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Icteric Type Hepatocellular Carcinoma: Clinical Features, Diagnosis and Treatment  [PDF]
Miin-Fu Chen
Chang Gung Medical Journal , 2002,
Abstract: Icteric type hepatocellular carcinoma (HCC), a clinical entity of HCC presenting asobstructive jaundice caused by floating tumor debris in common bile duct, is rare. Taiwanhas a high incidence of HCC and liver cirrhosis. The clinical features, diagnosis and treatmentof this disease entity were reviewed. Not all patients with this disease were terminallyill. With proper management and good palliation, occasional cure are possible.
Clinical features of hepatitis B virus-related hepatocellular carcinoma  [cached]
Toru Ishikawa
World Journal of Gastroenterology , 2010,
Abstract: Hepatocellular carcinoma (HCC) is a major cause of cancer death, and chronic hepatitis B is a serious worldwide problem. The epidemiology of HCC is distinctive. Hepatitis B virus (HBV) plays a major role in hepatocarcinogenesis. Prevention of HBV-related HCC is a key issue in current hepatology. This paper describes the prevention and clinical features of HBV-related HCC, along with a short review of the disease.
Hepatocarcinoma.: Descripción de características clínicas verificadas en una Región del sur de Chile Clinical features of 29 patients with hepatocellular carcinoma  [cached]
Carlos Manterola D,Sergio Mu?oz N,Juan Carlos Araya O,Ciro Calderón M
Revista médica de Chile , 2000,
Abstract: Background: Hepatocellular carcinoma is the most frequent primary tumor of the liver. It is associated to chronic liver diseases and has a high prevalence in some regions of Africa and Asia. Aim: To describe the clinical characteristics of patients with hepatocellular carcinoma, admitted to two hospitals of the IX region of southern Chile. Material and methods: Prospective study of 29 consecutive patients admitted to two hospitals in Temuco, Chile. Clinical features, laboratory values and viral markers were analyzed. Results: Eighteen patients were male and ages ranged from 29 to 75 years old. The most frequent presenting symptom was abdominal pain in 21 patients. Seven subjects had a history of alcoholism. Serum bilirubin values ranged from 0.1 to 15.8 mg/dl, alkaline phosphatases ranged from 171 to 3476 U/l, ASAT from 24 to 5400 U/l and alpha feto protein from 1.4 to 350 ng/ml. Two patients had a positive hepatitis B surface antigen and all had negative hepatitis C virus antibodies. Mean tumoral diameter was 9.6 cm and the most common presentation was nodular. Mean survival after the diagnosis was 6.3 months. Conclusions: These patients with hepatocellular carcinoma have a low frequency of positive viral markers and tumors of large sizes on presentation. (Rev Méd Chile 2000; 128: 887-95).
Brain metastases from hepatocellular carcinoma: clinical features and prognostic factors
Xiao-Bing Jiang, Chao Ke, Guan-Hua Zhang, Xiang-Heng Zhang, Ke Sai, Zhong-Ping Chen, Yong-Gao Mou
BMC Cancer , 2012, DOI: 10.1186/1471-2407-12-49
Abstract: Between January 1994 and December 2009, all patients with HCC and BM treated in Sun Yat-sen University Cancer Center were retrospectively reviewed. Univariate and multivariate survival analyses were performed to identify possible prognostic factors.Forty-one patients were diagnosed with BM from HCC, an incidence of 0.47%. The median age at diagnosis of BM was 48.5 years. Thirty-three patients (80.5%) developed extracranial metastases at diagnosis of BM, and 30 patients (73.2%) had hepatitis B. Intracranial hemorrhage occurred in 19 patients (46.3%). BM were treated primarily either with whole brain radiation therapy (WBRT; 5 patients), stereotactic radiosurgery (SRS; 7 patients), or surgical resection (6 patients). The cause of death was systemic disease in 17 patients and neurological disease in 23. Patients in a high RPA (recursive partitioning analysis) class, treated with conservatively and without lung metastases, tended to die from neurological disease. Median survival after the diagnosis of BM was 3 months (95% confidence interval: 2.2-3.8 months). In multivariate analysis, the presence of extracranial metastases, a low RPA class and aggressive treatment, were positively associated with improved survival.BM from HCC is rare and associated with