A Case of Epithelioid Hemangioendothelioma in the Liver

A 15-year-old girl was admitted to our hospital with a 9-month history of upper abdominal pain and loss of appetite. Her history showed no indication of hepatitis. Her abdomen appeared to be even and soft, and the liver and spleen could not be felt below the costal margin. Percussion pain in hepatic region was negative. Gastroscopy showed no abnormalities. An abdominal ultrasound examination revealed the presence of hepatic hypoechoic areas and an abdominal CT scan showed multiple roundlike low-density masses in both hepatic lobes. The edges of the focal lesions were smooth and continuous, with a heterogeneous center, the round-like edges were enhanced, but the enhancement in the focal lesions was not obvious.[第一段]     

Judgement on Extended Hepatectomy for Primary Liver Cancer

Objective: To expore the indications and safety of extended hepatectomy for primary liver cancer (PLC). Methods: From Nov. 2000 to Oct. 2002, 33 patients with PLC received extended hepatectomy, 26 of whom were complicated with liver cirrhosis. Preoperative findings, intraoperative management and the outcome of postoperative recovery were analyzed and evaluated. Results: Operative mortality was zero in this group and postoperative morbidity of complications was 33.3%, and all complications were cured after proper treatment. Conclusion: Extended hepatectomy for PLC was safe and viable for the patients who had enough reserve of liver function if the incised liver volume was less than 50% of the liver and the supporting treatment of the remnant liver was given as well as the postoperative complications were managed appropriately.     

Phosphatase of Regenerating Liver and Its Association with Tumors

Protein kinases and protein phosphatases play key roles in regulating functions of diverse proteins which control numerous     

Differential Proteomics in Malignant and Normal Liver Cell Lines

Objective： To detect differential protein expression in malignant and normal liver cell lines in vitro using the SELDI ProteinChip platform, for investigating the pathogenesis of liver cancer. Methods： Two cell lines, human normal liver cell line L02 and hepatoma cell line SMMC-7721 were cultured routinely, harvested in good condition and lysed. After quantification, the supernatant of the lysate was tested by IMAC3 （Immobilized Mental Affinity Capture） and WCX2 （Weak Cation Exchange） chips on the SELDI-TOF-MS ProteinChip reader. Results： Protein expression differed between the malignant and normal liver cell lines. A total of 20 differentially expressed proteins were found, among which, 7 were captured by the IMAC3 chip and 14 by the WCX2 chip. Peaks at 5,419, 7,979 and 11,265 Da were higher and at 8,103, 8,492, 10,160 and 11,304 Da lower in SMMC-7721 cells by the IMAC3 chip; peaks at 7,517, 7,945 and 7,979 Da were higher and at 5,061, 5,551, 5,818, 7,439, 9,401,10,100, 10,312, 11,621, 11,662, 11,830 and 12,772 Da lower in SMMC-7721 cells by the WCX2 chip. Interestingly, both chips captured the 7,979 Da peak. In addition, the 11,081 Da peak corresponded precisely with the molecular mass of the calcium binding protein S100A10, which may participate in the formation of liver cancer in association with p36. Conclusion： Detecting differential protein expression in malignant and normal liver cell lines using the SELDI ProteinChip platform was simple, sensitive and repeatable. The results we obtained can serve as a basis for investigating the pathogenesis of liver cancer and aid the discovery of new therapeutic targets.     

Rational Operation for Primary Gastric Carcinoma with Liver Metastasis

OBJECTIVE To investigate the prognosis of advanced gastric carcinoma patients with liver metastasis, and provide a foundation for rational operations. METHODS The operations and prognosis of 102 primary gastric carcinoma patients with liver metastasis were studied retrospectively. RESULTS In gastric carcinoma patients with H1 metastasis who underwent a resection operation, the 6-month, 1- and 2-year post-operative survival rates were 61%, 42% and 7%. There was a statistically significant difference in survival between resected and non-resected patients （P=0.000） in gastric carcinoma cases with H2 metastasis, resection operations resulted in 54%, 16% and 8% respective survival rates, with no significant difference compared to patients not receiving a resection （P=0.132）. Gastric carcinoma patients with H3 metastasis who received a resection operation showed 25%, 13% and 0% respective survivals with no significantly better prognosis compared to the non-resected cases （P=0.135）. There was no statistically significant difference in survival between the cases with or without peritoneal metastasis （P=0.152）. CONCLUSION A resection operation provides a better prognosis for gastric carcinoma patients with H1 metastasis independent of peritoneal metastasis, but resection has no benefit for gastric carcinoma cases with H2 or H3 metastasis. Peritoneal metastases are not the significant influencing factor for the prognosis of gastric cancer with liver metastasis.     

