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Uchikoshi M, Ito T, Nakajima Y, Sugiura I, Uozumi S, Shimozuma Y, Sakaki M, Ohira Y, Yamochi T, Yoshida H. Simultaneous gastric, pancreatic, and renal metastasis from poorly differentiated hepatocellular carcinoma. Clin J Gastroenterol 2024; 17:497-504. [PMID: 38451411 PMCID: PMC11127805 DOI: 10.1007/s12328-024-01935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024]
Abstract
Common extrahepatic metastasis sites of hepatocellular carcinoma (HCC) are the lungs, adrenal glands, and bones. Herein, we report a rare case of metastatic gastric, pancreatic, and renal tumors from HCC simultaneously, and review the relevant literature. A 75-year-old woman presented with right hypochondralgia, appetite loss, and weight loss. Computed tomography revealed suspected metastatic liver, lung, and renal tumors. A blood test revealed a leukocyte count of 26,210/μL and a high inflammatory reaction. As sepsis was suspected, the patient was referred to our hospital. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging revealed a hypovascular liver tumor that was suspected to be metastatic. Upper gastrointestinal endoscopy revealed two suspected metastatic gastric tumors. Liver and gastric tumor biopsies revealed poor carcinoma in both. The patient's condition gradually worsened and she died on day 8 of the illness. Based on autopsy findings, the patient was finally diagnosed with metastatic gastric and renal tumors originating from HCC. Additionally, a metastatic pancreatic tumor originating from the HCC was identified during autopsy. The pathological diagnosis of the pulmonary lesion was primary lung adenocarcinoma. In conclusion, HCC should be suspected in cases with multiple metastases of unknown primary lesions.
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Affiliation(s)
- Manabu Uchikoshi
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan.
| | - Takayoshi Ito
- Digestive Diseases Center, Showa University Koto Toyosu Hospital, 5-1-38 Toyosu, Kotoku, Tokyo, 135-8577, Japan
| | - Yoko Nakajima
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Ikuya Sugiura
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Shoujirou Uozumi
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Yuu Shimozuma
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Masashi Sakaki
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Yasuyuki Ohira
- Department of Pathology and Laboratory Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Toshiko Yamochi
- Department of Pathology and Laboratory Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
| | - Hitoshi Yoshida
- Division of Gastroenterology, Department of Internal Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawaku, Tokyo, 142-8666, Japan
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Ye L, Schneider JS, Ben Khaled N, Schirmacher P, Seifert C, Frey L, He Y, Geier A, De Toni EN, Zhang C, Reiter FP. Combined Hepatocellular-Cholangiocarcinoma: Biology, Diagnosis, and Management. Liver Cancer 2024; 13:6-28. [PMID: 38344449 PMCID: PMC10857821 DOI: 10.1159/000530700] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/03/2023] [Indexed: 01/04/2025] Open
Abstract
BACKGROUND Combined hepatocellular-cholangiocarcinoma (cHCC-iCCA) is a rare type of primary liver cancer displaying characteristics of both hepatocytic and cholangiocytic differentiation. SUMMARY Because of its aggressive nature, patients with cHCC-iCCA exhibit a poorer prognosis than those with HCC. Surgical resection and liver transplantation may be considered curative treatment approaches; however, only a minority of patients are eligible at the time of diagnosis, and postoperative recurrence rates are high. For cases that are not eligible for surgery, locoregional and systemic therapy are often administered based on treatment protocols applied for HCC or iCCA. Owing to the rarity of this cancer, there are still no established standard treatment protocols; therefore, the choice of therapy is often personalized and guided by the suspected predominant component. Further, the genomic and molecular heterogeneity of cHCC-iCCA can severely compromise the efficacy of the available therapies. KEY MESSAGES In the present review, we summarize the latest advances in cHCC-iCCA and attempt to clarify its terminology and molecular biology. We provide an overview of the etiology of cHCC-iCCA and present new insights into the molecular pathology of this disease that could contribute to further studies aiming to improve the patient outcomes through new systemic therapies.
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Affiliation(s)
- Liangtao Ye
- Digestive Diseases Center, Guangdong Provincial Key Laboratory of Digestive Cancer Research, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Julia S. Schneider
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Najib Ben Khaled
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | | | - Carolin Seifert
- Institute for Pathology, University Würzburg, Würzburg, Germany
| | - Lea Frey
- Institute for Pathology, University Würzburg, Würzburg, Germany
| | - Yulong He
- Digestive Diseases Center, Guangdong Provincial Key Laboratory of Digestive Cancer Research, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Andreas Geier
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Enrico N. De Toni
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
| | - Changhua Zhang
- Digestive Diseases Center, Guangdong Provincial Key Laboratory of Digestive Cancer Research, the Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Florian P. Reiter
- Division of Hepatology, Department of Medicine II, University Hospital Würzburg, Würzburg, Germany
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Robveille C, Cullen JM. Hepatocellular carcinomas in captive prosimians. Vet Pathol 2022; 59:1012-1021. [PMID: 35876312 DOI: 10.1177/03009858221114471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We performed a retrospective examination of spontaneous hepatocellular carcinomas (HCCs) (primary and metastatic tumors) in 14 captive prosimians brought to the Veterinary Medical Diagnostic Laboratory in North Carolina State University over a period of 11 years (2003 to 2014) to characterize the tumors. These animals are endangered primates; a better understanding of the main fatal neoplasms is crucial. In addition to the histologic evaluation, an immunohistochemical study was also performed, using a hepatocyte marker (hepatocyte paraffin 1 [HepPar-1]) and 2 cholangiocyte markers (keratin 7 [K7] and keratin 19 [K19]), in an attempt to identify a specific profile for HCCs with metastatic behavior. Six of the 14 HCCs had pulmonary metastases. The most frequent histopathological findings were a trabecular pattern (14/14, 100%), presence of multinucleated cells (12/14, 85.7%), and foci of extramedullary hematopoiesis (9/14, 64.3%). The mitotic count was significantly higher in the metastatic HCCs (P < .05). HepPar-1 was detected in all primary and metastatic HCCs, with a strong intensity of staining. Labeling for K7 and K19 was positive in 12 HCCs (85.7%) and 1 HCC (7.1%), respectively. Contrary to the less aggressive HCCs, most of the metastatic HCCs (5/6) expressed K7 in more than 15% of cells. The percentage of K7-positive neoplastic hepatocytes was significantly higher in metastatic HCCs. This study suggests that K7 might be a prognostically relevant marker in HCCs of captive prosimians.
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Mashiko T, Masuoka Y, Nakano A, Tsuruya K, Hirose S, Hirabayashi K, Kagawa T, Nakagohri T. Intussusception due to hematogenous metastasis of hepatocellular carcinoma to the small intestine: A case report. World J Gastroenterol 2020; 26:6698-6705. [PMID: 33268957 PMCID: PMC7673968 DOI: 10.3748/wjg.v26.i42.6698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma (HCC) are the lungs, bones, adrenal glands, and regional lymph nodes. Hematogenous metastasis to the gastrointestinal (GI) tract is a rare condition in patients with HCC, and the prognosis is usually poor. We report, herein, an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy. CASE SUMMARY The patient was a 71-year-old man with a history of chronic hepatitis B, who had undergone three surgeries for HCC. He was treated with sorafenib for peritoneal metastases of HCC. He was admitted to our hospital with chief complaints of abdominal pain and vomiting. Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor, presenting with intussusception and small bowel obstruction. Conservative treatment was started, but due to repeated exacerbation of symptoms, surgery was planned on the 28th d of hospitalization. Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed. On histological examination, tumor cells were not observed on the serosal surface, but intravascular invasion of tumor cells was seen. Immunohistochemistry was positive for immunohistochemical markers, and a diagnosis of hematogenous metastasis of HCC to the ileum was made. He remains alive 82 mo after the first surgery. CONCLUSION Prognosis of HCC patients with GI tract metastasis is usually poor, but in some cases, multidisciplinary therapy may prolong survival.
