To evaluate the possibility that HBxAg is related to an enhanced expression of IGF-II, immunohistochemical staining was performed for distribution and colocalization of HBxAg and IGF-II in liver tissues from 40 chronic active hepatitis (CAH-B), 51 cirrhosis and 46 hepatocellular carcinoma (HCC) patients using polyclonal rabbit anti HBxAg raised against full length-recombinant HBxAg and monoclonal mouse anti IGF-II. HBxAg in CAH-B, cirrhosis and HCC tissues was detected in 95%, 39% and 17%, whereas IGF-II in the same tissues was seen in 0%, 92% and 100%, respectively. There was a gradual decrease in the prevalence of HBxAg expression in cirrhosis and HCC, as compared to CAH-B tissues. All of the cirrhosis and HCC samples with positive staining for HBxAg expressed IGF-II. However, 55% of cirrhosis and 100% of HCC samples without HBxAg staining also expressed IGF-II. Moreover, colocalization at neighboring sections, even in both HBxAg and IGF-II positive samples, was not regularly observed. It is concluded that HBxAg expression in CAH-B may play a role in the pathogenesis of CAH-B. Although HBxAg may be related to the expression of IGF-II in some cirrhotic and HCC tissues, IGF-II expression in a large majority of these cases may be related to other factor(s) than HBxAg.