Human hepatocellular carcinoma tumor xenografts

Castrated or sham-operated male athymic mice were inoculated with cells from the human hepatocellular carcinoma cell line PLC/PRF/5. There were no significant differences between the two groups with respect to the number of animals developing tumors, the time to tumor development, or the subsequent rate of increase in either tumor base area or mouse serum alpha-fetoprotein concentration. Androgen receptors were assayed in nuclei obtained from three separate liver cancer cell lines and from normal adult human liver. Similar concentrations, ranging from 235 to 550 fmol/mg DNA, of nuclear androgen receptors were detected in all tissues. Low percentages of androgen receptors were retained on DNA-cellulose. Although the presence of receptors implies the potential for metabolic effects of androgens in normal and malignant liver, our in vivostudies suggest that castration does not alter significantly the growth of liver cancer xenografts in athymic mice.     

Resected case of hepatocellular carcinoma associated with lupoid hepatitis

A 65 year old woman with lupoid hepatitis developed hepatocellular carcinoma which was diagnosed at an early stage. She had no history of blood transfusion and serum hepatitis B virus markers were negative. Prednisolone and 6-mercaptopurine were administered for the treatment of lupoid hepatitis. A hepatocellular carcinoma was detected by the elevation of serum alpha-fetoprotein and imaging studies. A tumour, 1.4 cm in diameter, was located in the lateral segment of the left hepatic lobe. It was resected by hepatic subsegmentectomy. Histological study showed a hepatocellular carcinoma of Edmondson type II against a background of posthepatitic cirrhosis. The patient was in good condition 2.5 years after the operation.     

Successful management of the hepatocellular carcinoma with inferior vena cava tumor thrombus: A case report

Rationale:Hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT) is traditionally considered an advanced-stage cancer with a poor prognosis. There is no standard treatment for patients diagnosed as HCC with IVCTT.Patient concerns:A 52-year-old man was admitted to our hospital because of suspected hepatic mass during a health examination.Diagnoses:Computed tomography (CT) showed a hepatic mass approximately 4.3 cm × 6.3 cm in size located in segment VII of the liver, with thrombus in the inferior vena cava. The mass exhibited a pattern of early enhancement and washout on contrast-enhanced CT. Alpha-fetoprotein was 614.1 ng/mL (normal value, <8 ng/mL). The preoperative diagnosis was HCC with IVCTT.Interventions:Two months after stereotactic body radiotherapy combined with sorafenib therapy, a planned open anatomical resection of the right posterior lobe of the liver was performed.Outcomes:The patient is alive without disease 12 months after surgery, and the level of alpha-fetoprotein is normal.Lessons:The patient diagnosed as HCC with IVCTT was successfully treated by stereotactic body radiotherapy combined with molecularly targeted drugs followed by surgical treatment. If confirmed in future studies, this would suggest a promising strategy for the management of HCC with IVCTT.     

肝肉瘤样癌伴类白血病反应1例报告

1病例资料患者男性,65岁,因“上腹部疼痛3 d”于2017年10月7日入本院。既往史:糖尿病病史5年,口服二甲双胍,控制情况不详。否认肝炎、结核等传染病病史,无吸烟饮酒嗜好,无家族遗传病史。入院查体:腹部平软,上腹部有压痛伴肌卫,无反跳痛,肝脾肋下未及,无移动性浊音,双下肢无浮肿。     

A case of laparoscopic hepatectomy for recurrent hepatocellular carcinoma

Conventional hepatectomy is an effective way to treat hepatocellular carcinoma.However,it is invasive and stressful.The use of laparoscopy in hepatectomy,while technically demanding,reduces surgical invasiveness and stressfulness but still achieves complete resection with adequate margins.Compared with conventional hepatectomy,laparoscopic hepatectomy provides a better chance and situation for further surgery in the case of recurrence of hepatocellular carcinoma.Even aged patients can successfully endure re...     

