TTV感染及复制与原发性肝癌关系的病例——对照研究

应用病例一对照研究方法对ＴＴＶ感染及复制与原发性肝癌关系进行研究。选择原发性肝癌病人８８例，同时选择非肝病，非肿瘤病人以及献血员７５人作为对照。ＴＴＶＤＮＡ的检查采用套式－ＰＣＲ方法。     

Hepatocellular carcinoma in a non-cirrhotic liver. Two case reports and literature review

Hepatocellular carcinoma (HCC) is closely associated with cirrhosis, but it also develops, although much less frequently, in a non-cirrhotic liver. It is suspected that hepatocellular carcinoma has a different etiology when associated and not associated with chronic liver disease. We report two cases of patients with hepatocellular carcinoma that developed in a non-cirrhotic liver. In the first case we describe an incidental liver nodular lesion containing multiple foci of HCC including pseudogland or trabecular formation and areas of sclerosis. The non-cancerous parenchyma of the liver was histologically unremarkable except for mild fatty changes of hepatocytes and minimal dysplasia. The second case describes a combined hepatocellular carcinoma and cholangiocellular carcinoma (CCC) (mixed carcinoma) in a patient who was serologically negative for both hepatitis B and C viruses. The adjacent liver parenchyma showed mild piecemeal necrosis and mild lobular activity compatible with chronic viral hepatitis, but cirrhosis was not established. This case appears to indicate that mixed type carcinoma can develop in a non-cirrhotic liver, with CCC being far more dominant than HCC; such a finding is extremely unusual, based on previously published reports.     

Levels of vitamin A and cellular retinol binding protein in human hepatocellular carcinoma and adjacent normal tissue

The levels of vitamin A (retinol) and vitamin E were measured in the blood, in tissues of human hepatocellular carcinoma (HCC), and in adjacent liver parenchyma. The median values of vitamin A were 11.5 micrograms/g (ranging 0-82.5 micrograms/g) in HCC and 52.1 micrograms/g (ranging 0.4-895.2 micrograms/g) in normal liver tissues; the difference was statistically significant (p less than 0.05). By contrast, there was no significant difference in vitamin E levels between the two tissues. Although the levels of vitamin A were significantly lower in HCC in 10 patients, no significant difference was noted in the cellular retinol binding protein levels in the normal and malignant tissues. These results suggest that the decreased levels of vitamin A in HCC are not due to altered cellular retinol binding protein levels in tumors and the different vitamin A blood supply system. We conclude that either the decreased uptake of vitamin A, but not vitamin E, by HCC cells or the lack of vitamin A-storing cells in tumors might be responsible for the low levels of vitamin A in HCC.     

Case report: effect of antileishmanial treatment on hepatitis C viraemia in a visceral leishmaniasis patient with chronic hepatitis C

We describe a case of Mediterranean visceral leishmaniasis (VL) in a patient with pre-existing chronic hepatitis C, which caused high hepatitis C virus (HCV) plasma concentration and was followed by a rapidly growing hepatocellular carcinoma (HCC). The high HCV load was drastically and persistently reduced soon after treatment with liposomal amphotericin B suggesting a cause-effect interaction. Some data suggest that liposomal amphotericin B may have an immunomodulatory effect. VL may directly affect the liver function, but HCC has never been reported as a consequence of the disease. This case suggests that VL causes an increase in HCV replication, but, although the growth of the HCC can be defined as exceptional, a relationship with VL is not proven.     

Levels of vitamin a and cellular retinol binding protein in human hepatocellular carcinoma and adjacent normal tissue

The levels of vitamin A (retinol) and vitamin E were measured in the blood, in tissues of human hepatocellular carcinoma (HCC), and in adjacent liver parenchyma. The median values of vitamin A were 11.5 μg/g (ranging 0–82.5 μg/g) in HCC and 52.1 μg/g (ranging 0.4–895.2 μg/g) in normal liver tissues; the difference was statistically significant (p < 0.05). By contrast, there was no significant difference in vitamin E levels between the two tissues. Although the levels of vitamin A were significantly lower in HCC in 10 patients, no significant difference was noted in the cellular retinol binding protein levels in the normal and malignant tissues. These results suggest that the decreased levels of vitamin A in HCC are not due to altered cellular retinol binding protein levels in tumors end the different vitamin A blood supply system. We conclude that either the decreased uptake of vitamin A, but not vitamin E, by HCC cells or the lack of vitamin A‐storing cells in tumors might be responsible for the low levels of vitamin A in HCC.     