an extremely poor prognosis. However, patients with a low RPA class may benefit from aggressive treatment. The clinical implication of extracranial metastases in HCC patients with BM needs further assessment.Hepatocellular carcinoma (HCC) represents one of the most common causes of cancer related deaths worldwide [1]. The incidence of HCC demonstrates a striking geographic variability, with the highest rates in East and South-East Asia and Sub-Saharan Africa [1]. It is also one of the top three causes of cancer death in the Asia Pacific region, as a result of the high prevalence of the main etiological agents, hepatitis B virus and C virus infections [2]. In the United States and Europe, where chronic hepatitis C virus
The comparison of grey-scale ultrasonic and clinical features of hepatoblastoma and hepatocellular carcinoma in children: a retrospective study for ten years
Hua Zhuang, Yu-lan Peng, Tian-wu Chen, Yong Jiang, Yan Luo, Qiong Zhang, Zhi-gang Yang
BMC Gastroenterology , 2011, DOI: 10.1186/1471-230x-11-78
Abstract: Thirty cases of the confirmed HBL and 12 cases of the confirmed HCC in children under the age of 15 years were enrolled into our study. They were divided into the HBL group and the HCC group according to the histological types of the tumors. The ultrasonic features and the clinical manifestations of the two groups were retrospectively analyzed, with an emphasis on the following parameters: onset age, gender (male/female) ratio, positive epatitis-B-surface-antigen (HBV), alpha-fetoprotein increase, and echo features including septa, calcification and liquefaction within the tumors.Compared with the children with HCC, the children with HBL had a significantly younger onset age (8.2 years vs. 3.9 years, P < 0.001) and a significantly smaller frequency of positive HBV (66.7% vs. 13.3%, P < 0.001). The septa and liquefaction were more frequently found in HBL than in HCC (25/30, 83.3% vs. 2/12, 16.7%, P < 0.001; 17/30, 56.7% vs. 3/12, 25%, P = 0.02). When a combination of the liquefaction, septa, negative HBV and onset age smaller than 5 years was used in the evaluation, the sensitivity was raised to 90%, the accuracy was raised to 88%, and the negative predictive value was raised to 73%.Ultrasonic features combined with clinical manifestations are valuable for differentiating HBL from HCC in children.Two-thirds of the pediatric primary liver tumors are malignant [1,2]. Hepatoblastoma (HBL) accounts for 40-60% of the liver tumors in children, which is the most common malignant liver tumor in children [1,3]. Hepatocellular carcinoma (HCC) accounts for about 20%, which is the second most common malignant liver tumor in children [1,4]. The two malignant liver tumors have some similar clinical and imaging features but the prognosis and treatments are quite different. The origin and nature of the malignant liver tumors should be clear in order to use a proper treatment. The differential diagnosis should be based on the following findings: tumor encapsulation, calcification pre
Clinical features and prognostic factors in patients with bone metastases from hepatocellular carcinoma after liver transplantation
Jian He, Zhao-Chong Zeng, Jia Fan, Jian Zhou, Jing Sun, Bing Chen, Ping Yang, Bin-Liang Wang, Bo-Heng Zhang, Jian-Ying Zhang
BMC Cancer , 2011, DOI: 10.1186/1471-2407-11-492
Abstract: All adult patients undergoing LT from 2001 to 2010 were reviewed. Patients with HCC bone metastases after LT received external beam radiotherapy(EBRT) during this period. Demographic variables, laboratory values, and tumor characteristics were determined before LT and EBRT. Total radiation dose ranged from 8 to 60 Gy(median dose 40.0 Gy).The trunk was the most common site of bone metastases with finding of expansile soft-tissue masses in 23.3% of patients. Overall pain relief from EBRT occurred in 96.7% (29/30). No consistent dose-response relationship was found for palliation of with doses between 30 and 56 Gy (P = 0.670). The median survivals from the time of bone metastases was 8.6 months. On univariate and multivariate analyses, better survival was significantly associated with a better Karnofsky performance status (KPS) and well-controlled intrahepatic tumor, but not with lower alpha-fetoprotein levels. The median time from LT to