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. Author manuscript; available in PMC: 2011 Aug 1.
Published in final edited form as: Pathol Biol (Paris). 2010 Feb 8;58(4):258–266. doi: 10.1016/j.patbio.2009.11.001

Figure 5.

Figure 5

The chronic injury → HCC hypothesis. According to this hypothesis, a vigorous (+++) immune response to HBV leads to viral clearance while an absent (−) immune response leads to the “healthy” carrier state, and an intermediate (+) immune response produces chronic hepatitis. This indolent necroinflammatory liver disease is characterized by chronic liver cell necrosis which stimulates a sustained regenerative response. The inflammatory component includes activated macrophages that are a rich source of free radicals. The collaboration of these mitogenic and mutagenic stimuli has the potential to cause cellular and viral DNA damage, chromosomal abnormalities, genetic mutations, etc, that deregulate cellular growth control in a multistep process that eventually leads to hepatocellular carcinoma. Reprinted from Am J Pathol 2000, 156:1117–1132 with permission from the American Society for Investigative Pathology.