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Affiliation(s)
- Taro Mashiko
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Yoshihito Masuoka
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Akira Nakano
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Kota Tsuruya
- Department of Gastroenterology, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Shunji Hirose
- Department of Gastroenterology, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Kenichi Hirabayashi
- Department of Pathology, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Tatehiro Kagawa
- Department of Gastroenterology, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
| | - Toshio Nakagohri
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara 2591193, Kanagawa, Japan
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Xia Y, Zhang J, Ni X. Diagnosis, treatment and prognosis of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus. Oncol Lett 2020; 20:101. [PMID: 32831920 PMCID: PMC7439153 DOI: 10.3892/ol.2020.11962] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
Although tumor thrombus (TT) infringement of the inferior vena cava (IVC) and right atrium (RA) is rarely observed in hepatocellular carcinoma (HCC), the prognosis for this condition is extremely poor, with a median survival time of several months, given that the condition is often diagnosed at an advanced tumor stage or combined with multiple systemic metastases. Furthermore, there is no established effective treatment for the condition. However, some investigators insist that active treatment, including surgery, chemotherapy (systemic or intra-arterial), radiation therapy, best supportive care or a combination of these, may help prolong overall survival time in these patients. The management of patients with advanced HCC and a TT extending into the RA and IVC is extremely difficult and risky. To this end, the present review assessed the literature on the clinical features and treatments of this condition in recent years, with the aim of providing assistance for clinical work.
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Affiliation(s)
- Yinchuan Xia
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
| | - Junqi Zhang
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
| | - Xiaoling Ni
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
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Yu YM, Cao YS, Wu Z, Huang R, Shen ZL. Colon metastasis from hepatocellular carcinoma: a case report and literature review. World J Surg Oncol 2020; 18:189. [PMID: 32723336 PMCID: PMC7389379 DOI: 10.1186/s12957-020-01960-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/17/2020] [Indexed: 01/10/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a malignant tumor with frequent intrahepatic metastases; extrahepatic metastases are not rare but less frequent compared to intrahepatic ones. The most frequent sites of extrahepatic metastases are the lungs, followed by the lymph nodes, bones, and adrenal glands. Case report covering gastrointestinal (GI) tract involvement from HCC is limited. Case presentation A 60-year-old man was referred to us in May 2019 with a diagnosis of sigmoid colon tumor. The patient had a history of HCC and had received two stages of open resections for the primary and the abdominal metastasis successively and many times of transcatheter arterial chemoembolization (TACE). The sigmoid colon tumor received Hartmann procedure after abdominal enhanced computerized tomography (CT) scan and colonoscopy, while postoperative pathology and immunohistochemistry identified it as extrahepatic colonic metastasis from HCC. Conclusions The ratio of extrahepatic metastasis to the digestive tract was very low, and the majority was upper gastrointestinal involvement because of direct invasion or intraperitoneal implantation. TACE may be the risk factor of retrograde hematogenous metastasis to the downstream colon. Keywords Hepatocellular carcinoma; Extrahepatic metastases; Colon metastasis; Transcatheter arterial chemoembolization
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Affiliation(s)
- Yong-Ming Yu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, 315000, China
| | - Yi-Sheng Cao
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, China. .,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, China. .,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, 315000, China.
| | - Zhou Wu
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, 315000, China
| | - Rong Huang
- Ningbo Pathological Diagnosis Center, Ningbo, 315000, China
| | - Zhong-Lei Shen
- Department of General Surgery, HwaMei Hospital, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, 315000, China.,Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, Ningbo, 315000, China
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Tagliabue F, Burati M, Chiarelli M, Marando A, Simone MD, Cioffi U. Left colonic metastasis from primary hepatocellular carcinoma: A case report. World J Clin Cases 2019; 7:2044-2048. [PMID: 31423436 PMCID: PMC6695552 DOI: 10.12998/wjcc.v7.i15.2044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/29/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) accounts for 5-6% of all human cancers. Considering the extrahepatic metastasis, the main organs involved are lymphnodes, lung, bone and adrenal gland. Usually colon metastasis is very rare, especially on the left sided colon.
CASE SUMMARY We report a case of a 70 years-old man hepatitis B carrier with HCC treated four times with trans-arterial chemoembolization, presented to our surgical department complaining of gastrointestinal bleeding. A colonoscopy revealed a mass of 4 cm of the sigmoid colon with signs of bleeding. The computed tomography showed a mass originated from the sigmoid colon of 3.5 cm, and the presence of HCC in segment VI and VII, without portal vein thrombosis. Due to the large size of the mass and the active bleeding, the patient underwent a left colectomy. The postoperative period was uneventful, and the patient was discharged in fifth post-operative day. Histological examination revealed that the neoplasm was characterized by a diffuse proliferation of epithelial cells with an hepatoid differentiation. So, the presence of a history of HCC of the liver and the histopathological features supported the diagnosis of metastasis from the liver.
CONCLUSION Although rare, colon metastasis from an HCC can be left-sided and can present with acute bleeding.
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Affiliation(s)
- Fulvio Tagliabue
- Department of Emergency and Robotic Surgery, Ospedale “A Manzoni” Lecco via Dell’Eremo 9/11, Lecco 23900, Italy
| | - Morena Burati
- Department of Emergency and Robotic Surgery, Ospedale “A Manzoni” Lecco via Dell’Eremo 9/11, Lecco 23900, Italy
| | - Marco Chiarelli
- Department of Emergency and Robotic Surgery, Ospedale “A Manzoni” Lecco via Dell’Eremo 9/11, Lecco 23900, Italy
| | - Alessandro Marando
- Department of Pathology, Ospedale “A Manzoni” Lecco via Dell’Eremo 9/11, Lecco 23900, Italy
| | | | - Ugo Cioffi
- Department of Surgery, University of Milan, Milano 20122, Italy
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Imai M, Ishikawa T, Okoshi M, Tomiyoshi K, Kojima Y, Horigome R, Nozawa Y, Sano T, Iwanaga A, Honma T, Nemoto T, Takeda K, Nishikura K, Ishihara N, Yoshida T. Hemorrhagic Gastric Metastasis from Hepatocellular Carcinoma Successfully Treated Using Coil Embolization of the Left Gastric Artery. Intern Med 2019; 58:2179-2183. [PMID: 30996163 PMCID: PMC6709331 DOI: 10.2169/internalmedicine.2172-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
A 62-year-old man initially underwent transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma (HCC). One year after the initial treatment, he developed anemia. Upper gastrointestinal endoscopy revealed irregularly elevated tumors in the lower anterior gastric body, which were diagnosed to be metastasis from HCC. Left gastric artery coil embolization was performed to prevent sustained bleeding, and his anemia partially improved. In addition to direct invasion, hematogenous metastasis to the stomach from HCC is possible and therefore should be considered during treatment. Transcatheter arterial embolization for gastric metastasis is an effective treatment method which achieves a good degree of hemostasis in patients without any surgical indications.
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Affiliation(s)
- Michitaka Imai
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Marina Okoshi
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Kei Tomiyoshi
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Yuichi Kojima
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Ryoko Horigome
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Yujiro Nozawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Tomoe Sano
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Akito Iwanaga
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
| | - Takeo Nemoto
- Department of Radiology, Saiseikai Niigata Daini Hospital, Japan
| | - Keiko Takeda
- Department of Radiology, Saiseikai Niigata Daini Hospital, Japan
| | - Ken Nishikura
- Department of Pathology, Saiseikai Niigata Daini Hospital, Japan
| | - Noriko Ishihara
- Department of Pathology, Saiseikai Niigata Daini Hospital, Japan
| | - Toshiaki Yoshida
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Japan
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Andreola S, Audisio RA, Mazzaferro V, Doci R, Milella M. Spontaneous Massive Necrosis of a Hepatocellular Carcinoma. TUMORI JOURNAL 2018; 73:203-7. [PMID: 3033859 DOI: 10.1177/030089168707300220] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A case of hepatocellular carcinoma that underwent total necrosis without previous chemotherapy is described. Histologic examination of the neoplasm revealed massive thrombosis of numerous peritumoral venous vessels in the adjacent normal liver. Although the importance of a newly formed arterial blood supply for the maintenance of the viability of hepatocellular carcinoma is unquestionable, this case suggests a similar importance of the venous drainage of the surrounding liver.
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Abstract
A 76-year-old man with hepatocellular carcinoma associated with alcoholic cirrhosis was hospitalized for lightheadedness and melena. He had undergone multiple surgeries and had been treated with transcatheter arterial chemoembolization and sorafenib. Neither upper nor lower gastrointestinal endoscopy detected the source of bleeding. Oral double-balloon enteroscopy revealed a mass lesion in the upper jejunum, 20 cm from the Treitz ligament on the anal side, which was identified as the source of bleeding. Subsequently, a biopsy was performed. A histopathological examination detected a hepatocellular carcinoma, and a final diagnosis of jejunal metastasis from hepatocellular carcinoma was established.