bone metastases was 7.1 months. Patients exceeding the Shanghai criteria presented with bone metastases earlier than those within the Fudan criteria. Patients with soft-tissue extension always had later bone metastases. The majority of deaths were caused by liver failure due to hepatic decompensation or tumor progression.The prognostic factors of bone metastases of HCC following LT are KPS and well-controlled intrahepatic. Even though survival is shorter for these patients, EBRT provides effective palliation of pain.Over the last 30 years, liver transplantation (LT) was established as a durable therapy for all forms of end-stage liver disease [1,2]. Early experience with LT for management of hepatocellular carcinoma (HCC) resulted in poor post-transplantation survival and high recurrence rates that were attributed to suboptimal patient selection. Currently, preoperative imaging criteria based on the size and number of tumors are used to select candidates for LT. The Model for End Stage Liver Disease scoring system introduced in 2002 no
Clinical features and outcome of multiple primary malignancies involving hepatocellular carcinoma: A long-term follow-up study
Qing-An Zeng, Jiliang Qiu, Ruhai Zou, Yijie Li, Shengping Li, Binkui Li, Pinzhu Huang, Jian Hong, Yun Zheng, Xiangming Lao, Yunfei Yuan
BMC Cancer , 2012, DOI: 10.1186/1471-2407-12-148
Abstract: Clinicopathological data were analyzed for 68 MPM patients involving HCC, with 35 (target group) underwent curative liver resection. Additional 140 HCC-alone patients with hepatectomy were selected randomly during the same period as the control group.Of the 68 patients with extrahepatic primary malignancies (EHPM), 22 were diagnosed synchronously with HCC, and 46 metachronously. The most frequent EHPM was nasophargeal carcinoma, followed by colorectal and lung cancer. Univariate analysis demonstrated that synchronous (P?=?0.008) and non-radical treatment for EHPM (P?<?0.001) were significant risk factors associated with poorer overall survival (OS). While, Cox modeling revealed that the treatment modality for EHPM, but not the synchronous/metachronous determinant, was an independent factor for OS, and that therapeutic option for HCC was an independent factor for HCC-specific OS. Moreover, no HCC-specific overall and recurrence-free survival benefit were observed in the control group when compared with that of the target group (P?=?0.607, P?=?0.131, respectively).Curative treatment is an independent predictive factor for OS and HCC-specific OS, and should been taken into account both for synchronous and metachronous patients. MPM patients involving HCC should not be excluded from radical resection for HCC.
Liver Resection after Downstaging Hepatocellular Carcinoma with Sorafenib  [PDF]
L. Barbier,F. Muscari,S. Le Guellec,A. Pariente,P. Otal,B. Suc
International Journal of Hepatology , 2011, DOI: 10.4061/2011/791013
Abstract: Background. Sorafenib is a molecular-targeted therapy used in palliative treatment of advanced hepatocellular carcinoma in Child A patients. Aims. To address the question of sorafenib as neoadjuvant treatment. Methods. We describe the cases of 2 patients who had surgery after sorafenib. Results. The patients had a large hepatocellular carcinoma in the right liver with venous neoplastic thrombi (1 in the right portal branch, 1 in the right hepatic vein). After 9 months of sorafenib, reassessment showed that tumours had decreased in size with a necrotic component. A right hepatectomy with thrombectomy was performed, and histopathology showed 35% to 60% necrosis. One patient had a recurrence after 6 months and had another liver resection; they are both recurrence-free since then. Conclusion. Sorafenib can downstage hepatocellular carcinoma and thus could represent a bridge to surgery. It may be possible to select patients in good general condition with partial regression of the tumour with sorafenib for a treatment in a curative intent. 