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Rammohan A, Sathyanesan J, Rajendran K, Pitchaimuthu A, Perumal SK, Balaraman K, Ramasamy R, Palaniappan R, Govindan M. Bile duct thrombi in hepatocellular carcinoma: is aggressive surgery worthwhile? HPB (Oxford) 2015; 17:508-13. [PMID: 25639610 PMCID: PMC4430781 DOI: 10.1111/hpb.12383] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/30/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Obstructive jaundice as a result of bile duct tumour thrombus (BDTT) is an unusual clinical entity and an uncommon presenting feature of hepatocellular carcinoma (HCC). This study evaluates the outcome of hepatectomy for HCC with obstructive jaundice as a result of BDTT in non-cirrhotic livers. METHODS Between 1997 and 2012, out of 426 patients with HCC in non-cirrhotic livers, 39 patients with BDTT (Group I n = 39), who underwent a hepatectomy, were analysed and compared with the non-BDTT group (Group II n = 387). RESULTS The demographic profile and biochemical parameters between Group I and Group II were compared; apart from the presence of jaundice at presentation and an elevated serum bilirubin, there were no significant differences. Post-operative morbidity and mortality were 11 (28.2%) and 2 (5.1%), respectively, in Group I. There were no differences between the groups with regards to the operative variables and short-term outcomes. The 1-, 3- and 5-year survival rates in Group I were 82%, 48% and 10%, respectively, with a median survival of 28.6 months and were significantly poorer than Group II (90%, 55% and 38%, respectively, with a median survival of 39.2 months). CONCLUSION The mere presence of BDTT in HCC does not indicate an advanced or inoperable lesion. When technically feasible, a formal hepatic resection is the preferred first-line treatment option in these patients.
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Affiliation(s)
- Ashwin Rammohan
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia,Correspondence, Ashwin Rammohan, Division of HPB Diseases, The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt. Stanley Medical College & Hospital, Old Jail Road Chennai 600001, India. Tel.: +91 9884173583. Fax: +91 4425289595. E-mail:
| | - Jeswanth Sathyanesan
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Kamalakannan Rajendran
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Anbalagan Pitchaimuthu
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Senthil K Perumal
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Kesavan Balaraman
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Ravi Ramasamy
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Ravichandran Palaniappan
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
| | - Manoharan Govindan
- The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of Hepato-biliary Pancreatic Diseases, Govt, Stanley Medical College Hospital & Hospital ChennaiIndia
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Bile duct preserving surgery for hepatocellular carcinoma with bile duct tumor thrombus. Ann Surg 2015; 261:e123-5. [PMID: 25775076 DOI: 10.1097/sla.0000000000001209] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Wong TCL, Cheung TT, Chok KSH, Chan ACY, Dai WC, Chan SC, Poon RTP, Fan ST, Lo CM. Outcomes of hepatectomy for hepatocellular carcinoma with bile duct tumour thrombus. HPB (Oxford) 2015; 17:401-8. [PMID: 25410794 PMCID: PMC4402050 DOI: 10.1111/hpb.12368] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/19/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with bile duct tumour thrombus (BDTT) is rare. The aim of the present study was to determine the prognosis of HCC with BDTT after a hepatectomy. METHODS A retrospective analysis was performed on all HCC patients with BDTT having a hepatectomy from 1989 to 2012. The outcomes in these patients were compared with those in the control patients matched on a 1:6 ratio. RESULTS Thirty-seven HCC patients with BDTT having a hepatectomy (the BDTT group) were compared with 222 control patients. Patients in the BDTT group had poorer liver function (43.2% had Child-Pugh B disease). More patients in this group had a major hepatectomy (91.9% versus 27.5%, P = 0.001), portal vein resection (10.8% versus 1.4%, P = 0.006), en-bloc resection with adjacent structures (16.2% versus 5.4%, P = 0.041), hepaticojejunostomy (75.7% versus 1.6%, P < 0.001) and complications (51.4% versus 31.1%, P = 0.016). The two groups had similar hospital mortality (2.7% versus 5.0%, P = 0.856), 5-year overall survival (38.5% versus 34.6%, P = 0.59) and 5-year disease-free survival (21.1% versus 20.8%, P = 0.81). Multivariate analysis showed that lymphovascular permeation, tumour size and post-operative complication were significant predictors for worse survival whereas BDTT was not. DISCUSSION A major hepatectomy, extrahepatic biliary resection and hepaticojejunostomy should be the standard for HCC with BDTT, and long-term survival is possible after radical surgery.
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Affiliation(s)
- Tiffany C L Wong
- Department of Surgery, The University of Hong KongHong Kong, China
| | - Tan To Cheung
- Department of Surgery, The University of Hong KongHong Kong, China
| | - Kenneth S H Chok
- Department of Surgery, The University of Hong KongHong Kong, China
| | - Albert C Y Chan
- Department of Surgery, The University of Hong KongHong Kong, China
| | - Wing Chiu Dai
- Department of Surgery, The University of Hong KongHong Kong, China
| | - See Ching Chan
- Department of Surgery, The University of Hong KongHong Kong, China
| | - Ronnie T P Poon
- Department of Surgery, The University of Hong KongHong Kong, China
| | - Sheung Tat Fan
- Department of Surgery, The University of Hong KongHong Kong, China,Correspondence, Sheung Tat Fan, Department of Surgery, The University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China. Tel: +852 2255 4703. Fax: +852 2855 1897. E-mail:
| | - Chung Mau Lo
- Department of Surgery, The University of Hong KongHong Kong, China
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Rana SS, Chaudhary V, Sharma V, Sharma R, Gupta N, Sampath S, Mittal BR, Gupta R, Dutta U, Bhasin DK. Unusual cause of obstructive jaundice revealed by endoscopic ultrasound guided fine-needle aspiration of mediastinal lymph node. Endosc Ultrasound 2015; 4:73-5. [PMID: 25789290 PMCID: PMC4362010 DOI: 10.4103/2303-9027.151370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 04/01/2014] [Indexed: 01/09/2023] Open
Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vinita Chaudhary
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Ravi Sharma
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Nalini Gupta
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Santhosh Sampath
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Bhagwant R Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Rajesh Gupta
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Usha Dutta
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India
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Peeling-off technique or bile duct resection of tumor thrombus in hepatocellular carcinoma: does future liver-directed treatment justify less extensive surgery? Ann Surg 2015; 261:e126. [PMID: 25775077 DOI: 10.1097/sla.0000000000001210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zeng H, Xu LB, Wen JM, Zhang R, Zhu MS, Shi XD, Liu C. Hepatocellular carcinoma with bile duct tumor thrombus: a clinicopathological analysis of factors predictive of recurrence and outcome after surgery. Medicine (Baltimore) 2015; 94:e364. [PMID: 25569656 PMCID: PMC4602832 DOI: 10.1097/md.0000000000000364] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Although hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is a rare entity, most patients experience tumor recurrence even after curative resection and the prognosis remains dismal. This study aimed to analyze the clinicopathological risk factors for recurrence and poor outcome after surgical treatment of HCC with BDTT.Clinicopathological data of 37 patients with HCC and BDTT who underwent surgical treatment from July 2005 to June 2012 at the authors' hospital were reviewed retrospectively. Prognostic factors and potential risk factors for recurrence were assessed by Cox proportional hazard model and binary logistic regression model, respectively.Among the 37 patients, anatomical and nonanatomical liver resection was performed in 26 and 11 patients, respectively. The resection was considered curative in 19 patients and palliative in 18 patients. Also, 21 cases had tumor recurrence after operation and 7 cases of them were reoperated. Multivariate binary logistic regression model revealed that surgical curability was the only independent risk factor associated with postoperative tumor recurrence (P = 0.034). In addition, postoperative overall survival rates at 1, 2, and 3 years were 64.2%, 38.9%, and 24.3%, respectively. Cox multivariate analysis indicated that surgical curability and tumor recurrence were independent prognostic factors for both overall survival and recurrence-free survival (P < 0.05).Although patients with HCC and BDTT had a relatively high rate of early recurrence after surgery, relatively favorable long-term outcome after curative hepatic resection could be achieved. Therefore, extensive and curative surgical treatment should be recommended when complete resection can be achieved and liver functional reserve is satisfactory.