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Affiliation(s)
- Mimari Kanazawa
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Takeshi Sugaya
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | - Keiichi Tominaga
- Department of Gastroenterology, Dokkyo Medical University, Japan
| | | | | | - Masakazu Nakano
- Department of Gastroenterology, Dokkyo Medical University, Japan
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Bannasch P, Ribback S, Su Q, Mayer D. Clear cell hepatocellular carcinoma: origin, metabolic traits and fate of glycogenotic clear and ground glass cells. Hepatobiliary Pancreat Dis Int 2017; 16:570-594. [PMID: 29291777 DOI: 10.1016/s1499-3872(17)60071-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/14/2017] [Indexed: 02/05/2023]
Abstract
Clear cell hepatocellular carcinoma (CCHCC) has hitherto been considered an uncommon, highly differentiated variant of hepatocellular carcinoma (HCC) with a relatively favorable prognosis. CCHCC is composed of mixtures of clear and/or acidophilic ground glass hepatocytes with excessive glycogen and/or fat and shares histology, clinical features and etiology with common HCCs. Studies in animal models of chemical, hormonal and viral hepatocarcinogenesis and observations in patients with chronic liver diseases prone to develop HCC have shown that the majority of HCCs are preceded by, or associated with, focal or diffuse excessive storage of glycogen (glycogenosis) which later may be replaced by fat (lipidosis/steatosis). In ground glass cells, the glycogenosis is accompanied by proliferation of the smooth endoplasmic reticulum, which is closely related to glycogen particles and frequently harbors the hepatitis B surface antigen (HBsAg). From the findings in animal models a sequence of changes has been established, commencing with preneoplastic glycogenotic liver lesions, often containing ground glass cells, and progressing to glycogen-poor neoplasms via various intermediate stages, including glycogenotic/lipidotic clear cell foci, clear cell hepatocellular adenomas (CCHCA) rich in glycogen and/or fat, and CCHCC. A similar process seems to take place in humans, with clear cells frequently persisting in CCHCC and steatohepatitic HCC, which presumably represent intermediate stages in the development rather than particular variants of HCC. During the progression of the preneoplastic lesions, the clear and ground glass cells transform into cells characteristic of common HCC. The sequential cellular changes are associated with metabolic aberrations, which start with an activation of the insulin signaling cascade resulting in pre-neoplastic hepatic glycogenosis. The molecular and metabolic changes underlying the glycogenosis/lipidosis are apparently responsible for the dramatic metabolic shift from gluconeogenesis to the pentose phosphate pathway and Warburg-type glycolysis, which provide precursors and energy for an ever increasing cell proliferation during progression.
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Affiliation(s)
| | - Silvia Ribback
- Institut für Pathologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Qin Su
- Cell Marque, Millipore-Sigma Rocklin, USA
| | - Doris Mayer
- German Cancer Research Center, Heidelberg, Germany
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Ma KW, Chok KSH. Importance of surgical margin in the outcomes of hepatocholangiocarcinoma. World J Hepatol 2017; 9:635-641. [PMID: 28539991 PMCID: PMC5424293 DOI: 10.4254/wjh.v9.i13.635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/03/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the significance of resection margin width in the management of hepatocholangiocarcinoma (HCC-CC).
METHODS Data of consecutive patients who underwent hepatectomy for hepatic malignancies in the period from 1995 to 2014 were reviewed. Patients with pathologically confirmed HCC-CC were included for analysis. Demographic, biochemical, operative and pathological data were analyzed against survival outcomes.
RESULTS Forty-two patients were included for analysis. The median age was 53.5 years. There were 29 males. Hepatitis B virus was identified in 73.8% of the patients. Most patients had preserved liver function. The median preoperative indocyanine green retention rate at 15 min was 10.2%. The median tumor size was 6.5 cm. Major hepatectomy was required in over 70% of the patients. Hepaticojejunostomy was performed in 6 patients. No hospital death occurred. The median hospital stay was 13 d. The median follow-up period was 32 mo. The 5-year disease-free survival and overall survival were 23.6% and 35.4% respectively. Multifocality was the only independent factor associated with disease-free survival [P < 0.001, odds ratio 4, 95% confidence interval (CI): 1.9-8.0]. In patients with multifocal tumor (n = 20), resection margin of ≥ 1 cm was associated with improved 1-year disease-free survival (40% vs 0%; log-rank, P = 0.012).
CONCLUSION HCC-CC is a rare disease with poor prognosis. Resection margin of 1 cm or above was associated with improved survival outcome in patients with multifocal HCC-CC.
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Abdul Hakim MS, Azmi AN, Jayalakshmi P, Mahadeva S. Gastric Metastasis from Hepatocellular Carcinoma: A Rare Manifestation. J Gastrointest Cancer 2017; 49:346-348. [PMID: 28066868 DOI: 10.1007/s12029-016-9913-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | - Ahmad Najib Azmi
- Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Nilai, Malaysia
| | - Pailoor Jayalakshmi
- Department of Pathology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sanjiv Mahadeva
- Department of Gastroenterology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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Ikeda A, Nagayama S, Yamamoto N, Akiyoshi T, Konishi T, Fujimoto Y, Fukunaga Y, Ishikawa Y, Ueno M. A rare case of hepatocellular carcinoma metastasizing hematogenously to the rectum. Int Cancer Conf J 2016; 5:168-173. [PMID: 31149448 DOI: 10.1007/s13691-016-0251-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/14/2016] [Indexed: 11/25/2022] Open
Abstract
Metastasis to the gastrointestinal tract from hepatocellular carcinoma is uncommon. Herein, we report a rare case of with a metastatic lesion in the rectum, which resembled a primary rectal cancer. An 82-year-old Japanese woman, who had been diagnosed with liver cirrhosis and hepatocellular carcinoma due to chronic hepatitis C, was admitted for further examination of bloody stool. She had undergone radiofrequency ablation twice and transarterial chemoembolization twice before the admission. A colonoscopy revealed a protruding rectal tumor, which was confirmed by biopsy to be poorly differentiated adenocarcinoma. Meanwhile multiple liver recurrences were recognized by an abdominal computed tomography scan. To improve her symptoms and resume the treatment of hepatocellular carcinoma, laparoscopic anterior resection of the rectum was performed to remove the primary rectal cancer. To our surprise, detailed histological examination confirmed that the rectal tumor was a metastatic lesion from the hepatocellular carcinoma.
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Affiliation(s)
- Atsushi Ikeda
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Satoshi Nagayama
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Noriko Yamamoto
- 2Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Tsuyoshi Konishi
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Yoshiya Fujimoto
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Yosuke Fukunaga
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
| | - Yuichi Ishikawa
- 2Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- 1Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku Tokyo, 135-8550 Japan
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15
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Gyedu A, Shrauner WR, Kingham TP. No patients to resect or transplant: an analysis of patients with hepatocellular carcinoma admitted to a major African referral hospital. World J Surg 2015; 39:231-6. [PMID: 25167899 DOI: 10.1007/s00268-014-2762-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to describe the characteristics of patients diagnosed with hepatocellular carcinoma (HCC) at the Komfo Anokye Teaching Hospital (KATH) in Ghana and to determine their treatment options per the Barcelona Clinic Liver Cancer (BCLC) algorithm. METHODS We reviewed the medical records of patients diagnosed with HCC at KATH in the period 2007-2013. Patient demographics, medical history, investigations, management, and outcome were extracted. BCLC staging was applied to determine their treatment options. Results were expressed as descriptive statistics. RESULTS The charts for 206/465 patients were available for review. The male:female ratio was 2:1 and mean age was 44.0 ± 14.5 years. Common presenting complaints were abdominal distension, abdominal pain, and jaundice. hepatitis B virus (HBV) positivity was 52 %. Almost all patients received only supportive treatment. None underwent surgery, ablation, or transarterial chemoembolization. BCLC staging could be completed for 118 patients. Using predicted INR values in cases without the result, < 8 % of patients were eligible for resection, transplantation, or ablation; 25-53 % were eligible for embolization or sorafenib therapy. Up to 72 % were eligible only for supportive care. Seventy-six percent of patients reviewed were discharged alive; 71 % of patients whose charts were not available died during an admission. Thus, of the 465-patient cohort, 50 % died in the hospital. CONCLUSIONS The majority of HCC in our population is caused by HBV. Up to 61 % of patients may be eligible for curative treatment, transarterial chemoembolization, or sorafenib treatment. This percentage may be increased with a robust surveillance program for patients at increased risk for HCC. Hepatitis B vaccination must also be a public health priority.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Private Mailbag, University Post Office, Kumasi, Ghana,
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16
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Metastatic Periampullary Tumor from Hepatocellular Carcinoma Presenting as Gastrointestinal Bleeding. Case Rep Gastrointest Med 2015; 2015:732140. [PMID: 26064707 PMCID: PMC4429209 DOI: 10.1155/2015/732140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/13/2015] [Indexed: 01/29/2023] Open
Abstract
Periampullary tumors constitute a number of diverse neoplastic lesions located within 2 cm of the major duodenal papilla; among these, metastatic lesions account for only a small proportion of the periampullary tumors. To our knowledge, a metastatic periampullary tumor from hepatocellular carcinoma has never been reported. A 62-year-old male reported to our institute for fatigue and low hemoglobin. His medical history was remarkable for multifocal hepatocellular carcinoma (HCC) treated with selective transcatheter arterial chemoembolization (TACE). An esophagogastroduodenoscopy (EGD) was performed which revealed a periampullary mass. Histopathology was consistent with metastatic moderately differentiated HCC. Two endoloops were deployed around the base of the mass one month apart. The mass eventually sloughed off and patient's hemoglobin level stabilized. We postulated that periampullary metastasis in this patient was the result of tumor fragments migration through the biliary tracts and that TACE which increases tumor fragments burden might have played a contributory role. Metastasis of HCC to the gastrointestinal (GI) tract should be considered as a cause of GI bleeding.