肝癌组织相关基因表达与肝癌术后生存的关系

目的 探讨肝癌组织内多个肝癌相关基因表达情况及其与术后生存预后的关系。方法对72例手术切除肝癌患者的追踪随访资料进行生存分析,分析各临床和病理指标与生存预后的关系。对手术切除的肝癌标本以半定量RT-PCR方法测定癌组织中多个基因的表达情况。结果术前肝功能分级、血清AFP、AFU、癌组织分化程度、有无癌栓与预后相关（P〈0．05）。肝癌组织内COL1A2、Geminin、IGFBP3、SPINK2表达与患者的癌组织分化程度相关。结论肝癌组织内COLlA2、Gemlnin、IGFBP3和SPINK2基因表达为肝癌术后生存的主要相关分子生物学因素。     

Spontaneous tumor rupture and surgical prognosis of patients with hepatocellular carcinoma

Abstract

Background. Spontaneous rupture is an uncommon but the most fatal complication of hepatocellular carcinoma (HCC) and is recognized as a risk factor for tumor recurrence. The present study is to investigate the short- and long-term survival of the patients with HCC rupture and evaluate the influence of tumor rupture on patient's survival after hepatic resection. Patients and methods. The clinical data of 101 patients with HCC rupture from 2000 to 2010 were reviewed retrospectively. The management of tumor rupture and clinicopathological parameters affecting 30-day mortality of the patients were recorded and evaluated. Long-term survival of the 41 patients undergoing hepatic resection was compared with 446 patients with non-ruptured HCC at the same time period. Results. The 30-day mortality rate of the 101 patients with HCC rupture was 35.6% and median survival was 79 days. The independent risk factors affecting 30-day mortality were tumor size and blood transfusion quantity. Compared with 446 non-ruptured HCC patients, 41 patients with ruptured HCC undergoing hepatic resection had a similar overall and disease-free survival to 446 without rupture (Log-rank test, p = 0.704 and 0.084, respectively). Multivariate analysis revealed that age, gender, and tumor size were independently significant factors in differentiating tumor rupture from non-rupture. Conclusion. Early mortality of spontaneous rupture of HCC was dependent on preoperational liver function, tumor status, and severity of bleeding. Prolonged survival can be achieved in patients with ruptured HCC after hepatic resection as those without the complication.     

Hepatectomy with microwave tissue coagulation for hepatocellular carcinoma

From 1984 through 1994, 99 consecutive patients with hepatocellular carcinoma (HCC) underwent hepa-tectomy with microwave tissue coagulation (MTC). We performed limited resection (Hr0) in 28 patients, subsegmentectomy (HrS) in 25 patients, segmentectomy (Hr1) in 21 patients, and lobectomy or extended lobectomy (Hr2) in 25 patients. The patients were divided into two groups: group A, 86 patients with tumors smaller than 1 kg and no tumor thrombi in the main portal trunk; and group B, 13 patients with a tumor 1 kg or larger, or with macroscopic tumor thrombi in the main portal trunk. In group A, mean blood loss was 838 ml for Hr0, 1948 ml for HrS, 1765 ml for Hr1, and 1325 ml for Hr2. The mean operative time in group A ranged from 3 h 43 min for Hr0 to 4 h 57 min for Hr2. In group B, the mean operative time was 6 h 3 min and mean blood loss was 6053 ml. Our MTC method was associated with an in-hospital mortality rate of 3% and a major complication rate of 13.1%. The 5-year survival and disease-free survival rates were 43.4% and 25.4%, respectively. The 5-year survival rate of patients without portal tumor thrombi (50.9%) was significantly better than that of patients with portal tumor thrombi (11.9%) (P < 0.001). The 5-year survival rate of patients who underwent curative resection (58.1%) was significantly better than that of patients who underwent noncurative resection (22.9%) (P < 0.001). The 5-year survival rates of patients in group A without portal tumor thrombi did not differ between those who had cancer-negative margins (54.0%) and those with cancerpositive margins (49.6%) at resection. Recurrence and local recurrence rates did not differ in patients with cancer-positive margins (63.6% and 7.3%, respectively) and patients with cancer-negative margins (56.5% and 8.7%, respectively). These results suggested that microscopic residual cancer in the resected margin was coagulated by MTC. Blood loss, operative time, and clinical outcome in this series of 99 consecutive hepatectomies were comparable with values in earlier reports in which such hemostatic methods as the Pringle maneuver were used. We conclude that hepatectomy with MTC is useful and safe and produces consistent results.     

