Clinical Characteristics of Intrahepatic Cholangiocarcinoma in Spain. Liver Cirrhosis and High AFP are not Always Hepatocellular Carcinoma
Carlos Rodríguez de LopeMontserrat FornéJavier FuentesMaría ReigVictòria AndreuBeatriz MínguezMercedes IñarrairaeguiC. FernándezMercè RogetAlberto LuéInmaculada OrtízFelipe Piñol JiménezSilvia MontoliuM.C. GarrePaloma RendónManuel RodríguezJavier CrespoJordi BruixMarı́a Varela
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Intrahepatic Cholangiocarcinoma
The present studt was completed to assess the clinical utility of B protein, as a tumor marker of hepatocellular carcinoma. The association of B protein and liver cirrhosis was also evaluated because hepatocellular carcinoma is usually combined with cirrhosis. The serum levels of B protein were studied by a Latex-agglutination test. One hundred and twenty-nine patients including 23 hepatocellular carcinoma, 50 hepatocellular carcinoma combined with liver cirrhosis, 40 liver cirrhosis, and 16 chronic hepatitis were tested. The positive rates of B protein in various diseases were as follows: 30.4% (7/23) in patients with hepatocellular carcinoma; 68.6% (35/50) in patients with hepatocellular carcinoma combined with cirrhosis; 82.5% (33/40) in patients with cirrhosis; and 62.5% (10/16) in patients with chronic hepatitis. When B protein was used as a tumor marker of hepatocellular carcinoma, the sensitivity (57.5%) and specificity (25%) were very low. Furthermore, patients with hepatocellular carcinoma, usually combined with cirrhosis; which carried the highest positive rate on B protein determination. This also limited clinical utilization of B protein as a tumor marker of hepatocellular carcinoma. Moreover, there was no correlation of B protein with the serum alpha-fetoprotein level or tumor size. On the contrary, positive correlation of the B protein level with Child's staging (Tau-c value = 0.392, p = 0.008), and death during follow-up (Tau-c value = 0.456, p = 0.021), were discovered in patients with cirrhosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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We have measured the serum erythropoietin concentrations in 14 patients with liver cirrhosis and in 14 patients with a hepatocellular carcinoma. Among these patients, 2 with liver cirrhosis (14.3%) and 7 with a hepatocellular carcinoma (50.0%) were found to have raised serum erythropoietin concentrations, ranging up to 40 mU/ml. Negative correlations were found between erythropoietin and the RBC, and the Hb and Ht in the cases with liver cirrhosis. In contrast, a positive correlation which was not significant was found only between the erythropoietin and the RBC in cases involving a hepatocellular carcinoma. This has suggested that the relationship between the erythropoietin and the RBC in cases of a hepatocellular carcinoma differs from the relationship seen under the usual physiological circumstances of those with liver cirrhosis.
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Foreword. Preface. 1. The background to hepatocellular carcinoma and the liver. 2. Premalignant lesions of hepatocellular carcinoma. 3. Pathomorphologic characteristics of early-stage small hepatocellular carcinoma. 4. Morphologic evolution of hepatocellular carcinoma: from early to advanced. 5. Angioarchitecture of hepatocellular carcinoma. 6. Advanced hepatocellular carcinoma. 7. Multicentric occurrence of hepatocellular carcinoma. 8. Combined hepatocellular carcinoma and cholangiocarcinoma. 9. Nodular lesions mimicking hepatocellular carcinoma. 10. Biopsy diagnosis of tumorous lesions of the liver. 11. Chemoprevention of hepatocellular carcinoma. Index
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Hepatocellular carcinoma is the most common malignancy among males and the 7th among female patients in the Kingdom of Saudi Arabia. This is due to the endemicity of hepatitis B and hepatitis C. Spontaneous rupture of hepatocellular carcinoma is rare. We report 4 cases of spontaneous rupture of hepatocellular carcinoma. Initial control of bleeding was achieved surgically in 3 patients and by embolization in the 4th patient. All patients had very good hepatic reserve as reflected by Child-Pugh scoring (A & B). We found that the incidence of ruptured hepatocellular carcinoma among 85 patients was 4.7%. The prognosis of this subgroup of patients is poor as reflected by the low median survival ranging from 6-16 weeks.
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In a retrospective study, 42 out of 44 cases of hepatocellular carcinoma were investigated immunohistochemically for chronic hepatitis B infection. Surface antigen was found in the liver tissue of only 4 of these cases. In 41 of the patients, mildly to moderately active cirrhosis of the liver was found to be underlying the carcinoma. The age distribution and case histories showed that hepatocellular carcinoma often developed from low-complication cirrhosis of long standing and of various etiologies, and must thus be considered a late complication of cirrhosis.