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17
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Kew MC. Hepatitis B Virus: Epidemiology and Clinical Features of Related Cancer. VIRUSES AND HUMAN CANCER 2014:133-165. [DOI: 10.1007/978-1-4939-0870-7_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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18
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Abstract
The hepatitis B virus (HBV) plays a dominant role in the 749,000 new cases and 692,000 deaths related to hepatocellular carcinoma (HCC) that are estimated to occur each year worldwide. Chronic infection with HBV is responsible for 60% of HCCs in Asia and Africa and at least 20% of the tumors in Europe, Japan, and the United States. This article discusses the pathogenic role of HBV and the risk of HCC. Tumors almost invariably develop in the context of chronic hepatitis or cirrhosis, which makes early diagnosis the only practical approach to improve prognosis. The treatment options are also discussed.
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Affiliation(s)
- Massimo Iavarone
- 1st Division of Gastroenterology, A.M. & A. Migliavacca Center for Liver Disease, Fondazione IRCCS Ca' Granda Maggiore Hospital, Università degli Studi di Milano, Via F. Sforza 35, Milan 20122, Italy
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19
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20
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Zheng R, Dong F, Qiang W, Wang Y. Nurses' experiences with catastrophic upper gastrointestinal bleeding in patients with hepatocellular carcinoma: a qualitative study. Eur J Oncol Nurs 2013; 17:408-15. [PMID: 23337318 DOI: 10.1016/j.ejon.2012.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 11/21/2012] [Accepted: 12/01/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To explore how nurses experienced catastrophic upper gastrointestinal bleeding in hepatocellular carcinoma (HCC) patients. METHODS A qualitative descriptive method was used. Data were collected by semi- structured interviews. Twenty-one registered nurses who had taken care of HCC patients with catastrophic upper gastrointestinal bleeding were purposely recruited from the Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute and Hospital located in mainland China. RESULTS Four themes explicated from the study were: feelings expressed during the process of rescuing the lives of patients, feelings expressed from succeeding or failing to save the lives of patients, feelings expressed from family members response to nurses' actions, the impact of the experience on the personal life, work and philosophy of life of the nurse subjects. CONCLUSIONS The findings of this study indicate that it is necessary for nursing leaders to take effective measures to improve nurses' nursing skills, to provide more education in care of the dying, to offer nurses services that address their psychosocial health and to provide them with emotional support.
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Affiliation(s)
- Ruishuang Zheng
- Department of Hepatobiliary Cancer, Tianjin Medical University Cancer Institute and Hospital, Huanhu Middle Road, Tiyuanbei, Hexiqu, 300060 Tianjin, China.
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21
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Abstract
Hepatocellular Carcinoma (HCC) is the most frequent primary liver malignancy, mostly occurring in the context of chronic liver diseases leading to cirrhosis. Epidemiological data demonstrate the increasing incidence of HCC worldwide, mainly related to viral hepatitis and metabolic syndrome. Pathological analysis recognizes several types of HCC according to macroscopic and microscopic features. A subset of HCC can develop on normal liver and usually corresponds to specific variants, including fibrolamellar carcinoma mostly encountered in young population. Prognosis of HCC remains poor, depending on delayed tumor diagnosis, the clinical status of the patient but also tumor behavior with a great propensity for angioinvasion.
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Affiliation(s)
- Valérie Paradis
- Departement of Pathology, Beaujon Hospital-Assistance Publique-Hôpitaux de Paris, Clichy, France.
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22
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Kim JN, Lee HS, Kim SY, Kim JH, Jung SW, Koo JS, Yim HJ, Lee SW, Choi JH, Kim CD, Ryu HS. Endoscopic treatment of duodenal bleeding caused by direct hepatocellular carcinoma invasion with an ethanol injection. Gut Liver 2012; 6:122-5. [PMID: 22375182 PMCID: PMC3286730 DOI: 10.5009/gnl.2012.6.1.122] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/10/2010] [Indexed: 11/04/2022] Open
Abstract
We report a case of a man who developed duodenal bleeding caused by direct hepatocellular carcinoma (HCC) invasion, which was successfully treated with endoscopic ethanol injection. A 57-year-old man with known HCC was admitted for melena and exertional dyspnea. He had been diagnosed with inoperable HCC a year ago. Urgent esophagogastroduodenoscopy (EGD) showed two widely eroded mucosal lesions with irregularly shaped luminal protruding hard mass on the duodenal bulb. Argon plasma coagulation and Epinephrine injection failed to control bleeding. We injected ethanol via endoscopy to control bleeding two times with 14 cc and 15 cc separately without complication. Follow-up EGD catched a large ulcer with necrotic and sclerotic base but no bleeding evidence was present. He was discharged and he did relatively well during the following periods. In conclusion, Endoscopic ethanol injection can be used as a significantly effective and safe therapeutic tool in gastrointestinal tract bleeding caused by HCC invasion.
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Affiliation(s)
- Jin Nam Kim
- Division of Gastroenterology, Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
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23
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Jeong GH, Ye BD, Myung SJ. [Multiple colonic metastases from hepatocellular carcinoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 58:288-92. [PMID: 22113048 DOI: 10.4166/kjg.2011.58.5.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Gwi Hong Jeong
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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24
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Lee YJ, Kim JH, Song HY, Park JH, Na HK, Kim PH, Fan Y. Hepatocellular Carcinoma Complicated by Gastroduodenal Obstruction: Palliative Treatment with Metallic Stent Placement. Cardiovasc Intervent Radiol 2011; 35:1129-35. [PMID: 21882080 DOI: 10.1007/s00270-011-0262-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 08/14/2011] [Indexed: 01/14/2023]
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25
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Lin TL, Yap AQ, Wang JH, Chen CL, Iyer SG, Low JK, Lin CC, Li WF, Chen TY, Bora D, Lin CY, Wang CC. Long term survival in patients with hepatocellular carcinoma directly invading the gastrointestinal tract: case reports and literature review. Surg Oncol 2011; 20:e207-14. [PMID: 21824763 DOI: 10.1016/j.suronc.2011.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 05/09/2011] [Accepted: 06/29/2011] [Indexed: 01/28/2023]
Abstract
Hepatocellular carcinoma (HCC) directly invading the gastrointestinal (GI) organs is rare and is associated with poor survival outcome. We report two patients with good long-term outcome following resection of HCC that invaded the stomach and duodenum, respectively. A literature review was conducted to elucidate the course of patients with this pathology. Two cases (57-year-old and 72-year-old males) with enlarged hepatic tumors directly invading the stomach and duodenum underwent hepatectomies with en-bloc resection of the involved organs. Both patients are still alive at 80 and 68 months following the surgery. Our literature review showed that most of the patients with this pathology have manifested, and died of persistent GI bleeding. Patients who were treated surgically had a statistically significant longer survival than those who were treated with non-surgical palliative treatments (P < 0.001). In addition, patients who were treated with surgery with curative intent tend to have a longer survival times than those who were treated with surgery to palliate the bleeding but the difference was not statistically significant (P < 0.174). Removing the tumor completely could significantly prolong the survival of patients with HCC invading the GI tract.