1. Introduction Hepatocellular carcinoma (HCC) represents one of the highest causes of cancer-related death. Recent advances have been made for advanced HCC (extrahepatic spread or major vascular invasion) with molecular-targeted therapies [1] such as sorafenib (Nexavar, Bayer), which has been indicated as a palliative therapy in Child A patients since a benefit in median survival and time to radiologic progression has been shown in 2 large international trials [1, 2]. We report here the cases of 2 patients who were treated with sorafenib with a palliative intent but eventually had a resection after good clinical and radiological response. This is, to our knowledge, the first report of resection surgery after sorafenib. 2. Case Reports 2.1. Case 1 A 56-year-old man presented with asthenia, right subscapular pain, weight loss, and malaise with hypoglycaemia. He had a significant history of chronic alcoholism. The laboratory tests showed normal platelet count, polycythaemia, prothrombin time of 79%, liver cytolysis, and cholestasis with total bilirubin of 43?μmol/L. Alpha-foeto-protein (AFP) was 282,500?ng/mL, and anti-HCV antibodies were positive with high virus levels. MRI (Magnetic Resonance Imaging) showed (Figure 1(a)) a 120?mm hypervascular tumour of the right liver with a right portal branch tumoral thrombosis reaching the bifurcation. There was no sign of extra-abdominal spread. The lesion had all radiological features of HCC (i.e., hypervascular with portal phase washout). The middle hepatic vein was free of
Features of hepatocellular carcinoma in cases with autoimmune hepatitis and primary biliary cirrhosis  [cached]
Takuya Watanabe, Kenji Soga, Haruka Hirono, Katsuhiko Hasegawa, Koichi Shibasaki, Hirokazu Kawai, Yutaka Aoyagi
World Journal of Gastroenterology , 2009,
Abstract: AIM: To characterize the clinical features of hepatocellular carcinoma (HCC) associated with autoimmune liver disease, we critically evaluated the literature on HCC associated with autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC).METHODS: A systematic review of the literature was conducted using the Japana Centra Revuo Medicina database which produced 38 cases of HCC with AIH (AIH-series) and 50 cases of HCC with PBC (PBC-series). We compared the clinical features of these two sets of patients with the general Japanese HCC population.RESULTS: On average, HCC was more common in men than in women with AIH or PBC. While many patients underwent chemolipiodolization (CL) or transcatheter arterial embolization (TAE) (AIH-series: P = 0.048 (vs operation), P = 0.018 (vs RFA, PEIT); PBC-series: P = 0.027 (vs RFA, PEIT), others refused therapeutic interventions [AIH-series: P = 0.038 (vs RFA, PEIT); PBC-series: P = 0.003 (vs RFA, PEIT)]. Liver failure was the primary cause of death among patients in this study, followed by tumor rupture. The survival interval between diagnosis and death was fairly short, averaging 14 ± 12 mo in AIH patients and 8.4 ± 14 mo in PBC patients.CONCLUSION: We demonstrated common clinical features among Japanese cases of HCC arising from AIH and PBC.
FOXP3 expression and clinical characteristics of hepatocellular carcinoma  [cached]
Wei-Hua Wang, Chang-Li Jiang, Wei Yan, Yu-Hai Zhang, Jiang-Tao Yang, Cun Zhang, Bo Yan, Wei Zhang, Wei Han, Jun-Zhi Wang, Ying-Qi Zhang
World Journal of Gastroenterology , 2010,
Abstract: AIM: To study the biological and clinical characteristics of transcription factor forkhead box protein 3 (FOXP3) in hepatocellular carcinoma (HCC).METHODS: We analyzed the expression and localization of FOXP3 in HCC tissues and cell lines to evaluate its biological features. The relationship between FOXP3 staining and clinical risk factors of HCC was assessed to identify the clinical characteristics of FOXP3 in HCC.RESULTS: The mRNA and protein expression of FOXP3 were found in some hepatoma cell lines. Immunohistochemical (IHC) analysis of HCC sections revealed that 48% of HCC displayed FOXP3 staining, but we did not find any FOXP3 staining in normal liver tissues and para-tumor tissues. IHC and Confocal analysis showed that the expressions of FOXP3 were mainly present in the nucleus and cytoplasm of tumor cells in tissues or cell lines. In HCC, the distribution of FOXP3 was similar to that of the cirrhosis, but not to the hepatitis B virus. Those findings implicate that FOXP3 staining seems to be associated with the high risk of HCC.CONCLUSION: The clinical characteristics of FOXP3 in HCC warrants further studies to explore its functions and roles in the cirrhosis and development of HCC.
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