Sir.—Association between hepatitis B surface antigen (HBsAg) and hepatocellular carcinoma (HCC) has been strongly suggested by Szmuness,1 and integrated hepatitis B virus DNA (HBV-DNA) has been demonstrated in human HCC cell lines.2 It has also been strongly suggested that HCC patients acquire hepatitis B virus from their mothers during the perinatal period in populations with a high HBsAg prevalence. To our knowledge, this association has been reported only in adults, more in men than in women.
Patient Report.—A 10-year-old Turkish boy had HCC in whom HBsAg was present but in whom anti–HBs remained negative. He was seen in this hospital on Sept 21, 1984, because of a protuberant abdomen, lassitude for 1½ months' duration, and recent jaundice. He was underdeveloped, cachectic (weight, 24 kg; height, 125 cm; both values less than third percentile), and jaundiced. The liver was markedly enlarged with several very hard masses. The spleen