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Affiliation(s)
- Ting-Lung Lin
- Division of General Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan
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Yoo DJ, Chung YH, Lee YS, Kim SE, Jin YJ, Lee YM, Kim MJ. Sigmoid colon metastasis from hepatocellular carcinoma. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 16:397-400. [PMID: 21415584 PMCID: PMC3304608 DOI: 10.3350/kjhep.2010.16.4.397] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hepatocellular carcinoma (HCC) is a major health problem worldwide, and it has a poor prognosis. Extrahepatic metastasis from HCC is not unusual, with direct invasion representing the main spreading mode. Sites that are frequently involved are the lung, bone, and lymph nodes. There are few reports of HCC invading the distant gastrointestinal tract, especially hematogenously. Herein we report a case of sigmoid colon metastasis from HCC. The patient was diagnosed with HCC and treated with transcatheter arterial chemoembolization (TACE). Eighteen months after TACE the patient presented with abdominal pain on the left lower quadrant, and a CT scan showed an enhanced mass on the sigmoid colon. Immunohistochemical staining revealed that a tumor cell was positive for polyclonal carcinoembryonic antigen and weakly positive for hepatocyte antigen, supporting the diagnosis of HCC metastasis. The patient underwent anterior resection for the metastatic HCC.
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Affiliation(s)
- Dong Jun Yoo
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
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27
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Kato Y, Matsubara K, Akiyama Y, Hattori H, Hirata A, Yamamoto T, Suzuki F, Ohtaka H, Sugiura Y, Kitajima M. Direct biliopancreatoduodenal invasion by hepatocellular carcinoma: report of the first resected case and review of the literature. Int J Clin Oncol 2010; 16:421-7. [DOI: 10.1007/s10147-010-0136-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Accepted: 09/09/2010] [Indexed: 12/21/2022]
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Abstract
Combined hepatocellular-cholangiocarcinoma is a rare primary neoplasm in the liver. It has gained increasing recognition recently, which in part may be due to more extensive sampling of the explants and surgical resection specimens, the diagnostic challenges encountered in the clinical practice, and the yet to be determined clinical outcome, but partly may be attributed to its intriguing histogenesis/cells of origin. This review aims to update combined hepatocellular-cholangiocarcinoma with an emphasis on the pathological diagnosis, including the differential diagnosis and its diagnostic pitfalls, the possible cell of origin of this neoplasm, and its clinical outcome.
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Affiliation(s)
- Matthew M Yeh
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Hu ML, Tai WC, Chuah SK, Chiu YC, Wu KL, Chou YP, Kuo CM, Hu TH, Chiu KW. Gastric metastasis of hepatocellular carcinoma via a possible existing retrograde hematogenous pathway. J Gastroenterol Hepatol 2010; 25:408-412. [PMID: 19929932 DOI: 10.1111/j.1440-1746.2009.06022.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIM Hepatocellular carcinoma (HCC) tends to metastasize to extrahepatic organs. Stomach involvement has been seldom reported and has always been considered as direct invasion. This study aims to propose a possible existing pathway for the hematogenous metastasis of HCC to the stomach. METHODS Only seven cases with stomach involvement were found from 8267 HCC patients registered at our hospital between 2000 and 2007. Their laboratory data, the findings of computed tomography and upper endoscopy, therapeutic procedures, such as esophageal variceal banding ligation (EVL), and transhepatic arterial embolization (TAE) were further studied. RESULTS All seven patients were male. Liver cirrhosis was found in six patients (6/7 = 85.7%), HCC with portal vein thrombosis (PVT) in six patients (6/7 = 85.7%), splenomegaly in five patients (5/7 = 71.4%) and esophageal varices in five patients (5/7 = 71.4%). Six patients underwent TAE and one patient underwent EVL before the development of HCC in the stomach. Four patients had HCC at the cardia, one patient at the anterior wall of the high body and two patients at the greater curvature of the high body, far away from the original HCC. Six patients eventually developed distant metastasis. HCC with gastric metastasis developed 53-126 days after TAE in five patients and 74 days after EVL in one patient. CONCLUSIONS When cirrhotic patients with portal hypertension have HCC with PVT, a hematogenous pathway can exist for gastric metastasis of tumor thrombi involving hepatofugal flow to the stomach after TAE or EVL apart from the major pathway of direct invasion.
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Affiliation(s)
- Ming-Luen Hu
- Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan
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Hepatocellular carcinoma with intracavitary cardiac involvement: a case report and review of the literature. Am J Cardiol 2008; 102:643-5. [PMID: 18721529 DOI: 10.1016/j.amjcard.2008.04.042] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 04/17/2008] [Accepted: 04/17/2008] [Indexed: 12/25/2022]
Abstract
A 71-year-old man with hepatocellular carcinoma (HCC) presented with intracavitary cardiac involvement detected incidentally on surveillance computed tomography. Tumor with associated thrombus was found to extend from the liver through the inferior vena cava into the right atrium. This intracardiac mass prolapsed intermittently into the right ventricle, causing functional tricuspid stenosis. The mass was resected but recurred after 4 months, eventually causing refractory right-sided heart failure. This case illustrates how intracavitary cardiac involvement of HCC can develop insidiously and confer significant hemodynamic compromise. A review of the published research, including postmortem studies, demonstrates that the frequency of intracardiac mass lesions in HCC is not insignificant. In conclusion, early detection and diagnosis may have increasing importance in the advent of new therapies for treating advanced HCC.
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Hirashita T, Ohta M, Iwaki K, Kai S, Shibata K, Sasaki A, Nakashima K, Kitano S. Direct invasion to the colon by hepatocellular carcinoma: Report of two cases. World J Gastroenterol 2008; 14:4583-5. [PMID: 18680245 PMCID: PMC2731292 DOI: 10.3748/wjg.14.4583] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although hepatocellular carcinoma (HCC) is a common tumor, direct invasion of the gastrointestinal tract by HCC is uncommon. Recently, we encountered two cases of HCC with direct invasion to the colon. The first patient was a 79-year-old man who underwent transarterial chemo-embolization (TACE) for HCC 1.5 years prior to admission to our hospital. Computed tomography (CT) showed a 7.5-cm liver tumor directly invading the transverse colon. Partial resection of the liver and transverse colon was performed. The patient survived 6 mo after surgery, but died of recurrent HCC. The second patient was a 69-year-old man who underwent TACE and ablation for HCC 2 years and 7 months prior to being admitted to our hospital for melena and abdominal distension. CT revealed a 6-cm liver tumor with direct invasion to the colon. The patient underwent partial resection of the liver and right hemicolectomy. The patient recovered from the surgery. But, unfortunately, he died of liver failure due to liver cirrhosis one month later. Although the prognosis of HCC that has invaded the colon is generally poor due to the advanced stage of the disease, surgical resection may be a favorable treatment option in patients with a good general condition.
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32
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Ong JCA, Chow PKH, Chan WH, Chung AYF, Thng CH, Wong WK. Hepatocellular carcinoma masquerading as a bleeding gastric ulcer: A case report and a review of the surgical management. World J Gastroenterol 2007; 13:4523-5. [PMID: 17724814 PMCID: PMC4611591 DOI: 10.3748/wjg.v13.i33.4523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular Carcinoma (HCC) is a common malignancy worldwide. While bleeding from the gastrointestinal tract (BGIT) has a well known association with HCC, such cases are mainly due to gastric and esophageal varices. BGIT as a result of invasion of the gastrointestinal tract by HCC is extremely rare and is reportedly associated with very poor prognosis. We describe a 67-year-old male who presented with BGIT. Endoscopy showed the site of bleeding to be from a gastric ulcer, but endoscopic therapy failed to control the bleeding and emergency surgery was required. At surgery, the ulcer was found to have arisen from direct invasion of the gastrointestinal tract by HCC of the left lobe. Control of the bleeding was achieved by surgical resection of the HCC en-bloc with the lesser curve of the stomach. The patient remains alive 33 mo after surgery. Direct invasion of the gastrointestinal tract by HCC giving rise to BGIT is very uncommon. Surgical resection may offer significantly better survival over non-surgical therapy, especially if the patient is a good surgical candidate and has adequate functional liver reserves. Prognosis is not uniformly grave.