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Affiliation(s)
- Hong Zeng
- From the Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation (HZ, L-bX, RZ, M-sZ, X-dS, CL), Medical Research Center; Department of Pathology (HZ); Department of Hepato-pancreato-biliary Surgery (L-bX, RZ, M-sZ, X-dS, CL), Sun Yat-sen Memorial Hospital; and Department of Pathology (J-mW), First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Asaoka Y, Tateishi R, Nakagomi R, Kondo M, Fujiwara N, Minami T, Sato M, Uchino K, Enooku K, Nakagawa H, Kondo Y, Shiina S, Yoshida H, Koike K. Frequency of and predictive factors for vascular invasion after radiofrequency ablation for hepatocellular carcinoma. PLoS One 2014; 9:e111662. [PMID: 25397677 PMCID: PMC4232383 DOI: 10.1371/journal.pone.0111662] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/29/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Vascular invasion in patients with hepatocellular carcinoma (HCC) is representative of advanced disease with an extremely poor prognosis. The detailed course of its development has not been fully elucidated. METHODS We enrolled 1057 consecutive patients with HCC who had been treated with curative intent by radiofrequency ablation (RFA) as an initial therapy from 1999 to 2008 at our department. We analyzed the incidence rate of and predictive factors for vascular invasion. The survival rate after detection of vascular invasion was also analyzed. RESULTS During a mean follow-up period of 4.5 years, 6075 nodules including primary and recurrent lesions were treated by RFA. Vascular invasion was observed in 97 patients. The rate of vascular invasion associated with site of original RFA procedure was 0.66% on a nodule basis. The incidence rates of vascular invasion on a patient basis at 1, 3, and 5 years were 1.1%, 5.9%, and 10.4%, respectively. Univariate analysis revealed that tumor size, tumor number, alpha-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), and Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein were significant risk predictors of vascular invasion. In multivariate analysis, DCP was the most significant predictor for vascular invasion (compared with a DCP of ≤100 mAu/mL, the hazard ratio was 1.95 when DCP was 101-200 mAu/mL and 3.22 when DCP was >200 mAu/mL). The median survival time after development of vascular invasion was only 6 months. CONCLUSION Vascular invasion occurs during the clinical course of patients initially treated with curative intent. High-risk patients may be identified using tumor markers.
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Affiliation(s)
- Yoshinari Asaoka
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Ryo Nakagomi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayuko Kondo
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoto Fujiwara
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaya Sato
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Uchino
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kenichiro Enooku
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuji Kondo
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shuichiro Shiina
- Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Haruhiko Yoshida
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Park S, Park JY, Chung MJ, Chung JB, Park SW, Han KH, Song SY, Bang S. The efficacy of endoscopic palliation of obstructive jaundice in hepatocellular carcinoma. Yonsei Med J 2014; 55:1267-72. [PMID: 25048484 PMCID: PMC4108811 DOI: 10.3349/ymj.2014.55.5.1267] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE Obstructive jaundice in patients with hepatocellular carcinoma (HCC) is uncommon (0.5-13%). Unlike other causes of obstructive jaundice, the role of endoscopic intervention in obstructive jaundice complicated by HCC has not been clearly defined. The aim of this study was to evaluate the clinical characteristics of obstructive jaundice caused by HCC and predictive factors for successful endoscopic intervention. MATERIALS AND METHODS From 1999 to 2009, 54 patients with HCC who underwent endoscopic intervention to relieve obstructive jaundice were included. We defined endoscopic intervention as a clinical success when the obstructive jaundice was relieved within 4 weeks. RESULTS Clinical success was achieved in 23 patients (42.6%). Patients in the clinical success group showed better Child-Pugh liver function (C-P grade A or B/C; 17/6 vs. 8/20), lower total bilirubin levels (8.1±5.3 mg/dL vs. 23.1±10.4 mg/dL) prior to the treatment, and no history of alcohol consumption. The only factor predictive of clinical success by multivariate analysis was low total bilirubin level at the time of endoscopic intervention, regardless of history of alcohol consumption [odds ratio 1.223 (95% confidence interval, 1.071-1.396), p=0.003]. The cut-off value of pre-endoscopic treatment total bilirubin level was 12.8 mg/dL for predicting the clinical prognosis. Median survival after endoscopic intervention in the clinical success group was notably longer than that in the clinical failure group (5.6 months vs. 1.5 months, p≤0.001). CONCLUSION Before endoscopic intervention, liver function, especially total bilirubin level, should be checked to achieve the best clinical outcome. Endoscopic intervention can be helpful to relieve jaundice in well selected patients with HCC.
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Affiliation(s)
- Semi Park
- Department of Internal Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea. ; Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Youp Park
- Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Jae Chung
- Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Bock Chung
- Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Si Young Song
- Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea. ; Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Seungmin Bang
- Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
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Cho YY, Lee SH, Lee JW, Park JM, Ryu JK, Kim YT, Yoon CJ, Kim H. [Disappearance of intrahepatic bile duct hepatocellular carcinoma after endoscopic retrograde cholangiopancreatography and transarterial chemoinfusion: a case report]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:321-4. [PMID: 24870306 DOI: 10.4166/kjg.2014.63.5.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Invasion of the bile duct by hepatocellular carcinoma (HCC), which is called intrahepatic bile duct HCC, is rare and has a poor prognosis. Early diagnosis and surgical resection is important for treatment. A 58-year-old man who underwent hepatic resection for HCC 4 years ago and received transarterial chemoembolization (TACE) 2 years after the operation for recurred HCC presented with jaundice. CT scan revealed a tumor in the common bile duct without intrahepatic lesion. Therefore, ERCP was done to perform biopsy and biliary drainage. Histological examination was compatible with hepatocellular carcinoma. However, the tumor could not be visualized at angiography and thus, only transarterial chemoinfusion was performed without embolization. The tumor had disappeared on follow-up CT scan, and the patient has been disease free for 23 months without evidence of recurrence. Herein, we report a case of intrahepatic bile duct HCC which disappeared after ERCP.
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Affiliation(s)
- Young Youn Cho
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, Korea
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Farina A. Proximal fluid proteomics for the discovery of digestive cancer biomarkers. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2014; 1844:988-1002. [DOI: 10.1016/j.bbapap.2013.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 09/15/2013] [Accepted: 10/22/2013] [Indexed: 12/13/2022]
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Sensitivity of alternative testing for pancreaticobiliary cancer: a 10-y review of the literature. J Surg Res 2014; 190:535-47. [PMID: 24969546 DOI: 10.1016/j.jss.2014.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 03/25/2014] [Accepted: 04/04/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Biliary strictures present a diagnostic challenge to differentiate benign disease from hepatopancreaticobiliary (HPB) malignancies. Endoscopic retrograde cholangiopancreatography cytology is commonly performed in these patients; however, its sensitivity for diagnosis of HPB malignancy is poor (41.6%). Many adjunctive tests have been investigated to improve the sensitivity of HPB biopsies. To determine the best tests available, however, we reviewed the literature and performed a comparative analysis of all recently investigated tests and their sensitivities. METHODS A PubMed search identified articles published between 2003 and 2014, describing alternate methods for diagnosing HPB malignancies, reported sensitivity, final pathology, and had data available online. Meta-analysis was conducted for tests with multiple articles. Tests with the highest sensitivity and specificities were reported. RESULTS A total of 77 studies were identified. Meta-analysis was performed on the sensitivity of EUS-FNA (74.2%), fluorescence in situ hybridization (54.2%), immunostain of insulin-like growth factor 2 mRNA-binding Protein 3 (IMP3; 80.4%), IMP3 + cytology (86.4%), K homology domain containing protein overexpressed in cancer (KOC; 85.9%), S100P (77.8%), serum CA19-9 (69.3%), and K-ras mutations (47.0%) to detect malignancy. Ultimately, 12 tests were identified with superior sensitivity (85.3%-100%) and specificities (81.6%-100%) including stricture scrapping, brush sectioning, IMP3 stain + cytology, IMP3+S100A4, bile carcinoembryonic cell adhesion molecule 6 protein (±CA19-9), bile micro RNA (miRNA)-135b, serum miRNA-RNU2-1f, serum miRNA-21 (+CA19-9), peripheral blood mononuclear cells miRNA-27a-3p (+CA19-9), serum miRNA-16 + miRNA-196a (+CA19-9), peripheral blood mononuclear cells mRNAs h-TERT + CK20 + CEA + C-MET. CONCLUSIONS We recommend immunostaining with a panel of IMP3+KOC + S100A4 + cytology to achieve maximum sensitivity and specificity from HPB biopsies. One biliary protein (carcinoembryonic cell adhesion molecule 6) and several RNAs (bile and blood) offer exceptional sensitivity and specificity and should be tested prospectively in larger populations. Overall, this review identifies several tests to improve the sensitivity of diagnostic algorithms to identify HPB malignancies.
