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Editor,—We read with interest the excellent review article on hepatocellular carcinoma.1 However Badvie omits to mention Budd-Chiari syndrome and diabetes among the conditions associated with this disease. The evidence of hepatocellular carcinoma in patients with Budd-Chiari syndrome is high. In a study of Japanese patients with chronic Budd-Chiari syndrome by Okuda and colleagues,2 and commented on by Kashyap and Kashyap,3 an incidence of hepatocellular carcinoma of 6% was found. Lawson et al observed a fourfold increased risk of hepatocellular carcinoma in diabetic patients in a study designed to evaluate the effects of hepatic enzyme inducing drugs.4 A population based cohort of 153 852 diabetic patients also showed a fourfold risk of liver cancer in these patients, which was greater in males compared with females.5 La Vecchia et al in a case-control study reported an odds ratio risk associated with a history of diabetes of 2.3 and felt that in their study population history of diabetes could account for 8% of cases of liver cancer.6 It is difficult to speculate whether the fatty liver of diabetes is the hepatocellular injury that predisposes to hepatocellular carcinoma or whether it is the presence of diabetes that leads to increased susceptibility of the damaged liver to progression to hepatocellular carcinoma.