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Affiliation(s)
- Johnny C A Ong
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore, Singapore
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33
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Tapuria N, Sinha CK, Michael NG, Fisher PW. Haematogenous metastasis to ascending colon in a patient with hepatocellular carcinoma and autoimmune hepatitis. Eur J Gastroenterol Hepatol 2007; 19:607-9. [PMID: 17556911 DOI: 10.1097/meg.0b013e3281c55f3e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The association of hepatocellular carcinoma with chronic active autoimmune hepatitis and haematogenous metastasis to ascending colon has not been reported previously in the literature. The patient was asymptomatic for colonic disease and the finding of colonic involvement was incidental on scans subsequently confirmed by colonoscopy. Usually hepatocellular tumour mass would involve the colon by direct contiguity. Owing to haematogenous metastasis, which is extremely rare, the colonic mass was discontiguous from hepatic tumour lesions. The unique presentation of this case and the differential diagnosis of hepatic tumours coexisting with colonic tumours are highlighted in this case report.
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Affiliation(s)
- Niteen Tapuria
- Academic Department of Surgery, Royal Free Hospital, Hampstead, London, UK.
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Kaibori M, Morita M, Tagami S, Uchida Y, Tanaka H, Yoshioka K, Takahashi Y, Sakaida N, Uemura Y, Seki T, Okazaki K, Kamiyama Y. Cutaneous and colonic metastases after resection of hepatocellular carcinoma. Dig Dis Sci 2007; 52:1114-7. [PMID: 17342390 DOI: 10.1007/s10620-006-9465-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Accepted: 05/24/2006] [Indexed: 12/15/2022]
Affiliation(s)
- Masaki Kaibori
- Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan.
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Kim HS, Shin JW, Kim GY, Kim YM, Cha HJ, Jeong YK, Jeong ID, Bang SJ, Kim DH, Park NH. Metastasis of hepatocellular carcinoma to the small bowel manifested by intussusception. World J Gastroenterol 2006; 12:1969-71. [PMID: 16610010 PMCID: PMC4087529 DOI: 10.3748/wjg.v12.i12.1969] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a so highly invasive tumor that metastasizes hematogenously and lymphogenously to distant site. Frequent sites are lung, regional lymph node, bone, and adrenal gland. But metastasis to the gastrointestinal (GI) tract is rare, and most common site is stomach. Metastasis to the small intestine is extremely rare. Moreover, metastatic HCC of the small bowel causing intussusception has not been reported until now. Here, we report a case of metastasis of HCC to the small bowel manifested by intussusception.
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Affiliation(s)
- Hyun Soo Kim
- Ulsan University Hospital, 290-3 Jeonha-dong, Dong-gu, Ulsan 682-714, Korea
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Settakorn J, Kaewpila N, Burns GF, Leong ASY. FAT, E-cadherin, beta catenin, HER 2/neu, Ki67 immuno-expression, and histological grade in intrahepatic cholangiocarcinoma. J Clin Pathol 2005; 58:1249-54. [PMID: 16311342 PMCID: PMC1770788 DOI: 10.1136/jcp.2005.026575] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2005] [Indexed: 12/25/2022]
Abstract
AIM To identify surrogate prognostic markers in intrahepatic cholangiocarcinoma (IHCC). METHODS Thirty one cases of IHCC were graded and immunostained for FAT, Ki67, E-cadherin, beta catenin, and HER 2/neu. RESULTS Twenty two cases were high grade and 27 had high Ki67 counts. Strong membranous staining of HER 2/neu was found in 10 tumours and reduced membranous E-cadherin and beta catenin in 19 and 18 tumours, respectively. Nuclear localisation of beta catenin was identified in five tumours and 22 showed weak cytoplasmic staining of FAT. Strong HER 2/neu and weak FAT immuno-expression were significantly correlated with high histological grade (p=0.01) and high Ki67 index (p=0.03). Upregulation of HER 2/neu was also significantly associated with nuclear localisation of beta catenin (p=0.01). Reduced membranous beta catenin was significantly related to reduced membranous E-cadherin (p=0.03), weak staining for FAT (p=0.01), and nuclear translocation of beta catenin (p=0.04). CONCLUSIONS Reduced immuno-expression of E-cadherin and FAT at their normal membranous location may be potential prognostic markers, and the overexpression of HER 2/neu and beta catenin nuclear translocation may have a role in cholangiocarcinogenesis.
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Affiliation(s)
- J Settakorn
- Hunter Area Pathology Service, Locked Bag 1, HRMC, Newcastle, Australia 2310
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Otsuki Y, Shimizu SI, Hosoda Y, Nagasawa M, Sato Y, Kobayashi H. Hepatocellular carcinoma with mesothelioma-like dissemination. Pathol Int 2005; 55:738-44. [PMID: 16271087 DOI: 10.1111/j.1440-1827.2005.01897.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Reported herein is a case of hepatocellular carcinoma (HCC) with unusual peritoneal dissemination masquerading as peritoneal mesothelioma. A 61-year-old man was clinically found to have multiple tumors in his abdominal cavity; peritonitis carcinomatosa was suspected. An autopsy revealed numerous tumors of various sizes in the abdominal serosa, omentum, and diaphragm. No signs of tumor, fibrosis, or cirrhosis were found in the liver, except for a small nodule in the hepatic triangular ligament. Histologically, the tumor cells proliferated in thick trabeculae or in sheets and formed a few canaliculi and tubules with homogenously brown contents in their lumina, which stained positively with Hall stain. Immunohistochemically, these tumors were positive for hepatocyte, alpha-fetoprotein (AFP) and low-molecular-weight cytokeratin; were focally positive for pan-cytokeratin and epithelial membrane antigen (EMA); and were negative for high-molecular-weight cytokeratin, vimentin, and calretinin. Carcinoembryonic antigen (CEA) produced a bile canalicular immunohistochemical staining pattern. Thus, the tumor was diagnosed as an HCC (Edmondson II type) of the triangular ligament with massive peritoneal dissemination. The origin of this tumor and its differential diagnosis (malignant mesothelioma, hepatoid adenocarcinoma, and hepatoid yolk sac tumor) are discussed.
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Affiliation(s)
- Yoshiro Otsuki
- Department of Pathology, Seirei Hamamatsu General Hospital, Japan
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38
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Abstract
The natural history of hepatocellular carcinoma is variable. In many patients the tumor has a long-lasting subclinical incubation period and often grows as a solitary mass to a size at which it can be detected by ultrasound. In other patients, however, the onset of the tumor is multinodal with great variations in the growth rates. Prognostication of patients with hepatocellular carcinoma takes into account the size and number of tumor nodes and their relation to the portal veins, and the degree of liver impairment.
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Affiliation(s)
- Massimo Colombo
- Department of Gastroenterology and Endocrinology, A.M. & A. Migliavacca Center for Liver Disease, IRCCS, Maggiore Hospital, University of Milan, Milan, Italy.
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Abstract
The natural history of hepatocellular carcinoma has evolved considerably over past decades. Patient presentation is highly dependent on the severity of underlying hepatic function, although many patients are now diagnosed by screening programmes prior to the development of symptoms. Growth and maturation of hepatocellular carcinoma is variable and involves a complex network of hepatic vasculature. Staging systems have been developed to predict disease progression and survival and continue to undergo investigation.
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Affiliation(s)
- Eldad S Bialecki
- Division of Gastroenterology and Hepatology, Saint Louis University Liver Center, USA
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40
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García A, De la Torre J, Castellví J, Gil A, López M. Ovarian metastases caused by cholangiocarcinoma: a rare Krukenberg's tumour simulating a primary neoplasm of the ovary: a two-case study. Arch Gynecol Obstet 2004; 270:281-4. [PMID: 12768306 DOI: 10.1007/s00404-003-0508-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2002] [Accepted: 03/20/2003] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Ovarian metastases represent 10% of all ovarian malignancies. They are characterized by their ability to occasionally reproduce mimicking the clinical and morphological appearance of primary tumours, making diagnosis difficult. Most of these tumours originate in the digestive tract, the best known being Krukenberg's tumour in the stomach. Cholangiocarcinomas are rare neoplasias that very rarely affect the ovary. Their retroperitoneal location and low histological specificity in the ovary may lead to a misdiagnosis. This makes it necessary to accurately assess all clinical, radiological and morphological symptoms so as to avoid inappropriate treatments in affected patients. CASE REPORT Two cases of biliary cholangiocarcinomas simulating an ovarian neoplasia are reported.
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Affiliation(s)
- A García
- Department of Pathology, University Hospital Vall d'Hebron, C/ Pg Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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Dabbs DJ, Geisinger KR, Ruggiero F, Raab SS, Nalesnik M, Silverman JF. Recommendations for the reporting of tissues removed as part of the surgical treatment of malignant liver tumors. Hum Pathol 2004; 35:1315-23. [PMID: 15668887 DOI: 10.1016/j.humpath.2004.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Association of Directors of Anatomic and Surgical Pathology (ADASP) has developed recommendations for the surgical pathology report for primary and metastatic epithelial tumors in the liver. These recommendations are reported herein.