肝细胞癌伴门静脉癌栓的降期治疗

肝细胞癌伴门静脉癌栓发生率高,病情进展快,现有治疗方法有限且效果不佳。虽然国外指南推荐索拉非尼为唯一治疗手段,但临床研究显示部分患者,尤其是伴癌栓侵犯至门静脉一级或二级分支的患者(程氏分型Ⅰ/Ⅱ型),通过手术切除可以取得比其他非手术疗法更好的效果。然而临床实践中相当一部分患者由于病灶范围较广无法根治性切除,或者由于癌栓侵犯到门静脉主干(程氏Ⅲ型),术后癌栓残留可能性高,需要通过降期切除的方法改善预后。研究发现通过新辅助三维适形放疗、经肝动脉钇-90微球放射性栓塞、肝动脉灌注化疗等姑息性治疗方法,部分患者(5.7%~26.5%)可出现门静脉癌栓消退乃至消失、肿瘤体积缩小、卫星灶消失等现象,从而使病灶降期,提高手术切除率并延长患者生存时间。多学科综合治疗对于进一步提高肝细胞癌伴门静脉癌栓患者的降期切除率至关重要。     

Donafenib treatment for hepatocellular carcinoma: A case report

Rationale:Hepatocellular carcinoma (HCC) is the most common liver cancer. The efficacy of the present treatment is disappointing, and the prognosis is poor. Donafenib, a novel multikinase inhibitor, is a new deuterated derivative of sorafenib. It can improve overall survival in patients with advanced HCC, with a favorable safety and tolerability profile over sorafenib.Patient concerns:Here, we report the case of a 51-year-old male patient who presented with experienced epigastric discomfort for the prior several days. He had a history of untreated chronic hepatitis B virus infection for >29 years and no other underlying diseases. Based on further investigations, he was diagnosed with advanced HCC and refused surgery.Diagnosis:Based on the patient''s performance status, tumor status assessed by computed tomography, liver function, and percutaneous liver biopsy, he was diagnosed with advanced HCC Barcelona Clinic Liver Cancer Stage C.Interventions:The patient was administered a 200-mg oral dose of donafenib twice-daily.Outcomes:The patient was followed-up from the time of diagnosis. He received donafenib for 31 months, and the progression-free survival time was 31 months (from May 2017 to December 2019); the overall survival time was not reached. The patient reported little abdominal distension with no other obvious discomfort while taking the medication.Lesson:Donafenib showed good efficacy for the treatment of advanced HCC, with mild side effects. Deuterium-containing drugs seem to be a promising avenue for medical innovation.     

以Lambert-Eaton肌无力综合征为首发症状的肝细胞癌1例报告

正1病例资料患者女性,56岁,因眼睑下垂3个月就诊于当地医院神经内科,行肌电图提示Lambert-Eaton肌无力综合征(LambertEaton myasthenic syndrome,LEMS)可能性大。遂行头部核磁共振检查未见异常。肺部增强CT未见明显异常。肝胆三期增强CT示(图1):肝硬化、脾大、肝左叶外侧段异常强化影,考虑原发性肝癌可能性大,为求手术治疗入本院。既往史:患者     

GP73在原发性肝癌组织中的表达及意义

目的探讨高尔基体糖蛋白73(GP73)表达诊断肝癌的价值。方法采用免疫组织化学染色SP法检测60份肝癌组织、癌旁组织及24份正常肝组织中GP73表达;分析GP73表达与肝癌临床病理特征的关系。结果肝癌组织、癌旁组织GP73阳性率显著高于正常肝组织(P<0.05)。GP73表达与Child-Pugh分级呈正相关(P<0.05),在肝外转移和HBV感染中表达亦显著增强(P<0.05),与性别、年龄、AFP、肿瘤大小、肝硬化和门脉癌栓无明显相关性。结论 GP73与肝癌的发生发展有关。     

肝肉瘤样癌误诊为肝细胞癌1例报告

肉瘤样癌是指形态学类似梭形细胞肉瘤但实际上为癌的一类较少见恶性肿瘤的总称,可以发生在全身多个器官,但以上呼吸道、肺、乳腺和肾常见^（[1]）。肝肉瘤样癌（sarcomatoid hepatocellular carcinoma,SHC）是发生于肝脏的一种少见的恶性肿瘤,恶性程度高,预后较差,1年生存率几乎为0^（[2]）。1病例资料患者男性,54岁,因＂发现肝占位2年,反复发热1个月＂     