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Clinical characteristics and surgical prognosis of hepatocellular carcinoma with bile duct invasion. Gastroenterol Res Pract 2014; 2014:604971. [PMID: 24723944 PMCID: PMC3958710 DOI: 10.1155/2014/604971] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 01/15/2014] [Indexed: 12/14/2022] Open
Abstract
Objectives. Bile duct invasion (BDI) is a rare event in hepatocellular carcinoma (HCC). The present study aimed at investigating clinical characteristics and surgical outcome of HCC patients with bile duct invasion. Methods. 413 patients with HCC undergoing curative surgery were divided into two groups with (B(+)) and without BDI (B(-)). BDI was further classified as central type (B1) and peripheral type (B2). Survival was compared, and risk factors affecting prognosis were identified. Results. 35 (8.5%) patients were diagnosed BDI. Total bilirubin was significantly higher in B(+) group than in B(-) group (P < 0.001). Multiple lesions and large nodules (>5 cm) were predominantly identified in B(+) group (P < 0.01, resp.). Portal vein invasion was more frequently observed in B(+) than in B(-) group (P = 0.003). Univariate and multivariate analyses identified central BDI as a significant factor affecting prognosis of HCC patients (risk 1.3, 95% CI 1.1-2.2, P = 0.015). The gross overall survival of patients in B(+) was significantly worse than in B(-) (P = 0.001), which, however, was not different between B2 and B(-) (P > 0.05). Conclusions. Central but not peripheral BDI was associated with poorer prognosis of HCC patients. Curative surgical resection of tumors and invaded bile duct supplies the only hope for long-term survival of patients.
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Kang HY, Moon SH, Song IH. A unique bleeding-related complication of sorafenib, a tyrosine kinase inhibitor, in advanced hepatocellular carcinoma: a case report. J Med Case Rep 2014; 8:72. [PMID: 24571585 PMCID: PMC3943401 DOI: 10.1186/1752-1947-8-72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 12/16/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction Sorafenib, a multikinase inhibitor as a standard of care for advanced hepatocellular carcinoma, may lead endothelial cells to an unstable state by blocking the signaling pathway of vascular endothelial growth factor receptor, which may result in the disruption of the architecture and integrity of the microvasculature, and eventually increase the risk of hemorrhage. Hemobilia is a relatively uncommon condition as a consequence of hepatocellular carcinoma and its risk factors remain uncertain. Case presentation Here we report a unique case of hemobilia occurring in a 55-year-old Korean man with hepatitis B virus-related hepatocellular carcinoma on Barcelona Clinic Liver Cancer advanced stage after seven days of treatment with sorafenib. He had received prior radiation therapy. Endoscopy revealed bleeding from the major duodenal papilla and endoscopic retrograde cholangiography revealed an amorphous filling defect throughout the common bile duct. Blood clots were removed by balloon sweeping and a nasobiliary drainage tube was placed. No further bleeding has been detected as of eight months after discontinuation of sorafenib. Conclusion Sorafenib may increase the risk of biliary bleeding in hepatocellular carcinoma patients who were primed with irradiation, by blocking the signaling pathway of the vascular endothelial growth factor receptor. Therefore, sorafenib should be used with caution in patients with advanced hepatocellular carcinoma, especially when combined with radiation therapy.
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Affiliation(s)
| | | | - Il Han Song
- Division of Hepatology, Department of Internal Medicine, Dankook University College of Medicine, 16-5 Anseo-dong, Cheonan 330-715, Chungnam, Republic of Korea.
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Acute pancreatitis and obstructive jaundice as initial complaints of hepatocellular carcinoma: case report. World J Surg Oncol 2014; 12:13. [PMID: 24422982 PMCID: PMC3896744 DOI: 10.1186/1477-7819-12-13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 01/03/2014] [Indexed: 01/08/2023] Open
Abstract
Background Patients with cirrhosis-associated hepatocellular carcinoma (HCC) rarely present with acute pancreatitis (AP) and obstructive jaundice as the main clinical features. AP with obstructive jaundice caused by common bile duct embolism (CBDE) is very rare. Case presentation A 54-year-old man with CBDE was misdiagnosed with common bile duct stones three times over a 7-month period. Investigations during this time did not identify CBDE. Surgical exploration was performed because of AP, obstructive jaundice, and a tumor in the left lobe of the liver. CBDE from the hepatic tumor was diagnosed by intraoperative biopsy and frozen section examination. The patient underwent left hemihepatectomy, cholecystectomy, and bile duct exploration. Conclusion Preoperative diagnosis of CBDE is difficult because of the rarity of the condition, lack of physician awareness, and easy misdiagnosis on imaging examinations. Early and accurate diagnosis of this condition is important.
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Seriau L, Leo CA, Girometti R, Avellini C, Baccarani U, Uzzau A. Hepatocellular carcinoma presenting as bile duct tumor: a case report. J Gastrointest Cancer 2014; 45 Suppl 1:103-7. [PMID: 24408273 DOI: 10.1007/s12029-013-9577-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Luca Seriau
- Department of General Surgery, University Hospital, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy,
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Park HC, Park HB, Chung CY, Jung MW, Joo YE, Choi SK, Cho SB. Acute Obstructive Cholangitis Complicated by Tumor Migration after Transarterial Chemoembolization: A Case Report and Literature Review. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 63:171-5. [DOI: 10.4166/kjg.2014.63.3.171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Hyung Chul Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Bum Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Cho Yun Chung
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Min Woo Jung
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young Eun Joo
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Kyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Bum Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Jiang XW, Tang SH, Yang JQ, Huang W. Ultrasound-guided endoscopic biliary drainage: a useful drainage method for biliary decompression in patients with biliary obstructions. Dig Dis Sci 2014; 59:161-7. [PMID: 24026407 DOI: 10.1007/s10620-013-2868-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 08/26/2013] [Indexed: 12/09/2022]
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography with fluoroscopy guidance is a well-established technique for providing biliary drainage in patients with biliary obstructions. However, fluoroscopic facilities may not always be available and fluoroscopy carries a risk of radiation exposure. AIM We retrospectively compared the procedure success rate and efficacy of ultrasound-guided endoscopic biliary drainage (UG-EBD) and fluoroscopy-guided endoscopic biliary drainage (FG-EBD) in patients with biliary obstructions. METHODS Patients who had received either UG-EBD or FG-EBD were included in the study. Main outcome measurements included the procedure success rate, procedure time, and clinical response. RESULTS A total of 125 patients who had undergone UG-EBD (n = 63) and FG-EBD (n = 62) were identified. The total procedure success rate was 93.7 % in the UG-EBD group and 96.8 % in the FG-EBD group without statistical difference. Also, no significant difference was found in the procedure success rate of lower or upper/middle obstructions of the common bile duct (CBD) between the 2 groups. The mean procedure time was not different between the 2 groups [UG-EBD group 24.54 (9.52) min vs. FG-EBD group 21.74 (8.77) min, p = 0.09]. There were no differences in the normalization of clinical and laboratory parameters and immediate complication between the 2 groups. CONCLUSIONS Endoscopic biliary drainage (EBD) under US-guidance and under fluoroscopy guidance is equally effective and safe for patients with lower or upper/middle obstructions of the CBD. The UG-EBD technique is especially suitable for special patients, such as critically ill patients, pregnant woman, etc.
