Telomerase activity was examined in 105 frozen samples from human normal liver tissues, chronic liver disease, and hepatocellular carcinoma (HCC). Telomerase activity was positive in 28 of 33 HCC tissues regardless of tumor stage or size. Telomerase was expressed in 15 of 18 differentiated HCC nodules smaller than 3 cm. HCC tissues from all eight hepatitis B virus-positive patients were telomerase positive, while telomerase activity was not detected in normal liver tissues (0 of 4). Weak telomerase activity was only detected in 1 of 22 nontumor liver tissues from HCC patients. Interestingly, in 19 of 38 hepatitis tissues and 6 of 8 cirrhotic liver tissues from apparently cancer-free patients, very weak telomerase activity was detected. These results indicate that the expression of telomerase may play a crucial role in hepatocarcinogenesis.