A case of ectopic hepatocellular carcinoma in the jejunum

We describe the case of a 72 year-old man with a huge tumor in his lower abdomen and extremely high serum α-fetoprotein levels (99 100 ng/ml). The patient had no risk factors for hepatocellular carcinoma (HCC) or liver disease. Computed tomography, magnetic resonance imaging, and hepatic angiography detected no tumors in the liver before surgery. The arteries feeding the tumor arose from the superior mesenteric artery, but were not recognized on celiac angiography. Histologically, the tumor cells had features of HCC. Immunohistochemical staining revealed that the tumor cells were positive for AFP and the hepatocyte paraffin 1 monoclonal antibody. Furthermore, the tumor cells were strongly positive for cytokeratin 8 and cytokeratin 18, which are usually expressed on hepatocytes in HCC, and negative for both cytokeratin 7 and cytokeratin 20, which are not usually expressed in HCC. Hence, the tumor was diagnosed as an ectopic HCC that possibly developed from ectopic liver tissue in the jejunum. Approximately 2 months after the operation, transarterial chemoembolization was performed for liver metastasis from this tumor. One year after the transarterial chemoembolization procedure, the patient remains well with no evidence of a recurrent tumor or serum AFP elevation.     

Fibrolamellar hepatocellular carcinoma

Fibrolamellar hepatocellular carcinoma is an uncommon malignancy seen in young adults without underlying liver disease. Physical signs are minimal and laboratory values are noncontributory. Diagnosis is suggested by clinical history, supported by radiographic studies, and confirmed by histologic examination. Individuals with fibrolamellar carcinoma generally have a greater survival than those with hepatocellular carcinoma. Although most patients with fibrolamellar carcinoma undergo curative surgery, two of the three patients we report had inoperable tumors.     

Surgical treatment for advanced hepatocellular carcinoma with portal vein tumor thrombus

The Barcelona Clinic Liver Cancer staging system recommends a tyrosine kinase inhibitor (sorafenib) as standard therapy in advanced hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT). Sorafenib has been shown to prolong median overall survival (OS) by approximately 3 months in advanced HCC patients with PVTT (8.1 vs. 4.9 months). However, its clinical effectiveness is still controversial and standard treatment with sorafenib is not established in Japan. Surgical resection is considered a potentially curative treatment and provides an acceptable outcome for carefully selected patients. The surgical mortality rate in patients with PVTT who receive surgical resection ranges from 0% to 10%. The median survival time and 1-year OS rate in HCC patients with PVTT who undergo surgical resection have been found to range from 8 to 22 months and 21.7% to 69.6%, respectively. But improvement in therapeutic outcome is difficult with surgical treatment alone. Combination treatment in conjunction with such methods as transarterial chemoembolization, hepatic artery infusion chemotherapy, and radiotherapy has been found to improve the prognosis (median survival time, 11.5–37 months; 1-year OS rate, 46.8–100%). Yet, many problems remain, such as surgical indications and surgical techniques. After resolving these points, a multidisciplinary strategy based on surgical treatment should be established for advanced HCC with PVTT.     

A case of well-differentiated minute hepatocellular carcinoma with extrahepatic metastasis

A rare case of well-differentiated minute hepatocellular carcinoma (HCC) metastasizing to distant sites in a 77-year-old man with hepatitis C virus (HCV)-related cirrhosis is presented. Ultrasonography (US) disclosed a 9 mm hypoechoic lesion in segment seven (S₇) of the liver, although computed tomography (CT), magnetic resonance imaging (MRI) and angiography did not reveal any space-occupying lesion. Ultrasound-guided biopsy showed the histological features of well-differentiated HCC. A plain film of the abdomen and CT revealed osteolytic changes in the sacrum and the lumbar vertebra. Ultrasound-guided biopsy of the sacrum revealed well-to-moderately differentiated HCC metastasizing from the liver. Percutaneous ethanol injection therapy (PEIT) effected complete response and completely eliminated the abnormal findings on US. Three months after PEIT, metastasis to the thoracic vertebra was revealed by CT, despite negative α-fetoprotein-mRNA in serum. This is the first report describing a well-differentiated HCC with metastatic potential. Further studies may provide insights into metastasis of well-differentiated HCC.