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Affiliation(s)
- Xiang Wu Jiang
- Department of Gastroenterology, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China,
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68
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Burnett AS, Calvert TJ, Chokshi RJ. Sensitivity of endoscopic retrograde cholangiopancreatography standard cytology: 10-y review of the literature. J Surg Res 2013; 184:304-11. [DOI: 10.1016/j.jss.2013.06.028] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/12/2013] [Accepted: 06/13/2013] [Indexed: 02/06/2023]
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Choi J, Ryu JK, Lee SH, Hwang JH, Ahn DW, Kim YT, Yoon YB, Yoon CJ, Kang SG, Chung JW. Palliative treatment of unresectable hepatocellular carcinoma with obstructive jaundice using biliary drainage with subsequent transarterial chemoembolization. J Palliat Med 2013; 16:1026-33. [PMID: 23888306 DOI: 10.1089/jpm.2013.0067] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nonsurgical biliary drainage is considered as a priority for obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC). Successful drainage allows the patient to receive antitumor therapy, such as transarterial chemoembolization (TACE). However, only limited data are available on clinical outcomes in patients who treated biliary drainage with subsequent TACE. OBJECTIVE This study evaluated the clinical outcome of biliary drainage with subsequent TACE in unresectable HCC patients with obstructive jaundice. DESIGN This was a retrospective study. SETTING/SUBJECTS A total of 60 patients received endoscopic biliary drainage (ERBD) or percutaneous transhepatic biliary drainage (PTBD) in two tertiary care referral centers. MEASUREMENTS Successful drainage and survival were measured. RESULTS Successful drainage was achieved in 39 (65%) patients. The median survival of 39 patients in whom successful drainage was achieved, regardless of which procedure was performed, was much longer than that of 21 patients without successful drainage (147 days versus 38 days, respectively, P<.001). In particular, the median survival was longer in 17 patients who underwent TACE after achieving successful drainage than in 22 patients who were treated conservatively after achieving successful drainage (410 days versus 77 days, respectively, P<.001). Multivariable analysis in 39 patients in the successful drainage group showed that TACE (hazard ratio 0.15; 95% confidence interval 0.05-0.45, P=.001) was an independent predictive factor of a favorable outcome. CONCLUSIONS Effective palliation by successful biliary drainage with subsequent TACE might prolong the survival in patients with obstructive jaundice caused by unresectable HCC.
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Affiliation(s)
- Jongkyoung Choi
- 1 Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul National University Hospital , Seoul, Republic of Korea
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Clinical application of percutaneous drainage in treating hepatocellular carcinoma with bile duct tumor thrombus. Contemp Oncol (Pozn) 2013; 17:176-83. [PMID: 23788987 PMCID: PMC3685370 DOI: 10.5114/wo.2013.34622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 09/15/2012] [Accepted: 11/27/2012] [Indexed: 12/21/2022] Open
Abstract
Aim of the study This study aimed to evaluate the effect of percutaneous interventional treatment on obstructive jaundice caused by hepatocellular carcinoma with bile duct tumor thrombus. Material and methods A total of 16 patients with bile duct tumor thrombus were included in the current retrospective study. All the patients were subjected to percutaneous transhepatic biliary drainage (PTBD). Treatment included permanent external drainage, internal drainage and routine tube adjustment, and covered stents according to the patients’ clinical manifestations. Results The success rate of PTBD was 100%. Among all the patients, two were treated with permanent external drainage, seven were treated with internal drainage and routine tube adjustment, and seven were treated with detaining covered stents. All the drainage tubes were successfully pulled out from the patients receiving covered stents. Among all the 16 patients, the clinical symptoms and life quality of 12 patients (12/16, 75%) were improved. The average survival time of all the patients was 203.7 days (ranging from 30 days to 391 days) with the median survival time of 199.5 days. Conclusions Percutaneous interventional therapy for obstructive jaundice caused by hepatocellular carcinoma with bile duct tumor thrombus is a good choice. It improves patients’ life quality. Permanent external drainage, internal drainage, and covered stents are alternative methods which should be chosen according to the patient's condition.
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71
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Ebara C, Yamazaki S, Moriguchi M, Mitsuka Y, Funada T, Higaki T, Takayama T. Complete remission by transarterial infusion with cisplatin for recurrent bile duct tumor thrombus of hepatocellular carcinoma: report of a case. World J Surg Oncol 2013; 11:78. [PMID: 23521831 PMCID: PMC3616869 DOI: 10.1186/1477-7819-11-78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 03/04/2013] [Indexed: 01/14/2023] Open
Abstract
Bile duct tumor thrombus (BDTT) of a hepatocellular carcinoma (HCC) is a rare entity which was found microscopically in 1 to 9.2% of the resected specimen.A 54-year-old male was found to have a 65-mm hepatocellular carcinoma in segment VI of the liver with a huge intrahepatic bile duct tumor thrombus. As the main trunk of the posterior segment branched from the left bile duct, the BDTT of the posterior branch extended to the common bile duct via the left bile duct. When the posterior segment was resected along with the left lobe, the estimated remnant liver volume was less than 30%. Therefore, the patient underwent extended posterior segmentectomy with choledochotomy and all of the BDTT was removed via the common bile duct.Three months later, his serum bilirubin (6.63 mg/dL) and des-gamma-carboxy prothrombin (410 ng/mL) were re-elevated due to recurrent BDTT. A well-enhanced BDTT was observed by computed tomography (CT) at the left bile duct. Transarterial chemotherapy with cisplatin was scheduled, followed by endoscopic retrograde bile duct drainage. After four sessions of this chemotherapy, the BDTT had vanished and the tumor marker was decreased to within the normal range. The patient was stably treated with this regimen and has remained recurrence-free for five years.
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Affiliation(s)
- Chiharu Ebara
- Department of Digestive Surgery, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
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72
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Lee KE, Kim CW, Kim MJ, Park J, Cho GM, Jang JW, Lee YS, Lee CD. [Massive bleeding hemobilia occurred in patient with hepatocellular carcinoma]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2013; 61:46-9. [PMID: 23354350 DOI: 10.4166/kjg.2013.61.1.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Massive bleeding hemobilia occurs rarely in patients with hepatocellular carcinoma (HCC) without any invasive procedure. Upper gastrointestinal bleeding in patient with cirrhosis and abdominal pain with progressive jaundice in patient with HCC were usually thought as variceal bleeding and HCC progression respectively. We experienced recently massive bleeding hemobilia in patient with HCC who was a 73-year old man and showed sudden abdominal pain, jaundice and hematochezia. He had alcoholic cirrhosis and history of variceal bleeding. One year ago, he was diagnosed as HCC and treated with transarterial chemoembolization periodically. Sudden right upper abdominal pain occurred then subsided with onset of hemotochezia. Computed tomography showed bile duct thrombosis spreading in the intrahepatic and extrahepatic ducts, while an ampulla of vater bleeding was observed during duodenoscopy. Hemobilia could be one of the causes of massive bleeding in patients with cirrhosis and HCC especially when they had sudden abdominal pain and abrupt elevation of bilirubin.
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Affiliation(s)
- Kyung Eun Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Bahng S, Yoo BC, Paik SW, Koh KC, Lee KT, Lee JK, Lee JH, Choi MS, Lee KH. Photodynamic therapy for bile duct invasion of hepatocellular carcinoma. Photochem Photobiol Sci 2013; 12:439-45. [DOI: 10.1039/c2pp25265a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Choi J, Ryu JK, Lee SH, Ahn DW, Hwang JH, Kim YT, Yoon YB, Han JK. Biliary drainage for obstructive jaundice caused by unresectable hepatocellular carcinoma: the endoscopic versus percutaneous approach. Hepatobiliary Pancreat Dis Int 2012; 11:636-42. [PMID: 23232636 DOI: 10.1016/s1499-3872(12)60237-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND For palliative treatment of the obstructive jaundice associated with unresectable hepatocellular carcinoma (HCC), percutaneous transhepatic biliary drainage (PTBD) or endoscopic retrograde biliary drainage (ERBD) has been performed. PTBD is preferred as an initial procedure. Little is known about the better option for patients with obstructive jaundice caused by unresectable HCC. METHODS Sixty patients who had received ERBD or PTBD for the palliative treatment of obstructive jaundice caused by unresectable HCC between January 2006 and May 2010 were included in this retrospective study. Successful drainage, drainage patency, and the overall survival of patients were evaluated. RESULTS Univariate analysis revealed that the overall frequency of successful drainage was higher in the ERBD group (22/29, 75.9%) than in the PTBD group (15/31, 48.4%) (P=0.029); but multivariate analysis showed marginal significance (P=0.057). The duration of drainage patency was longer in the ERBD group than in the PTBD group (82 vs 37 days, respectively, P=0.020). Regardless of what procedure was performed, the median survival time of patients who had a successful drainage was much longer than that of the patients who did not have a successful drainage (143 vs 38 days, respectively, P<0.001). CONCLUSION Besides PTBD, ERBD may be used as the initial treatment option to improve obstructive jaundice in patients with unresectable HCC if there is a longer duration of drainage patency after a successful drainage.
