.S. Loginov, Moscow 111123, Russia
Sergey Morozov, Department of Gastroenterology, Hepatology and Nutrition, Federal Research Center of Nutrition and Biotechnology, Moscow 115446, Russia
Dmitry Kostyushev, Laboratory of Genetic Technologies, Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases, First Moscow State Medical University (Sechenov University), Moscow 119991, Russia
Dmitry Kostyushev, Division of Biotechnology, Sirius University of Science and Technology, Sochi 354340, Russia
Author contributions: Batskikh S collected the data; Batskikh S and Morozov S analyzed the data; Kostyushev D performed PCR and immunohistochemistry, and prepared the figures; Morozov S and Batskikh S drafted the manuscript; all authors critically revised the manuscript and approved its final version.
Supported by the Ministry of Science and Higher Education, No. FGMF-2022-0005; the Russian Science Foundation, No. 20-15-00373; and the Moscow Healthcare Department, No. AAAA-A18-118021590196-1.
Informed consent statement: The participants provided written informed consent for examination beyond standards of care and use their data for scientific purposes, including publication, prior to study enrollment.
Conflict-of-interest statement: Dr. Morozov reports grants from Russian Science Foundation, personal fees from AstraZeneca, personal fees from AlfaSigma, non-financial support from Laborie, personal fees from DrFalk, personal fees from Takeda, and other from Federal Research Center of Nutrition and Biotechnology, outside the submitted work. Dr. Batskikh reports personal fees from AbbVie, personal fees from MSD, and personal fees from R-PHARM, outside the submitted work. Dr. Kostyushev reports grants from Russian Science Foundation, within submitted work. All authors declare no competing interests.
CARE Checklist (2016) statement: All authors have read the CARE statement - checklist of items and the manuscript was prepared and revised according to CARE statement - checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sergey Morozov, MD, PhD, Doctor, Senior Researcher, Department of Gastroenterology, Hepatology and Nutrition, Federal Research Center of Nutrition and Biotechnology, Kashirskoye Shosse 21, Moscow 115446, Russia. morosoffsv@mail.ru
Received: March 29, 2022
Peer-review started: March 29, 2022
First decision: May 12, 2022
Revised: May 25, 2022
Accepted: June 27, 2022
Article in press: June 27, 2022
Published online: July 27, 2022
Abstract
BACKGROUND

Hepatitis B virus (HBV) is a known carcinogen that may be involved in pancreatic cancer development. Detection of HBV biomarkers [especially expression of HBV regulatory X protein (HBx)] within the tumor tissue may provide direct support for this. However, there is still a lack of such reports, particularly in non-endemic regions for HBV infection. Here we present two cases of patients with pancreatic ductal adenocarcinoma, without a history of viral hepatitis, in whom the markers of HBV infection were detected in blood and in the resected pancreatic tissue.

CASE SUMMARY

The results of examination of two patients with pancreatic cancer, who gave informed consent for participation and publication, were the source for this study. Besides standards of care, special examination to reveal occult HBV infection was performed. This included blood tests for HBsAg, anti-HBc, anti-HBs, HBV DNA, and pancreatic tissue examinations with polymerase chain reaction for HBV DNA, pregenomic HBV RNA (pgRNA HBV), and covalently closed circular DNA HBV (cccDNA) and immunohistochemistry staining for HBxAg and Ki-67. Both subjects were operated on due to pancreatic ductal adenocarcinoma and serum HBsAg was not detected. However, in both of them anti-HBc antibodies were detected in blood, although HBV DNA was not found. Examination of the resected pancreatic tissue gave positive results for HBV DNA, expression of HBx, and active cellular proliferation by Ki-67 index in both cases. However, HBV pgRNA and cccDNA were detected only in case 1.

CONCLUSION

These cases may reflect potential involvement of HBV infection in the development of pancreatic cancer.

Keywords: Pancreatic cancer, Pancreatic ductal adenocarcinoma, Hepatitis B virus, Previous hepatitis B, Anti-HBc, Hepatitis B virus X antigen

Core Tip: Hepatitis B virus (HBV) is a known carcinogen that may be involved in pancreatic cancer development. Detection of HBV biomarkers (especially expression of HBV regulatory X protein) within the tumor tissue may provide direct support for this. However, there is still a lack of such reports, particularly in non-endemic regions for HBV infection. We present two cases of HBsAg-negative patients with pancreatic ductal adenocarcinoma, in whom the markers of HBV were detected in blood and in the tumor tissue. This reflects potential role of the virus in the etiology and pathogenesis of pancreatic ductal adenocarcinoma.