彩超引导下酒精注射治疗小肝癌的疗效观察

目的 探讨彩超引导下酒精介入治疗小肝癌的声像图改变及可行性和疗效。方法 应用彩色超声引导无水酒精注射治疗21例小肝癌，每周一次，四次为一疗程。结果 所有病例治疗后3月彩超检查，其中3例肿块完全消失，18例肿块均有不同程度的缩小，肿块中央回声增强，周边呈低回声，境界清晰，肿瘤内血流消失或减少。病人治疗后全身情况好转，症状减轻或消失，饮食明显增加，AFP改善，生活质量提高，无严重并发症发生。结论 超声引导酒精介入治疗对小肝癌的治疗有较好的疗效，安全实用，声像图表现有助于判断无水酒精注射治疗的疗效。     

Case report of hepatocellular carcinoma and cytofluorometric nuclear DNA ploidy.

Cytofluorometric nuclear DNA ploidy analysis was performed in two cases of primary hepatocellular carcinoma (HCC). This study was done to get the information about clinical behavior of tissues and to assess the prognosis. In both cases, almost all the liver function tests were abnormal, the tumors were thickly encapsulated, and the size of the tumors were below 5 cm in diameter. The DNA distribution pattern was categorized in two types, diploid and aneuploid with low and high ploidy, according to the mode and degree of dispersion of cells on the DNA histogram. Low ploidy pattern of histogram was found in one and diploidy pattern in another case. The serum alpha FP level was found high in case of diploidy pattern of histogram. The case of diploidy pattern of histogram died earlier than the case of aneuploid low ploidy pattern of histogram. The DNA ploidy patterns did not relate to the survival rates of patients. A preoperative cytofluorometric nuclear DNA ploidy analysis on biopsy specimens may be potentially useful to get the information about clinical behavior of tissues, to do the selective surgical procedures, and to assess the prognosis.     

Surgical treatment of hepatocellular carcinoma

Surgical treatment of hepatocellular carcinoma. The therapy of hepatocellular carcinoma (HCC) has got nowadays an important problem of medicine. The five year survival time has increased in the consequences of the last 25 year medical activities. The development of liver surgery, the introduction of aggressive surgical strategy, the prognosis of the disease and the special indication of the operation have had important factors in bettering of the results. The size and number of the tumor, the tumor-free region of the tissue resected, capsule building, and the venous infiltration are the most important factors influencing the survival time. The repeated resection in case of newly developed HCC has got also a result with 19-20 per cent of five year survival time. In cases of non resectable tumors the a la carte chemotherapy, radiofrequency, TACE for down staging produce an opportunity in 10-20% of tumors being resectable. The new combined surgical-oncologic-intervention strategies involve the two step and repeated interventions, the minimal invasive technique (MIT), the TACE and the a la carte chemotherapy. Liver transplantation can be carried out exclusively in tumors less than 3 cm and in those having no more than 3 metastases.     

Characteristics of hepatocellular carcinoma in a high arsenicism area in Taiwan: a case-control study

Arsenic contamination of drinking water is noticeably linked to the occurrence of skin, bladder, lung cancers, and hepatocellular carcinoma (HCC). Blackfoot disease (BFD) caused by arsenicosis is endemic in southwestern Taiwan, where artesian well water contains high concentrations of arsenic, and mortality from HCC shows a dose-response increase by concentration of arsenic in the well water. This case-control study was conducted to examine the clinical characteristics of HCC patients of BFD-endemic area. A total of 65 HCC cases (54 men and 11 women) were recruited from the BFD-endemic areas. The clinicopathological features were compared with 130 age- and sex-matched HCC control patients from non-BFD-endemic areas. Characteristics analyzed included hepatitis viral infection status, hepatitis activity, liver function, histological findings, computed tomography scan characteristics, and patient survival. No differences were observed between HCC patients or their tumors, from study and control areas.     

Increased risk for hepatitis B-related liver cirrhosis in relatives of patients with hepatocellular carcinoma in northern Taiwan

BACKGROUND: There is a tendency for familial aggregation of hepatocellular carcinoma (HCC). The aims of this study were to assess the degree to which familial aggregation of hepatitis B surface antigen (HBsAg) carriers accounts for familiality of HCC in families of hepatitis B-related HCC patients, and whether HCC shares a familial predisposition with liver cirrhosis among HBsAg carriers. METHODS: A total of 671 first-degree relatives of HBsAg-positive HCC cases were recruited using abdominal ultrasonography and tests for HBsAg and serum aminotransferases. They were from 165 simplex families defined as having only one HCC case and 72 multiplex families with more than one case. In analyses of family history of HCC and cirrhosis, the data set consisted of 4,471 unrelated asymptomatic HBsAg carriers recruited in a prospective study. RESULTS: There was no significant difference in the HBsAg-positive rate among relatives between multiplex (55.7%) and simplex (48.1%) families. Sonographic evidence of liver cirrhosis was present in 14.4% of HBsAg-positive relatives from multiplex families but in only 7.8% of HBsAg-positive relatives from simplex families (multiplex versus simplex families: adjusted odds ratio [OR] = 2.29; 95% CI: 1.10-4.77). Among unrelated asymptomatic HBsAg carriers, the adjusted OR of liver cirrhosis associated with a first-degree family history of HCC was 2.80 (95% CI: 1.68-4.66). This association was stronger in HBsAg carriers <50 years. No association was seen between family history of HCC and hepatitis activity based on elevated levels of aminotransferases. CONCLUSIONS: Familial aggregation of HCC in HBsAg carriers is associated with familial clustering of liver cirrhosis.     