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Affiliation(s)
- Jongkyoung Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Liu QY, Li HG, Gao M, Zhang WD, Lin XF. The T1W hyperintense signal on the surface of distal segment of bile duct tumor thrombi and its significance. Acad Radiol 2012; 19:1141-8. [PMID: 22709535 DOI: 10.1016/j.acra.2012.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the magnetic resonance (MR) findings of bile duct tumor thrombi (BDTT) and intraductal growing-type cholangiocarcinoma (IDG-type CC), especially focusing on the distal segment of intrabiliary tumors. MATERIALS AND METHODS Twenty-nine cases of hepatocellular carcinoma with BDTT and 17 cases of IDG-type CC were available for retrospective review. The following MR findings were evaluated: presence of necrosis and T1-weighted (T1W) hyperintense signal on the surface of the distal segment of intrabiliary tumors, bile duct wall thickening adjacent to the tumor, dilation of bile duct of the tumor-bearing segment, location and maximum diameter of intraductal mass, and presence of a hepatic parenchymal mass. RESULTS There was significant difference in T1W hyperintense signal on the surface of the distal segment of intrabiliary tumors between BDTT and IDG-type CC (P < .05). The T1W hyperintense signal detected in BDTT was identified as bile layering (9/25) or hemobilia (16/25) pathologically. For the diagnosis of BDTT, the sensitivity and specificity of T1W hyperintense signal was 86.2% and 100%, respectively. There was significant difference in necrosis at the distal end of intrabiliary tumors and presence of hepatic parenchymal mass between BDTT and IDG-type CC (P < .05). However, no statistical significance was found in bile duct dilation, the absence of wall thickening, the location of intraductal mass, or the maximum diameter of intrabiliary mass between the two groups (P > .05). CONCLUSIONS The T1W hyperintense signal on the distal segment of intrabiliary mass was because of concentrated bile deposits or hemobilia. The sign of T1W hyper signal on the distal segment is valuable to differentiate BDTT and IDG-type CC.
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Kim KH, Kim TN. Etiology, clinical features, and endoscopic management of hemobilia: a retrospective analysis of 37 cases. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 59:296-302. [PMID: 22544027 DOI: 10.4166/kjg.2012.59.4.296] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS Hemobilia is a rare cause of upper gastrointestinal bleeding. Endoscopic retrograde cholangiopancreaticography (ERCP) is considered to be an excellent diagnostic and treatment modality. Thirty-seven cases of hemobilia with different underlying pathologies were analyzed to illustrate clinical features and to evaluate the role of endoscopic management. METHODS A total of 37 patients (26 men and 11 women; mean age, 66.2±15.3 years) who were confirmed to have hemobilia by ERCP in a single center from 2000 to 2010 were reviewed retrospectively. Patients with iatrogenic causes of hemobilia were excluded in this study. RESULTS The causes of hemobilia were hepatocellular carcinoma in 14, bile duct and gallbladder malignancies in 12, common bile duct stones with cholangitis in 4, acute cholecystitis in 4, and pancreatic cancer in 2 patients. The clinical features of hemobilia were jaundice (89.2%), abdominal pain (78.4%), and melena (13.5%). The cholangiographic findings of hemobilia were amorphous filling defects in 15, tubular filling defects in 6, and cast-like filling defects in 6 patients. Endoscopic management included endoscopic nasobiliary drainage in 26 patients and endoscopic retrograde biliary drainage in 7 patients. Biliary obstruction caused by hemobilia was successfully treated with endoscopic biliary drainages in most cases. CONCLUSIONS The most common non-iatrogenic causes of hemobilia were hepatobiliary malignancies, and the majority of patients presented with jaundice and abdominal pain. Endoscopic biliary drainage is recommended as the initial management to control biliary obstruction.
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Affiliation(s)
- Kook Hyun Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Yang T, Lin C, Zhai J, Shi S, Zhu M, Zhu N, Lu JH, Yang GS, Wu MC. Surgical resection for advanced hepatocellular carcinoma according to Barcelona Clinic Liver Cancer (BCLC) staging. J Cancer Res Clin Oncol 2012; 138:1121-9. [PMID: 22402598 DOI: 10.1007/s00432-012-1188-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Accepted: 02/24/2012] [Indexed: 12/12/2022]
Abstract
PURPOSE The BCLC staging classification has been widely endorsed to predict the prognosis of patients with HCC. However, its validity as a means of therapeutic instructions needs to be challenged. This study aimed to evaluate perioperative and long-term outcomes of surgical resection in patients with advanced hepatocellular carcinoma (HCC) according to the Barcelona Clinic Liver Cancer (BCLC) staging. METHODS This study used a prospectively maintained database consisting of a consecutive series of 511 Chinese patients with advanced HCC who underwent surgical resection in a hepatobiliary surgical center from 2001 to 2007. Mortality, morbidity, long-term overall survival (OS) and disease-free survival (DFS) were evaluated. RESULTS Hospital mortality was 2.3%, and overall morbidity was 31.3%. After a median follow-up period of 27.8 months (range, 0-112 months), the 1-, 3- and 5-year OS rate was 69.9, 41.2 and 30.5%, and the 1-, 3- and 5-year DFS rate was 48.2, 30.3 and 24.0%, respectively. The 1-, 3- and 5-year OS and DFS rates were significantly poorer in patients with vascular invasion and/or extrahepatic spread than those in patients without (both P < 0.001), and also poorer in patients with biliary invasion than those in patients without (both P < 0.05). CONCLUSIONS Surgical resection could be considered in part of patients with advanced HCC (BCLC stage C), with low mortality, acceptable morbidity and favorable survival benefits. These results imply that BCLC recommendations for treatment schedules of advanced HCC need to be re-evaluated.
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Affiliation(s)
- Tian Yang
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, Shanghai 200438, China
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Intraductal Hepatocellular Carcinoma without Parenchymal Tumor: A Case Report. J Gastrointest Cancer 2011; 43 Suppl 1:S77-9. [PMID: 21814761 DOI: 10.1007/s12029-011-9309-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Obstructive jaundice due to hepatocellular carcinoma is rare. We present a case of hepatocellular carcinoma presenting as an intraductal tumor, which was clinically and radiologically diagnosed as cholangiocarcinoma. CLINICAL PRESENTATION A 59-year-old male was admitted with recurrent episodes of jaundice. He was found to have a tumor in the right hepatic duct extending into intrahepatic ducts, which was clinically and radiologically diagnosed as cholangiocarcinoma. RESULTS The patient underwent right hepatectomy with excision of the bile duct and left hepaticojejunostomy. Histological examination revealed an intraductal moderately differentiated hepatocellular carcinoma. The rest of the liver parenchyma showed features secondary to biliary obstruction but no tumor. CONCLUSION A case of hepatocellular carcinoma presenting as an intraductal tumor with obstructive jaundice and no evidence of parenchymal tumor is presented.
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Aydin S, Aytac E, Uzun H, Altug T, Mansur B, Saygili S, Buyukpinarbasili N, Sariyar M. Effects of Ganoderma lucidum on obstructive jaundice-induced oxidative stress. Asian J Surg 2011; 33:173-80. [PMID: 21377103 DOI: 10.1016/s1015-9584(11)60003-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2010] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Obstructive jaundice develops after occlusion of the common bile duct. Direct hyperbilirubinaemia, which occurs secondary to the condition, causes various life-threatening pathologies. Cytoprotective effects of Ganoderma lucidum (GL) have previously been shown. In this study, the effects of GL on oxidative stress and oxidant DNA damage in experimental obstructive jaundice were evaluated. METHODS Sixty Wistar albino adult female rats were randomly divided into six weight-matched equal groups: sham group, bile duct ligated group (BDL); after sham operation 250 mg/kg/d of GL administered group, after sham operation 500 mg/kg/d of GL administered group, after bile duct ligation 250 mg/kg/d of GL administered (GL1BDL) group, and after bile duct ligation 500 mg/kg/d of GL administered (GL2BDL) group. GL polysaccharide was orally administered to the rats via gavage tube once a day for 14 days after bile duct ligation. RESULTS The plasma malondialdehyde levels of the GL1BDL and GL2BDL groups were significantly lower than those of the BDL group (p < 0.01). The plasma 8-hydroxy-2'-deoxyguanosine levels of the GL1BDL and GL2BDL groups were significantly lower than those of the BDL group (p < 0.001). The liver tissue Cu-Zn superoxide dismutase level of the GL2BDL group was significantly higher than that of the BDL group (p < 0.05). CONCLUSION GL protected against DNA and liver tissue damage by reducing oxidative stress in obstructive jaundice.