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Affiliation(s)
- David J Dabbs
- Department of Pathology, University of Pittsburgh School of Medicine, PA 15213, USA
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Park MS, Kim KW, Yu JS, Kim MJ, Yoon SW, Chung KW, Lee JT, Yoo HS. Radiologic findings of gastrointestinal tract involvement in hepatocellular carcinoma. J Comput Assist Tomogr 2002; 26:95-101. [PMID: 11801910 DOI: 10.1097/00004728-200201000-00014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this work was to evaluate the radiologic findings of gastrointestinal (GI) tract involvement in hepatocellular carcinoma (HCC) and to discuss mechanisms of spread. METHOD Eighteen patients with histologically proven GI tract metastasis in HCC for 4.5 years underwent CT and five also underwent upper GI (UGI) series. The cases were classified according to the mode of spread, based on the radiologic findings. RESULTS The involved portion of the GI tract was the stomach (n = 11), duodenum (n = 4), and colon (n = 4). The mode of spread was direct invasion from a contiguous primary tumor (n = 12), hematogenous metastasis (n = 3), peritoneal seeding (n = 1), and undetermined (n = 2). In cases of direct invasion from contiguous primary tumors, CT revealed GI tract invasion directly from bulky hepatic masses (n = 9) or daughter masses at the portion of the bowel wall contiguous to the hepatic masses (n = 3). In cases of hematogenous spread, CT revealed an intramural mass in the stomach and duodenum (n = 2) or a diffuse thickening of the wall of the stomach (n = 1). In the case of peritoneal seeding, CT revealed multiple small nodules in the right paracolic gutter, omentum, and mesentery with invasion to the colon. CONCLUSION GI tract involvement in HCC shows various radiologic findings according to the mode of spread, but the most common finding is direct invasion of the stomach, duodenum, or colon from contiguous primary tumor.
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Affiliation(s)
- Mi-Suk Park
- Department of Diagnostic Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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43
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Chia-Hsien Cheng J, Chuang VP, Cheng SH, Lin YM, Cheng TI, Yang PS, Jian JJ, You DL, Horng CF, Huang AT. Unresectable hepatocellular carcinoma treated with radiotherapy and/or chemoembolization. Int J Cancer 2001; 96:243-52. [PMID: 11474499 DOI: 10.1002/ijc.1022] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The purpose of our study was to evaluate the outcome, patterns of failure, and toxicity for patients with unresectable hepatocellular carcinoma (HCC) treated with radiotherapy, transcatheter arterial chemoembolization (TACE), or combined TACE and radiotherapy. Forty-two patients with unresectable HCC were treated with combined radiotherapy and TACE (TACE+RT group, 17 patients), radiotherapy alone (RT group, 9 patients), or with TACE alone (TACE group, 16 patients). Mean dose of radiation was 46.9 +/- 5.8 Gy in a daily fraction of 1.8 to 2 Gy, directed only to the cancer-involved areas of the liver. TACE was performed with a combination of Lipiodol, doxorubicin, cisplatin, and mitomycin C, followed by Gelfoam or Ivalon embolization. Tumor size was smaller in the TACE group (mean: 5.4 cm) compared with the TACE+RT group (8.6 cm) and the RT group (13.1 cm) (P = 0.0003). The median follow-up was 24 months in the TACE+RT group, 28 months in the RT group, and 23 months in the TACE group. Survival was significantly worse for patients treated with radiotherapy alone due to the selection bias of patients with more advanced disease and compromised condition in this group. In contrast, the TACE+RT and TACE groups had comparable survival (two-year rates: TACE+RT 58%, TACE 56%, P = 0.69). The local control rate for the treated tumors was similar in the TACE+RT and TACE groups (P = 0.11). The intrahepatic recurrence outside the treated tumors was common and similar between these two groups (P = 0.48). The extrahepatic progression-free survival was significantly shorter for patients in the TACE+RT group than in the TACE group (two-year rates: TACE+RT 36%, TACE 100%, P = 0.002). Seven patients died from complications of treatment. Local radiotherapy may be added to treat patients with unresectable HCC, and the control of progression of the treated tumors was promising even in patients with large hepatic tumors. Survival of patients with combined TACE and radiotherapy was similar to that with TACE as the only treatment, while a significant portion of the patients treated with radiotherapy developed extrahepatic metastasis.
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Affiliation(s)
- J Chia-Hsien Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
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Uenishi T, Hirohashi K, Shuto T, Kubo S, Tanaka H, Sakata C, Ikebe T, Kinoshita H. The clinical significance of lymph node metastases in patients undergoing surgery for hepatocellular carcinoma. Surg Today 2001; 30:892-5. [PMID: 11059728 DOI: 10.1007/s005950070040] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The frequency of lymph node (LN) metastasis in patients undergoing surgery for hepatocellular carcinoma (HCC) has rarely been studied. We evaluated the clinicopathologic characteristics and outcomes of six patients with nodal metastases from HCC among a total of 504 patients who underwent hepatic resection for HCC in our department over a 16-year period. The nodal metastases were diagnosed preoperatively in two patients. The average diameter of the resected tumors was 7.8 cm and all were confirmed as poorly differentiated HCC. All of the six patients had intrahepatic metastatic nodules and five also had portal vein invasion. One patient underwent limited resection, and the other five underwent bisegmentectomy. All of the regional LNs were removed in one patient, while only enlarged LNs were removed in the other five. One patient died of postoperative liver failure and the others all died later of intrahepatic or nodal recurrence. Our findings suggest that the prognosis of patients with nodal metastasis from HCC is generally poor, even if hepatic resection with regional LN dissection is performed.
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Affiliation(s)
- T Uenishi
- Second Department of Surgery, Osaka City University Medical School, Osaka, Japan
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45
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Emile JF, Lemoine A, Azoulay D, Debuire B, Bismuth H, Reynès M. Histological, genomic and clinical heterogeneity of clear cell hepatocellular carcinoma. Histopathology 2001; 38:225-31. [PMID: 11260303 DOI: 10.1046/j.1365-2559.2001.01096.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The aim of the study was to determine whether clear cell type hepatocellular carcinoma should still be regarded as a separate uniform diagnostic entity. METHODS AND RESULTS We retrospectively studied 118 cirrhotic patients with hepatocellular carcinoma treated by orthotopic liver transplantation, and 31 noncirrhotic patients with hepatocellular carcinoma treated by either liver surgical resection or transplantation. The pathology of all liver resections was reviewed. Microsatellite instability was performed on paraffin-embedded samples at loci located on chromosomes 2p, 3p, 5q, 8q, 9p, 13q, 16q and 17p. Among the 118 cirrhotic patients, 10 (8.5%) had a clear cell hepatocellular carcinoma; these had clinical characteristics and prognosis similar to the other cirrhotic patients. No genetic alterations were detected in these tumours. Among the 31 noncirrhotic patients, one (3.2%) had a clear cell hepatocellular tumour. This 170-mm tumour had a lipid density on computed tomography, and its histology resembled chromophobe cell renal carcinoma. Furthermore, this tumour had unusual genomic alterations, with microsatellite instability in 6/8 chromosome loci. CONCLUSIONS Clear cell hepatocellular carcinoma is a heterogeneous entity in which a chromophobe cell subtype should be identified.