国内丙型肝炎病毒感染与肝细胞癌关系的19个病例对照研究的 Meta 分析

本文对国内１９个有关丙型肝炎病毒（ＨＣＶ）感染与肝细胞癌（ＨＣＣ）关系的病例对照研究进行Ｍｅｔａ分析。经齐性检验表明，１９个研究中有１７个研究结果是一致的。对此１７个研究结果加权合并，累积ＨＣＣ病例１５７７例，ＨＣＶ感染率为２３．０％，累积对照１９８０例，ＨＣＶ感染率为４．０％；合并ＯＲ值为６．７。结果表明，国内ＨＣＶ感染与ＨＣＣ关系密切，ＨＣＶ感染是ＨＣＣ发生的一个危险因素。     

Assessment of some risk factors for hepatocellular carcinoma: a case control study

A case-control study of risk for hepatocellular carcinoma (HCC) was carried out in our Department from December 1980 to December 1983. One hundred and twenty consecutive inpatients with HCC were compared with 360 controls pair-matched by sex and age (within years). For each case three different controls were selected from inpatients at the same hospital: one patient with liver cirrhosis; one patient with solid tumor and one patient with chronic illness other than neoplasm or liver disease. We report here the results on alcohol consumption, smoking habit and hepatitis B virus infection. The risk factors investigated are distributed similarly in HCC and cirrhosis. The prevalence of alcohol abuse in HCC is similar to that in cirrhosis and is significantly higher than in other neoplastic or otherwise chronically ill patients (odds ratio 2 X 3 and 3 X 2 respectively). Thus alcohol abuse is probably a risk factor for HCC as a cause of cirrhosis. Smoking habits were similar among the various disease groups and independent of alcohol consumption. The prevalence of heavy smoking was comparable in cases and controls. HbsAg negative-HCC with an ultrasonographic pattern of 'diffuse' alteration was more frequent in heavy smokers.     

酞胺哌啶酮对裸鼠人肝癌血管生成和肿瘤生长、转移的作用

目的　通过建立肝原位移植性高转移潜能人肝癌裸鼠模型 ,观察酞胺哌啶酮对肝细胞癌 (HCC)血管生成和肿瘤生长、转移的干预作用。方法　 2 4只人肝癌裸鼠模型随机分成两组 ,实验组和对照组 ,每组 12只。自模型建立次日始两组分别给予2 0 0mg·kg-1·d-1剂量酞胺哌啶酮 (混悬于 0 5 %CMC溶液 )和等体积 0 5 %CMC腹腔注射 ,给药第 3 0d处死裸小鼠 ,观察肿瘤生长、转移情况 ,分别用免疫组化和RT -PCR的方法检测癌组织CD和VEGFmRNA的表达水平 ,记录微血管密度 (MVD)。结果　实验组MVD和VEGFmRNA低于对照组 (P <0 0 5 ) ;肿瘤体积、重量及肝肺转移率组间无统计学差异 ,但肝肺转移灶数目实验组低于对照组 (P <0 0 5 )。结论　酞胺哌啶酮对HCC生长无明显抑制作用 ,但明显能抑制肿瘤血管生成和HCC的肝内转移和肺转移。     

肝细胞癌组织中PTEN和p27蛋白的表达

目的　研究肝细胞癌 (hepatocellular carcinoma,HCC)组织中 PTEN和 p2 7蛋白的表达。　方法　利用免疫组织化学技术检测 65例 HCC中 PTEN和 p2 7蛋白的表达。　结果　在 HCC中 ,PTEN和 p2 7蛋白的阳性率分别为 60 %(3 9/ 65 )和 5 3 .85 % (3 5 / 65 ) ,PTEN蛋白阴性表达率 40 % (2 6/ 65 ) ;PTEN和 p2 7蛋白的阳性表达强度之间呈明显正相关(r=0 .7461) ;PTEN和 p2 7蛋白的阳性表达强度与 HCC的分化程度明显相关 ,分化愈差 ,表达愈强 (p<0 .0 1) ,但与患者年龄、性别及肿瘤大小无关。　结论　在 HCC的发生及进展过程中 ,PTEN蛋白表达的缺失和降低可能导致 p2 7蛋白表达减少 ,使其不能有效发挥细胞周期负调控因子的抑瘤作用 ,使得瘤细胞具有更高的恶性程度     