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Affiliation(s)
- Seval Aydin
- Department of Biochemistry, Istanbul University Cerrahpasa Medical Faculty, Turkey
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Hepatocellular carcinoma with bile duct tumor thrombus: dynamic computed tomography findings and histopathologic correlation. J Comput Assist Tomogr 2011; 35:187-94. [PMID: 21412088 DOI: 10.1097/rct.0b013e3182067f2e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE This purpose of this study was to analyze the computed tomography (CT) findings of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) and explore their correlations with pathological manifestations. METHODS The clinical data, CT findings, and pathological manifestations of the 16 HCC patients with BDTT were retrospectively reviewed. All cases were pathologically proven. RESULTS Most HCCs showed hyperattenuation at hepatic arterial phase (HAP) (14/16) and hypoattenuation at portal venous phase (PVP) (12/16) and equilibrium phase (9/10), and the presence of rapid washout of contrast material was noted in 11 cases. The BDTT presented as cordlike masses in the dilated bile ducts, and mostly showed hyperattenuation at HAP (12/16) and hypoattenuation at PVP (13/16) and equilibrium phase (10/10), and the presence of rapid washout of contrast material was noted in 10 cases. Four cases of BDTT showed homogeneous enhancement, which were mainly consisted of cancer cells; 9 cases showed heterogeneous enhancement, which were mainly consisted of cancer cells with flakes of necrotic tissues or abundant red blood cells. Bile duct tumor thrombus was composed of 2 different pathological tissues in 3 cases, proximal part of BDTT was composed of tumor tissue, which was uniformly enhanced on dynamic enhanced CT, whereas the distal part was composed of necrotic or debris tissue without enhancement. CONCLUSIONS Hepatocellular carcinoma lesion and soft-tissue mass in the bile ducts with bilary dilation are usually depicted on dynamic enhanced CT in HCC patients with BDTT. Early enhancement at HAP and rapid washout of contrast material at PVP are the characteristic findings of HCC and BDTT. Dynamic contrast CT examination is very valuable for diagnosing this disease.
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81
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Clinicopathological characteristics of 20 cases of hepatocellular carcinoma with bile duct tumor thrombi. Dig Dis Sci 2011; 56:252-9. [PMID: 20437099 DOI: 10.1007/s10620-010-1256-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 04/13/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with bile duct tumor thrombi (BDTT) is a rare type of primary liver cancer, and its clinical and pathological characteristics remain to be defined. AIMS To investigate the clinical and pathological characteristics of HCC with BDTT. METHODS Among 676 HCC patients who underwent surgical treatment from Dec. 2002 to Dec. 2008 at the author's hospital, HCC with BDTT was identified in 20 patients. The clinical and pathological characteristics of the 20 patients were measured or analyzed retrospectively. The integrity of the involved bile duct was examined macroscopically and microscopically, the expression of liver stem cell markers was investigated by immunohistochemistry, and the Kaplan-Meier method was adopted for evaluating survival. RESULTS Among the 20 patients, the diameter of the primary tumor was less than 5 cm in 13 patients (range: 0.5-10 cm, mean 4.47±0.68 cm). Most of the primary tumors lacked an intact tumor capsule (15/20, 75%), had simultaneous blood vessel invasion (12/20, 60%), and were poorly differentiated (13/20, 65%). There was no evidence of bile duct wall infiltration by the tumor cells macroscopically or microscopically. The positive rate of the liver stem cell markers c-kit, CD90, CD133, and EpCAM was 90, 90, 85 and 85%, respectively. Postoperative overall survival rates at 1, 2, and 3 years were 73.1, 41.1, and 20.6%, respectively. The log-rank test showed that the overall survival rates were significantly worse for HCC patients with BDTT than for HCC patients without BDTT (P=0.016). CONCLUSIONS HCC with BDTT has aggressive characteristics and the long-term prognosis is extremely dismal.
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82
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Long XY, Li YX, Wu W, Li L, Cao J. Diagnosis of bile duct hepatocellular carcinoma thrombus without obvious intrahepatic mass. World J Gastroenterol 2010; 16:4998-5004. [PMID: 20954289 PMCID: PMC2957611 DOI: 10.3748/wjg.v16.i39.4998] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 04/15/2010] [Accepted: 04/22/2010] [Indexed: 02/06/2023] Open
Abstract
AIM To study the diagnosis of hepatocellular carcinoma (HCC) presenting as bile duct tumor thrombus with no detectable intrahepatic mass. METHODS Six patients with pathologically proven bile duct HCC thrombi but no intrahepatic mass demonstrated on the preoperative imaging or palpated intrahepatic mass during operative exploration, were collected. Their clinical and imaging data were retrospectively analyzed. The major findings or signs on comprehensive imaging were correlated with the surgical and pathologic findings. RESULTS Jaundice was the major clinical symptom of the patients. The elevated serum total bilirubin, direct bilirubin and alanine aminotransferase levels were in concordance with obstructive jaundice and the underlying liver disease. Of the 6 patients showing evidence of viral hepatitis, 5 were positive for serum alpha fetoprotein and carbohydrate antigen 19-9, and 1 was positive for serum carcinoembryonic antigen. No patient was correctly diagnosed by ultrasound. The main features of patients on comprehensive imaging were filling defects with cup-shaped ends of the bile duct, with large filling defects presenting as casting moulds in the expanded bile duct, hypervascular intraluminal nodules, debris or blood clots in the bile duct. No obvious circular thickening of the bile duct walls was observed. CONCLUSION Even with no detectable intrahepatic tumor, bile duct HCC thrombus should be considered in patients predisposed to HCC, and some imaging signs are indicative of its diagnosis.
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MESH Headings
- Alanine Transaminase/blood
- Bile Ducts/diagnostic imaging
- Bile Ducts/pathology
- Bilirubin/blood
- CA-19-9 Antigen/blood
- Carcinoembryonic Antigen/blood
- Carcinoma, Hepatocellular/blood
- Carcinoma, Hepatocellular/complications
- Carcinoma, Hepatocellular/diagnosis
- Carcinoma, Hepatocellular/pathology
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangiopancreatography, Magnetic Resonance
- Cholestasis/blood
- Cholestasis/etiology
- Cholestasis/pathology
- Female
- Humans
- Jaundice, Obstructive/blood
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/pathology
- Liver Neoplasms/blood
- Liver Neoplasms/complications
- Liver Neoplasms/diagnosis
- Liver Neoplasms/pathology
- Male
- Middle Aged
- Neoplasm Invasiveness
- Retrospective Studies
- Tomography, X-Ray Computed
- Ultrasonography
- alpha-Fetoproteins/analysis
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83
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Noh SH, Park DH, Kim YR, Chun YH, Song TJ, Moon SH, Lee SS, Seo DW, Lee SK, Kim MH. Peroral direct cholangioscopic-guided biopsy and photodynamic therapy using an ultraslim upper endoscope for recurrent hepatocellular carcinoma with intraductal tiny nodular tumor growth. Gut Liver 2010; 4:398-401. [PMID: 20981221 DOI: 10.5009/gnl.2010.4.3.398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 01/25/2010] [Indexed: 12/28/2022] Open
Abstract
Bile-duct invasion is rare in patients with hepatocellular carcinoma (HCC). We report a case that received peroral direct cholangioscopy (PDCS)-guided endoscopic biopsy and photodynamic treatment (PDT) for recurrent HCC with intraductal tiny nodular tumor growth. A 64-year-old woman presented with recurrent right upper-quadrant pain. Six months previously she had been diagnosed with HCC with bile-duct invasion in the right anterior segment and had received right anterior segmentectomy. On pathological examination, the margin of resection was clear, but macroscopic bile-duct invasion was noted. On admission, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) revealed a 0.5-cm-sized polypoid mass at the hilar portion. ERCP-guided biopsy failed, and an ampullary stricture was noted. PDCS-guided endoscopic biopsy was thus performed, and histopathology of the retrieved specimen revealed HCC. The patient submitted to PDT. There was no procedure-related complication. After 1 month of PDT the polypoid lesion and scar change at the hilar lesion had disappeared.