Inpatients’ Knowledge about Primary Liver Cancer and Hepatitis

Objective: To assess the level of an inpatient population’s awareness about hepatitis and primary liver cancer(PLC), the most common type of which is hepatocellular carcinoma (HCC), and then to initiate education ofthis group. Methods: A survey was conducted with 1300 participants within the inpatient unit in representativetertiary hospitals in the Chaoshan area of China. Structured questionnaires contained demographic data andstatements about different aspects of liver cancer and hepatitis. The questionnaires were completed by trainedmedical practitioners after they had conducted the interviews. Results: One way ANOVA showed that thesample population lacked adequate knowledge about HCC and hepatitis. Stepwise multiple regression analysisdemonstrated that the participant’s level of education had the greatest impact on their total knowledge scorewhen other variables remained constant. Conclusions: The study demonstrated: a general lack of awarenessamongst the participants about the preventative strategies, and the management options available for peoplewith primary liver cancer and hepatitis; education level was an important factor affecting knowledge levels.The demonstrated deficiencies in people’s knowledge about hepatitis and HCC, and their lack of subsequentprotective behaviours are likely to play an important role in HCC and hepatitis transmission or prevention.     

Malignant Hemangioendothelioma of the Liver： a Case Report

A male patient, 50 years old, was hospitalized in our department because of repeated vague pain under the right rib for more than 3 months. Two weeks prior to his hospitalization the pain became severe accompanied by fever. The right subcostal vague pain and discomfort occurred 3 months before admission, with no radiating pain elsewhere, no vomiting, no diarrhea or jaundice but with chilis and pyrexia. In the afternoon the fever intensified, with a body temperature of about 38.5℃. There was the vague pain and discomfort under the right rib, which was paroxysmally intensified.     

Rare Benign Tumors of the Liver: Still Rare?

Background

Benign liver tumors are common. They do not spread to other areas of the body, and they usually do not pose a serious health risk. In fact, in most cases, benign liver tumors are not diagnosed because patients are asymptomatic. When they are detected, it’s usually because the person has had medical imaging tests, such as an ultrasound (US), computed tomography (CT) scan, or magnetic resonance imaging (MRI), for another condition.

Materials and methods

A search of the literature was made using cancer literature and the PubMed, Scopus, and Web of Science (WOS) database for the following keywords: “hepatic benign tumors”, “hepatic cystic tumors”, “polycystic liver disease”, “liver macroregenerative nodules”, “hepatic mesenchymal hamartoma”, “hepatic angiomyolipoma”, “biliary cystadenoma”, and “nodular regenerative hyperplasia”.

Discussion and conclusion

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in some areas of the world; there is an increasing incidence worldwide. Approximately 750,000 new cases are reported per year. More than 75 % of cases occur in the Asia-Pacific region, largely in association with chronic hepatitis B virus (HBV) infection. The incidence of HCC is increasing in the USA and Europe because of the increased incidence of hepatitis C virus (HCV) infection. Unlike the liver HCC, benign tumors are less frequent. However, they represent a chapter always more interesting of liver disease. In fact, a careful differential diagnosis with the forms of malignant tumor is often required in such a way so as to direct the patient to the correct therapy. In conclusion, many of these tumors present with typical features in various imaging studies. On occasions, biopsies are required, and/or surgical removal is needed. In the majority of cases of benign hepatic tumors, no treatment is indicated. The main indication for treatment is the presence of significant clinical symptoms or suspicion of malignancy or fear of malignant transformation.     

“Three-Grade Criteria” of Radical Resection for Primary Liver Cancer

OBJECTIVE The present study was designed to develop the “Three- Grade Criteria” for radical resection of primary liver cancer （PLC） and to evaluate its clinical significance. METHODS Criteria for radical resection of PLC were summed up to 3 grades based on criterion development. Grade Ⅰ： complete removal of all gross tumors with no residual tumor at the excision margin. Grade Ⅱ： on the basis of Grade Ⅰ, additional 4 requirements were added： （1） the tumor was not more than two in number; （2） no tumor thrombi in the main trunks or the primary branches of the portal vein, the common hepatic duct or its primary branches, the hepatic veins or the inferior vena cava; （3）no hilar lymph nodes metastases; （4）no extrahepatic metastases. Grade Ⅲ ： in addition to the above criteria, negative postoperative follow-up result including AFP dropping to a normal level （with positive AFP before surgery） within 2 months after operation, and no residual tumor upon diagnostic imaging.The clinical data from 354 patients with PLC who underwent hepatectomy were reviewed retrospectively. Based on the “Three-Grade Criteria” these patients were divided into 6 groups： Grade Ⅰ radical group, Grade Ⅰ palliative group, Grade Ⅱ radical group, Grade Ⅱ palliative group, Grade Ⅲ radical group, Grade Ⅲ palliative group. The survival rate of each group was calculated by the life-table method and the rates compared among the groups. RESULTS The survival rate of patients receiving radical treatment was better than those receiving palliative treatment （P〈0.01）. Survival improved as more criteria were applied. The 5-year survival rate of the patients in Grade Ⅰ, Ⅱ and Ⅲ who underwent radical resection was 43.2%, 51.2% and 64.4%, respectively （P〈0.01）. CONCLUSION The “Three-Grade Criteria” may be applied for judging the curability of resection therapy for PLC. The stricter the criterion used, the better the survival would be. Adopting high-grade criteria to select cases and guide operations and strengthening postoperative follow-up would improve the results of hepatectomy for PLC.     