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Objective To investigate the expression and relationship of TRA1 mRNA among hepatocellular carcinoma,liver cirrhosis and normal liver tissues. Methods RT-PCR was used to detect the expression of TRA1 mRNA in 34specimens of hepatocellular carcinoma,liver cirrhosis and normal liver tissues. Results The expression rates of TRA1in hepatocellular carcinoma,liver cirrhosis and normal liver tissues were 95. 00%,84. 21% and 50. 00%,respectively,there were significant differences between hepatocellular carcinoma and normal liver tissues(P 0. 05),but no significant differences between liver cirrhosis and normal liver tissues(P 0. 05). The expression levels of TRA1 mRNA were 1. 67 ± 0. 96,1. 49 ± 0. 53,0. 57 ± 0. 27,respectively,which was significantly higher in hepatocellular carcinoma and liver cirrhosis tissues than that in normal liver tissues(P 0. 05). Conclusion TRA1 mRNA is involved in the progression of hepatocellular carcinoma and liver cirrhosis,and it may be a potential biomarker for diagnosis and target for therapy.
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Objective To determine the AST/ALT ratio in healthy control,chronic hepatitis (G 0～3) and hepatic cirrhosis, and evaluate the relationship of AST/ALT ratio and hepatic cirrhosis. Method The levels of AST and ALT of healthy control group, patients with chronic hepatitis (G 0～3) and patients with hepatic cirrhosis were determined by Olympus AU640 automatic biochemical analyzer. Results There was no statistically significance difference between the AST/ALT ratios of healthy control group and patients with chronic hepatitis of different phases (G 0～3,P0.05), but there was statistically significance diference between healthy control group and patients with hepatic cirrhosis(P0.01). The difference was increasing with the increase in the class of Child-Pugh classification (P0.01).Correlation analysis demonstrated that the AST/ALT ratio of patients with hepatic cirrhosis has positive correlation with the child-Pugh integral (r=0.656,P0.01). There was statistically significance between the AST/ALT ratios of patients with chronic hepatitis (G 0～3) and patients with hepatic cirrhosis (P0.01). There was statistically significance difference between AST/ALT ratios of living and dead patients with hepatic cirrhosis (P0.05). There was statistically significance difference between AST/ALT ratios of hepatic cirrhosis patients with and without upper gastrointestinal bleeding (P0.05). Conclusion The AST/ALT ratios of patients with hepatic cirrhosis can be used as a indicator of the condition of patients with hepatic cirrhosis, and for prognosis judgement.
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Objective To evaluate the diagnostic value of diffusion weighted imaging(DWI) at 3.0 T magnetic resonance in liver cirrhosis and hepatocellular carcinoma.Methods DWI was performed in 10 healthy volunteers,21 patients with liver cirrhosis and 30 patients with hepatocellular carcinoma at 3.0T magnetic resonance. DWI and ADC values in normal liver, liver cirrhosis and hepatocellular carcinoma were analysed.The diagnostic sensitivity and specificity of ADC values in normal liver, liver cirrhosis and hepatocellular carcinoma were also analysed.Results When b value was 100 s/mm2,the ADC values of normal liver were higher than liver cirrhosis, hepatocellular carcinoma(P0.05),but there was not significance between liver cirrhosis and hepatocellular carcinoma(P0.05).When b value was 300 s/mm2,1000 s/mm2,the ADC values of three groups had significant differences(P0.01). When b value was 300 s/mm2, the diagnostic sensitivity and specificity were 82.6% and 100% in liver cirrhosis ,95.2% and 90.4% in hepatocellular carcinoma ,respectively. When b value was 1000 s/mm2, the diagnostic sensitivity and specificity of ADC values were 86.9% and 100% in liver cirrhosis,95.2% and 66.7% in hepatocellular carcinoma,respectively. Conclusion DWI at 3.0 T magnetic resonance in examination of liver could synthetically and quantitatively analyze the rule of ADC values in liver cirrhosis and hepatocellular carcinoma.
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The aim of this study was to determine the characteristics of hepatocellular carcinoma at a major health center in southern Turkey. Computed tomography was compared to the combination of ultrasonography and serum alpha-fetoprotein determination in the diagnosis of hepatocellular carcinoma.Of 226 patients with liver cirrhosis, 35 were diagnosed with hepatocellular carcinoma on first admission or during follow-up in the period between 1999 and 2002. The features investigated were, age at time of hepatocellular carcinoma diagnosis, etiology of cirrhosis, severity of cirrhosis at presentation, tumor pattern, stage of hepatocellular carcinoma, serum alpha-fetoprotein level, and dynamic computed tomography findings. Results were compared to previous findings in Turkey and elsewhere.In the hepatocellular carcinoma patients, the male:female ratio was 4:1 and the mean age at presentation was 61 years. Chronic hepatitis B virus infection (65.7%) and chronic hepatitis C virus infection (28.6%) were the most frequently identified risk factors for hepatocellular carcinoma. Forty percent of the patients had Child-Pugh A cirrhosis when they were diagnosed with hepatocellular carcinoma. Sixty-seven percent of patients had fewer than three hepatocellular carcinoma nodules in the liver at the time of diagnosis. Only three of the hepatocellular carcinoma cases were Okuda stage I. The combination of ultrasonography and serum alpha-fetoprotein >20 ng/ml identified hepatocellular carcinoma in 32 of the 35 total cases.The results indicate that hepatitis B virus infection in patients with cirrhosis is still the leading risk factor for the development of hepatocellular carcinoma. Also, early-stage hepatocellular carcinoma is rarely diagnosed in cirrhosis patients from this region of Turkey. Surveillance with computed tomography for early diagnosis of hepatocellular carcinoma seems not to be mandatory.
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