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Affiliation(s)
- Se Hui Noh
- Division of Gastroenterology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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84
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Galal A, Faro J, Al-Khawari H, Fahmy H, Al-Morsy M, Karar A. Interventional radiology in billiary diseases: A non-surgical therapeutic option. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2010. [DOI: 10.1016/j.ejrnm.2010.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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85
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Tangkijvanich P, Chanmee T, Komtong S, Mahachai V, Wisedopas N, Pothacharoen P, Kongtawelert P. Diagnostic role of serum glypican-3 in differentiating hepatocellular carcinoma from non-malignant chronic liver disease and other liver cancers. J Gastroenterol Hepatol 2010; 25:129-37. [PMID: 19793164 DOI: 10.1111/j.1440-1746.2009.05988.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The role of glypican-3 (GPC3), a novel serum marker, in differentiating hepatocellular carcinoma (HCC) from non-malignant chronic liver disease and other malignant space-occupying lesions in the liver is largely unknown. The aims of this study were to evaluate its diagnostic role and clinical correlations in patients with HCC. METHODS Six groups were studied which included 40 healthy subjects, 50 patients with chronic hepatitis (CH), 50 patients with liver cirrhosis (LC), 100 patients with HCC, 50 patients with intrahepatic cholangiocarcinoma (ICC) and 50 patients with metastatic carcinoma (MCA). Serum GPC3 levels were measured by using a sandwich enzyme-linked immunosorbent assay method. RESULTS Fifty-three percent of HCC patients had elevated serum GPC3 levels with values ranging 35.5-7826.6 ng/mL. The serum marker was undetectable in other groups except one patient (2%) with LC and another patient (2%) with MCA. In most cases of HCC, elevated GPC3 values did not correlate with alpha-fetoprotein (AFP) levels. Detectable GPC3 was significantly correlated with the presence of viral hepatitis markers but was not correlated with tumor size and stage of HCC. Serum GPC3 was superior to AFP in detecting small HCC (56.3% and 31.3%, respectively). A combination of serum GPC3 and AFP yielded an improved sensitivity for detecting small HCC to 75%. CONCLUSION Serum GPC3 is highly specific for detecting HCC. The combined use of serum GPC3 and AFP provides a potentially promising tool to better differentiate HCC from benign liver disorders, as well as from other liver cancers.
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Affiliation(s)
- Pisit Tangkijvanich
- Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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86
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Small hepatocellular carcinoma with bile duct tumor thrombi: CT and MRI findings. ACTA ACUST UNITED AC 2009; 35:537-42. [PMID: 19763681 DOI: 10.1007/s00261-009-9571-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 08/20/2009] [Indexed: 02/06/2023]
Abstract
BACKGROUND Small hepatocellular carcinoma (sHCC) with bile duct tumor thrombi (BDTT) is rare and easily misdiagnosed as cholangiocarcinoma. This study was to analyze the imaging features of sHCC with BDTT. PATIENTS AND METHODS CT and/or MRI examinations were performed on seven patients who had sHCC with BDTT. One patient received CT scan, one received CT and MR scan, and five received MR scan. Magnetic resonance cholangiopancreatography (MRCP) was performed in five patients. The diagnosis of sHCC with BDTT was based on surgical specimens in all patients. RESULTS The sHCC lesions and BDTT were presented on CT or MRI scans in all the seven cases. The BDTT is presented as soft tissue mass in the bile duct with biliary dilatation above the obstruction. In the two patients who had received dynamic contrast CT scan, the sHCC lesions showed atypical enhancement pattern of HCC. The BDTT showed similar enhancement pattern as sHCC in one of the two patients. The sHCC and BDTT showed homogenous hypointense signals on T1W images and hyperintense signals on T2W images in all six cases. In the three patients who had received dynamic enhancement MR scan, the enhancement patterns of sHCC lesions and BDTT were similar. Early enhancement of sHCC lesion and BDTT at hepatic arterial phase with hyperintense signals was observed in one patient, while two other patients had no early enhancement. All sHCC lesions and BDTT showed hypointense signals at portal venous phase, equilibrium phase, and delayed phase. Six patients showed hyperintense signal of hemorrhage in the dilated bile ducts on both T1W and T2W images. Five cases of BDTT presented as filling defect in the bile ducts on MRCP. The BDTT were directly connected with sHCC lesions in all the seven patients, without bile duct wall thickening or extra-bile duct invasion. CONCLUSION CT or MRI is a safe, reliable, and valuable method for the detection and diagnosis of sHCC with BDTT.
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87
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Hepatocellular carcinoma with bile duct tumor thrombi: correlation of magnetic resonance imaging features to histopathologic manifestations. Eur J Radiol 2009; 76:103-9. [PMID: 19501994 DOI: 10.1016/j.ejrad.2009.05.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 05/12/2009] [Accepted: 05/13/2009] [Indexed: 12/22/2022]
Abstract
PURPOSE This study was to analyze the magnetic resonance imaging (MRI) features of hepatocellular carcinoma (HCC) with bile duct tumor thrombi, and explore their correlations to histopathology to improve the accuracy of diagnosis. MATERIALS AND METHODS 21 patients with pathologically confirmed HCC with bile duct tumor thrombi was performed with a superconducting 1.5-T MR imager within two weeks before operation. Magnetic resonance cholangiopancreatography (MRCP) was performed on 18 patients. Images were retrospectively assessed for the size, location and MRI manifestations of HCC lesions and associated bile duct tumor thrombi. The differentiation of HCC lesions and the pathologic changes of bile duct tumor thrombi were retrospectively analyzed under microscope. RESULTS The average diameter of HCC lesions was 5.8±2.8 cm, and ≤5.0 cm in nine cases. Capsule formation was observed on MRI or pathology in 4 cases of HCC (19%). Of the 21 cases with bile duct tumor thrombi, 20 were clearly presented on MRI as cord-like or columnar masses in the bile duct with proximal cholangiectasis. The tumor thrombi showed slightly hypointense on T1WI and slightly hyperintense on T2WI. On enhanced scan, three cases of tumor thrombi, which were mainly consisted of necrotic tissue, did not show enhancement; 17 cases, which were mainly consisted of cancer cells, showed mild or moderate enhancement. On magnetic resonance cholangiopancreatogram (MRCP), 14 cases of tumor thrombi presented as filling defect in the bile duct, abrupt obstruction of the bile duct, and cholangiectasis above the obstruction; four presented as dilated intra-hepatic bile ducts with missing common bile duct. Of the 21 patients, 16 had biliary hemorrhage; three also had tumor thrombi in the portal vein. Seventeen of the 21 HCC with biliary thrombi were poorly differentiated, unencapsulated and with an invasive growth. Nineteen of 21 bile duct tumor thrombi did not invade the bile duct wall and could be easily extracted. CONCLUSION MRI plays a valuable role in diagnosing HCC with bile duct tumor thrombi and identifying the extent of the thrombi; the MRI features of HCC with bile duct tumor thrombi are associated with its pathologic changes.
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88
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Choi KH, Cho YK, An JK, Woo JJ, Kim HS, Choi YS. Acute obstructive cholangitis after transarterial chemoembolization: the effect of percutaneous transhepatic removal of tumor fragment. Korean J Radiol 2009; 10:197-201. [PMID: 19270868 PMCID: PMC2651439 DOI: 10.3348/kjr.2009.10.2.197] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 07/28/2008] [Indexed: 02/05/2023] Open
Abstract
Acute obstructive cholangitis due to the migration of necrotized tumor fragment is a rare complication occurring after a transarterial chemoembolization. The percutaneous tumor removal procedure following percutaneous transhepatic biliary drainage is an appropriate treatment over endoscopic removal for the relief of acute cholangitis in this case. Following this serial management, no invasive hepatocellular carcinoma of the bile duct recurred after two years of follow-up.
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Affiliation(s)
- Kyu-Ho Choi
- Department of Radiology, Eulji Medical Center, Eulji University College of Medicine, Seoul 139-711, Korea
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89
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Abstract
Hepatocellular carcinoma (HCC) annually causes about one million deaths. Because of advanced stage at diagnosis, HCC carries a five-year survival rate of less than 5% in patients diagnosed with unresectable disease. Incidence for HCC is higher in men and individuals of Asian descent, where viral hepatitis, a leading cause of HCC, is endemic. This article will provide an overview of the complex symptom management of patients with HCC. The occurrence of multiple symptoms, including pain, fatigue, weight loss, and obstructive syndromes (e.g., ascites, jaundice) in patients with HCC is common. Because of limitations in the efficacy of current treatment options, aggressive symptom management is key to preserving physical functioning and quality of life in patients with HCC. A multidisciplinary team approach to symptom management of patients with HCC is critical, with oncology nurses playing an integral role.
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Affiliation(s)
- Virginia Chih-Yi Sun
- Department of Nursing Research and Education in Division of Population Sciences, City of Hope National Medical Center, Duarte, CA, USA.