Elevated Renin Levels in Patients with Liver Cirrhosis and Hepatocellular Carcinoma

Liver fibrosis is the common consequence of chronic liver injury of any etiology, disrupting the normalarchitecture,and causing hepatocellular dysfunction and portal hypertension. Since the renin-angiotensin system(RAS) may be involved in chronic liver diseases, in the present study we assayed renin levels using ELISA in groupsof Egyptian patients with liver cirrhosis (N=32) and hepatocellular carcinoma (HCC) (N=67), for comparisonwith twenty five healthy controls. The results showed significant differences between the control and liver cirrhosispatients (P<0.001) and also the controls and HCC patients (P<0.001), without significant variation between thepatient groups. Furthermore, in HCC patients, it was found that the renin levels negatively correlated with serumalbumin and prothrombin time (P=0.003 for each) and positively with α-fetoprotein (P=0.04). Thus, it is concludedthat renin levels are elevated in patients with liver cirrhosis and HCC and suitable medical intervention shouldbe placed for management of such alteration. Moreover, further studies are warranted to explore its prognosticsignificance.     

Radiation Therapy for Liver Tumors: Ready for Inclusion in Guidelines?

Despite the historically limited role of radiotherapy in the management of primary hepatic malignancies, modern advances in treatment design and delivery have renewed enthusiasm for radiation as a potentially curative treatment modality. Surgical resection and/or liver transplantation are traditionally regarded as the most effective forms of therapy, although the majority of patients with hepatocellular carcinoma and intrahepatic cholangiocarcinoma present with locally advanced or unresectable disease on the basis of local vascular invasion or inadequate baseline hepatobiliary function. In this context, many efforts have focused on nonoperative treatment approaches including novel systemic therapies, transarterial chemoembolization, ethanol ablation, radiofrequency ablation, and stereotactic body radiation therapy (SBRT). This review aims to summarize modern advances in radiotherapy, particularly SBRT, in the treatment of primary hepatic malignancies.     

Mesenchymal Hamartoma of the Liver in Children： a Report of Four Cases

OBJECTIVE Mesenchymal hamartoma of the liver (MHL) is a rare disease that makes up about 5%-8% of primitive hepatic tumors in children. The etiology of MHL has been the subject of considerable discussion. The possibility of malignant transformation of MHL is inclusive. To enhance the recognition of MHL in children, we have review the procedures in diagnosis and treatment and present 4 of our own cases. METHODS The clinical characteristics of MHL in 4 children including history, physical examination, lab examination, imaging data and pathology were analyzed and discussed and related to reports from the literature. RESULTS All the cases were diagnosed with B-ultrasonography and CT preoperatively, and were confirmed intra-operatively and histologically. Satisfactory results were reached postoperatively. CONCLUSION MHL is an uncommon benign lesion in children. The main presentation is abdominal painless mass. Diagnosis is aided with B-ultrasonography and CT preoperatively. Complete tumor removal is the best choice for MHL treatment resulting in a good outcome.     

Preliminary Study of Oxidative Stress in Human Hepatocellular Carcinoma and Adjacent Normal Liver Tissues

OBJECTIVE The antioxidative system in human hepatocellular carcinoma was investigated. METHODS The activities of cytosolic catalase (CAT), superoxide dismu-tase, glutathione peroxidase (GSH-Px), glutathione S-tranferase and levels of reduced glutathione, total protein thiols and malondialdehyde were assayed in 10 cases of hepatocellular carcinoma and adjacent normal liver. RESULTS Hepatoma tissues showed higher activities of CAT, GSH -Px and lower content of total antioxidative capacity compared to adjacent normal liver tissue (P<0.05). CONCLUSION These findings suggest that the antioxidative defense-related enzymes and antioxidants are largely regulated in hepatoma cells. However, the mechanism which is not clear requires further investigation.