Splenic metastasis of hepatocellular carcinoma

A 76-year-old man, who underwent central bisegmentectomy of the liver, transcatheter arterial chemoembolization, and radiofrequency ablation for chronic hepatitis C virus-related hepatocellular carcinoma (HCC), was found to have a 3 cm mass in the spleen and a 2 cm mass in the liver by computed tomography in January 2003. As both tumors were adjacent, a diagnosis of HCC with splenic infiltration was made. In February 2003, transcatheter arterial chemoembolization and splenic arterial chemo-infusion were performed. However, the splenic tumor increased to 5 cm with slight enhancement on contrast-enhanced computed tomography performed 6 months later, while the hepatic tumor had no enhancement. Limited resection of the liver with splenectomy was performed in October 2003. Macroscopically, the splenic tumor showed infiltrative growth without a capsule while the hepatic tumor showed complete necrosis within its capsule. The splenic tumor was limited to the splenic parenchyma. Histologic examination revealed that the splenic tumor was poorly differentiated HCC, leading to the diagnosis of splenic metastasis. The patient is doing well 17 months after surgery without recurrence. One should perform surgery for splenic metastasis of HCC without hesitation whenever possible.     

A long surviving hepatocellular carcinoma case (2 years 1 month) with tumor thrombus in the portal trunk treated by embolization

A 55-year-old male patient suffered from hepatocellular carcinoma (HCC) with tumor thrombus in the portal trunk and cavernous transformation in the liver hilus. He was treated 4 times effectively by transcatheter arterial embolization (TAE). Tumor thrombus in the portal trunk which was demonstrated by portography before TAE disappeared following initial TAE. He is still alive 2 years and 1 month after initial TAE. We reported a long surviving case with advanced HCC treated by TAE and TAE for advanced HCC was discussed.     

Mortality from liver disease among Italian vinyl chloride monomer/polyvinyl chloride manufacturers

The possible association in humans between nonangiosarcoma primary liver tumors (PLC-non-A), particularly hepatocellular carcinoma (HCC), and exposure to vinyl chloride monomer (VCM) is supported by both experimental and human data. This article presents a review of the information regarding 253 deaths that occurred in seven plants manufacturing VCM/PVC and one plant extruding PVC. The retrieval of clinical and pathological data, in addition to the information from death certificate, is referred to as "best evidence" (BE). BE has been carried out for 63 deaths. A total of 14 primary liver cancer (PLC) were detected: seven were angiosarcoma (PLC-A), and two of the remaining seven were hepatocellular carcinoma (HCC). In our series of 14 PLC cases, there was no significant difference between PLC-A and PLC-non-A as to length of exposure and latency. There was no noticeable difference in terms of job title between ASL and non-ASL cases. The list of longest held jobs shows the presence of various job titles, different from autoclave cleaner, for primary liver cancer, PLC-A and PLC-non-A. In conclusion, our observations show that VCM may have a broader carcinogenicity action on the liver and that exposure lower than that occurring in autoclave cleaning can cause primary liver cancer, both angiosarcoma and nonangiosarcoma.     

Sarcomatoid liver carcinoma diagnosed clinically as hemangioma]

This is a case report of a 69-year-old woman with sarcomatoid hepatocellular carcinoma (HCC), which was diagnosed clinically as hemangioma. She was first admitted to our university hospital, complaining of general fatigue in December, 1988, and cholelithiasis and liver cirrhosis with hepatic tumor in Segment 8 were diagnosed. The serum AFP level was within normal range, and the tumor was diagnosed as hemangioma radiologically. She underwent only cholecystectomy and was well without any therapy for the liver tumor up until March in 1991 when she was readmitted to our university hospital due to rapidly progressive liver dysfunction. The size of the liver tumor was unchanged. Despite intensive care, she died of hepatic failure due to cirrhosis in a decompensation state. At autopsy, a well defined yellowish white tumor of 3 cm in maximum diameter was seen in the cirrhotic liver. Although the largest part of the tumor revealed necrosis and hyalinization, a sarcomatoid part composed of spindle-shaped cells was noted in the peripheral portion. In addition, some necrotic ghost cells, probably hepatocellular carcinoma, were also noted. Low molecular cytokeratin, which is always found in HCCs, was seen in spindle-shaped sarcomatoid cells. The liver tumor was diagnosed as sarcomatoid HCC from these pathological findings. We report this histologically unusual HCC with an immunohistochemical study.