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Affiliation(s)
- J F Emile
- Service d'Anatomie Pathologique, Hôpital Paul Brousse and UPRES 1596 Virus Hépatotropes et Cancer, Université Paris-Sud, France
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46
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Cheng JC, Chuang VP, Cheng SH, Huang AT, Lin YM, Cheng TI, Yang PS, You DL, Jian JJ, Tsai SY, Sung JL, Horng CF. Local radiotherapy with or without transcatheter arterial chemoembolization for patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2000; 47:435-42. [PMID: 10802371 DOI: 10.1016/s0360-3016(00)00462-4] [Citation(s) in RCA: 140] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the treatment outcome, patterns of failure, and prognostic factors for patients with unresectable hepatocellular carcinoma (HCC) treated with local radiotherapy alone or as an adjunct to transcatheter arterial chemoembolization (TACE). METHODS AND MATERIALS From March 1994 to December 1997, 25 patients with unresectable HCC underwent local radiotherapy to a portion of the liver. Twenty-three patients were classified as having cirrhosis in Child-Pugh class A and 2 in class B. Mean diameter of the treated hepatic tumor was 10.3 cm. Mean dose of radiation was 46.9 +/- 5.9 Gy in a daily fraction of 1.8-2 Gy. Sixteen patients were also treated with Lipiodol and chemotherapeutic agents mixed with Ivalon or Gelfoam particles for chemoembolization, either before and/or after radiotherapy. Percutaneous ethanol injection therapy (PEIT) was given to one patient. All patients were monitored for treatment-related toxicity and for survival and patterns of failure. RESULTS In a median follow-up period of 23 months, 11 patients were alive and 14 dead. The median survival duration from treatment was 19.2 months with a 2-year survival of 41%. Only 3 of 25 patients had local progression of the treated hepatic tumor. The recurrences were seen within the liver or extrahepatic. The 2-year local, regional, and extrahepatic progression-free survival rates were 78%, 46%, and 39%, respectively. The local control ranked the highest. Patients with Okuda Stage I disease had significantly longer survival than those with Stage II and III (p = 0.02). Patients with T4 disease (p = 0.02) or treated with radiotherapy alone (p = 0.003) had significantly shorter survival. T4 disease (p = 0.03) and pretreatment alpha-fetoprotein level of more than 200 ng/ml (p = 0. 03) were associated with significantly worse regional progression-free survival. A significant difference was observed in both regional progression-free survival (p = 0.0001) and extrahepatic progression-free survival (p = 0.005) between patients with and without portal vein thrombosis before treatment. The presence of satellite nodules had a significantly worse impact on regional progression-free survival (p = 0.04) and extrahepatic progression-free survival (p = 0.03). Patients with hepatic tumor more than 6 cm in diameter or portal vein thrombosis tended to have shorter survival. Radiation-induced liver disease (RILD) and gastrointestinal bleeding were the most common treatment-related toxicities. CONCLUSION Radiotherapy is effective in the treatment of patients with unresectable HCC. Its effect appeared to be more prominent within the site to which radiation was given. The combination of TACE and radiation was associated with better control of HCC than radiation given alone, probably due to the selection of patients with favorable prognosis for the combined treatment. A dose-volume model should be established in the next phase of research in the treatment of unresectable HCC.
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Affiliation(s)
- J C Cheng
- Departments of Department ofRadiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
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Lin CP, Cheng JS, Lai KH, Lo GH, Hsu PI, Chan HH, Hsu JH, Wang YY, Pan HB, Tseng HH. Gastrointestinal metastasis in hepatocellular carcinoma: radiological and endoscopic studies of 11 cases. J Gastroenterol Hepatol 2000; 15:536-41. [PMID: 10847441 DOI: 10.1046/j.1440-1746.2000.02152.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND From October 1990 to January 1999, 11 of 2237 hepatoma patients at our hospital had gastrointestinal tract metastasis. We describe the radiological and endoscopic features, clinical course and prognoses of those patients. METHODS All patients were male. Six patients were hepatitis B carriers, and cirrhosis was noted in eight patients on admission. We reviewed all available radiological, endoscopic and pathological features. RESULTS The commonest clinical presentation was frank gastrointestinal bleeding. Histological proof of gastrointestinal involvement was seen in six patients. Endoscopic features included ulcerative tumours mimicking advanced gastric carcinoma (43%) and submucosal tumours (29%). The sites of organ involvement were stomach (five), duodenum (two), colon (three) and duodenum and colon (one). Direct invasion by a contiguous neoplasm was the major route of gastrointestinal tract metastasis. Portal vein thrombosis may be the key point of haematogenous spread to other sites. CONCLUSIONS The prognosis in these patients was extremely poor. Almost all patients died within 5 months if no further aggressive management was performed. Surgical intervention may be the optimal choice for palliative treatment of HCC with gastrointestinal tract involvement.
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Affiliation(s)
- C P Lin
- Department of Internal Medicine, Veterans General Hospital-Kaohsiung, National Yang-Ming University, Taiwan, Republic of China
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48
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Abstract
In most Western countries hepatitis C virus (HCV) is a common risk factor for hepatocellular carcinoma (HCC). Many HCCs are multifocal in origin, but HCC may also grow as a single hepatic nodule for years before generating satellite or distant tumours. HCV may promote cancer through cirrhosis, which is often associated with HCV-related HCC, but it might also have oncogenic properties by interacting with cellular genes that regulate cell growth and differentiation. Treatment of patients with chronic hepatitis C using interferon might attenuate HCC risk, particularly in those who respond to therapy. Many patients whose cancer is detected early have been successfully treated by liver transplantation and have shown significantly prolonged survival. This is less often achieved with hepatic resection or regional therapies, which may indeed destroy small tumours, without affecting the complications of portal hypertension. Screening remains the only realistic approach for improving the treatment of HCC patients, but its cost-effectiveness is uncertain.
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Affiliation(s)
- M Colombo
- Angela Maria e Antonio Migliavacca' Center for Liver Disease and the FIRC-University Unit for Liver Cancer, IRCCS Maggiore Hospital, University of Milan, Italy
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Oliveira AM, Erickson LA, Burgart LJ, Lloyd RV. Differentiation of primary and metastatic clear cell tumors in the liver by in situ hybridization for albumin messenger RNA. Am J Surg Pathol 2000; 24:177-82. [PMID: 10680884 DOI: 10.1097/00000478-200002000-00002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clear cell neoplasms presenting as metastatic hepatic masses may be difficult to differentiate histologically and immunohistochemically from hepatocellular carcinoma (HCC) with prominent clear cell features, especially in small biopsy specimens. In situ hybridization (ISH) for albumin messenger RNA (mRNA) has been previously shown to be sensitive and specific for the detection of hepatocellular differentiation, but its use for the identification of clear cell HCC has not been previously evaluated. Among 309 cases of hepatocellular carcinoma diagnosed at Mayo Clinic between 1985 and 1998, 30 cases (9.7%) with at least 30% (range, 30%-90%; median 60%) clear cells were studied by ISH for albumin mRNA. In addition, immunohistochemical expression of AFP and polyclonal CEA, serum determination of AFP, and histopathologic analyses of the tumor were done. Forty-two clear cell tumors were used as a control group: 21 metastatic clear cell tumors to the liver (14 renal cell carcinomas and 7 adrenal cortical carcinomas) and 21 primary clear cell tumors of the retroperitoneum (10 renal cell carcinomas, 5 adrenal cortical adenomas, 4 adrenal cortical carcinomas, and 2 ovarian carcinomas). ISH for albumin mRNA was reactive in 28 of 30 cases of clear cell HCC (93%). Clear cell HCC expressed AFP (15 cases; 50%) and polyclonal CEA (19 cases; 63%). Tumors expressed either AFP or polyclonal CEA in 23 cases (77%). Elevated serum AFP was present in 24 of 26 cases (92%). These results indicate that ISH for albumin mRNA is a useful method to distinguish clear cell HCC from other clear cell carcinomas metastatic to the liver and clear cell neoplasms in the retroperitoneum.
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Affiliation(s)
- A M Oliveira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA
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50
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Abstract
Generally, 0.4-2.5% of patients with chronic hepatitis C virus (HCV) infection develop hepatocellular carcinoma (HCC). HCC occurs more often in patients with cirrhosis and in those with increased liver cell proliferation. HCV-related tumors occur in older patients and often have a less aggressive course than HCC, related to other etiological factors. Many HCV-related HCC are multifocal in origin. However, many tumors grow as a single hepatic nodule for years before generating satellite or distant tumor nodules. The growth pattern varies from one tumor to another, with tumor volume doubling times ranging from 1 to 20 months. Tumor progression and hepatic failure are the leading causes of death in most patients. Using the polymerase chain reaction technique, HCV-RNA has been almost invariably detected in serum and tumor tissue of anti-HCV patients with HCC. In many patients, HCV-RNA was found to belong to the possibly more pathogenic type 1b. However, it is unlikely that HCV plays a direct role in liver tumorogenesis, since no reverse transcriptase activity has been found in infected livers. One current opinion is that HCV may promote cancer through cirrhosis, which is per se an important risk factor for this tumor. In HCV carriers, the risk of developing HCC and having more severe tumor disease may be increased by coexisting hepatitis B virus (HBV) or alcohol abuse, further supporting the idea that both HCC and cirrhosis might be a result of the interplay of several risk factors. HCC could also be the consequence of HCV interacting with cellular genes that regulate cell growth and differentiation, independent of the effect of cirrhosis.
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Affiliation(s)
- M Colombo
- Division of Internal Medicine, FIRC-University Unit for Liver Cancer, IRCCS Maggiore Hospital, University of Milan, Italy.
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