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90
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Menias CO, Surabhi VR, Prasad SR, Wang HL, Narra VR, Chintapalli KN. Mimics of cholangiocarcinoma: spectrum of disease. Radiographics 2008; 28:1115-29. [PMID: 18635632 DOI: 10.1148/rg.284075148] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cholangiocarcinoma is the second most common primary malignant hepatobiliary neoplasm, accounting for approximately 15% of liver cancers. Diagnosis of cholangiocarcinoma is challenging and the prognosis is uniformly poor, with recurrence rates of 60%-90% after surgical resection. A wide spectrum of neoplastic and nonneoplastic conditions of the biliary tract may masquerade as cholangiocarcinoma, adding to the complexity of management in patients suspected to have cholangiocarcinoma. Mimics of cholangiocarcinoma constitute a heterogeneous group of entities that includes primary sclerosing cholangitis, recurrent pyogenic cholangitis, acquired immunodeficiency syndrome cholangiopathy, autoimmune pancreatitis, inflammatory pseudotumor, Mirizzi syndrome, xanthogranulomatous cholangitis, sarcoidosis, chemotherapy-induced sclerosis, hepatocellular carcinoma, metastases, melanoma, lymphoma, leukemia, and carcinoid tumors. These entities demonstrate characteristic histomorphology and variable clinicobiologic behaviors. The imaging findings of these disparate entities are protean and may be indistinguishable from those of cholangiocarcinoma. In most cases, a definitive diagnosis can be established only with histopathologic examination of a biopsy specimen.
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Affiliation(s)
- Christine O Menias
- Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, MO, USA
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91
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Lippo NJ, Williams JE, Brawer RS, Sobel KE. Acute hemobilia and hemocholecyst in 2 dogs with gallbladder carcinoid. J Vet Intern Med 2008; 22:1249-52. [PMID: 18673422 DOI: 10.1111/j.1939-1676.2008.0156.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- N J Lippo
- VCA Veterinary Referral Associates, Gaithersburg, MD, USA.
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92
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Hong HP, Kim SK, Seo TS. Percutaneous Metallic Stents in Patients with Obstructive Jaundice due to Hepatocellular Carcinoma. J Vasc Interv Radiol 2008; 19:748-54. [DOI: 10.1016/j.jvir.2007.12.455] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 12/30/2007] [Accepted: 12/31/2007] [Indexed: 01/01/2023] Open
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93
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Mesci A, Gurer S, Guzel G, Demirbakan K. Obstructive jaundice caused by hepatocellular carcinoma with bile duct tumor thrombi: a case report. Eurasian J Med 2008; 40:45-47. [PMID: 25610024 PMCID: PMC4261316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common malignancy and cause of death in the developing world. In this report, a case of obstructive jaundice caused by hepatocellular carcinoma with bile duct tumor thrombi is presented.
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Affiliation(s)
- Ayhan Mesci
- Akdeniz University, Faculty of Medicine, Department of General Surgery, Antalya, Turkey
| | - Sezer Gurer
- Akdeniz University, Faculty of Medicine, Department of General Surgery, Antalya, Turkey
| | - Gokmen Guzel
- Akdeniz University, Faculty of Medicine, Department of General Surgery, Antalya, Turkey
| | - Kenan Demirbakan
- Akdeniz University, Faculty of Medicine, Department of General Surgery, Antalya, Turkey
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94
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Bigot P, Buchanan GM, Hamy A, Teyssedou C, Pessaux P, Arnaud JP. Rupture of hepatocellular carcinoma into the biliary system with resulting bile duct thrombi: report of two cases. Case Rep Gastroenterol 2007; 1:123-9. [PMID: 21487557 PMCID: PMC3073799 DOI: 10.1159/000109651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report two cases of hepatocellular carcinoma revealed by jaundice and the presence of free-floating tumoural fragments within the biliary system. Two men (one of 64 and one of 73) presented with isolated jaundice. The results from ultrasound, CT and MRI were suggestive of a cholangiocarcinoma. Surgical intervention demonstrated bile duct thrombi from the primary tumour causing obstructive jaundice.
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Affiliation(s)
- P Bigot
- Department of Visceral Surgery, Angers, France
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95
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Sun L, Wu H, Guan YS. Positron emission tomography/computer tomography: Challenge to conventional imaging modalities in evaluating primary and metastatic liver malignancies. World J Gastroenterol 2007; 13:2775-83. [PMID: 17569111 PMCID: PMC4395627 DOI: 10.3748/wjg.v13.i20.2775] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Computer tomography (CT) and magnetic resonance imaging (MRI), as conventional imaging modalities, are the preferred methodology for tumor, nodal and systemic metastasis (TNM) staging. However, all the noninvasive techniques in current use are not sufficiently able to identify primary tumors and even unable to define the extent of metastatic spread. In addition, relying exclusively on macromorphological characteristics to make a conclusion runs the risk of misdiagnosis due mainly to the intrinsic limitations of the imaging modalities themselves. Solely based on the macromorphological characteristics of cancer, one cannot give an appropriate assessment of the biological characteristics of tumors. Currently, positron emission tomography/computer tomography (PET/CT) are more and more widely available and their application with 18F-fluorodeoxyglucose (18F-FDG) in oncology has become one of the standard imaging modalities in diagnosing and staging of tumors, and monitoring the therapeutic efficacy in hepatic malignancies. Recently, investigators have measured glucose utilization in liver tumors using 18F-FDG, PET and PET/CT in order to establish diagnosis of tumors, assess their biologic characteristics and predict therapeutic effects on hepatic malignancies. PET/CT with 18F-FDG as a radiotracer may further enhance the hepatic malignancy diagnostic algorithm by accurate diagnosis, staging, restaging and evaluating its biological characteristics, which can benefit the patients suffering from hepatic metastases, hepatocellular carcinoma and cholangiocarcinoma.
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Affiliation(s)
- Long Sun
- Minnan PET Center, The First Hospital of Xiamen, Fujian Medical University, Xiamen, China
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96
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Yigit T, Yiğitler C, Demiriz M, Arslan I, Tufan T. Hepatocellular carcinoma in the common bile duct "Hepatocellular Carcinoma". Liver Int 2007; 27:288-90. [PMID: 17311628 DOI: 10.1111/j.1478-3231.2006.01421.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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97
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Batsis JA, Halfdanarson TR, Pitot H. Extra-hepatic hepatocellular carcinoma presenting as obstructive jaundice. Dig Liver Dis 2006; 38:768-71. [PMID: 16243009 DOI: 10.1016/j.dld.2005.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 08/31/2005] [Accepted: 09/15/2005] [Indexed: 12/11/2022]
Abstract
Hepatocellular carcinoma is a neoplasm with a uniformly poor prognosis. Risk factors for its development include chronic hepatitis B or C infection, haemochromatosis and alpha-1-antitrypsin deficiency, but individuals with any type of chronic liver disease are predisposed. The incidence is significantly higher in Asia and Africa although it has been noted to be increasing in the United States. We present a patient with notable atypical clinical features for hepatocellular carcinoma. The patient had neither predisposing risk factors nor a primary liver lesion causing obstructive jaundice. After multiple tissue specimens were obtained, the final pathological diagnosis was established. Hepatocellular carcinoma generally requires a surgical cure, but patients who are icteric often portend poorer prognoses. For those at high risk, screening may be indicated to identify early curative treatment.
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Affiliation(s)
- J A Batsis
- Department of Medicine, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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98
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Abstract
BACKGROUND Jaundice occurs in 5-44% of patients with hepatocellular carcinoma (HCC). It is an important clinical presentation as the different aetiological causes of jaundice in HCC determine the therapeutic approach and the prognosis. This article aims to review the classification, management and prognosis of patients with jaundice associated with HCC. METHODS A Medline search was undertaken to identify articles using the key words 'hepatocellular carcinoma', 'jaundice' and 'tumour thrombus'. Additional articles were identified by a manual search of the references from the key articles. RESULTS Patients with jaundice due to hepatic parenchymal insufficiency (hepatocellular type) have a very dismal prognosis. For patients with biliary obstruction due to HCC (icteric type), the reported 1-, 3- and 5-year survival rates after curative resection were 57.1-100%, 20-47% and 6.7-45%, respectively. The mean survival after palliative biliary drainage alone was less than 6 months but when biliary drainage was combined with other palliative treatment, the mean survival could be up to 1 year. CONCLUSIONS It is important to differentiate the hepatocellular type from the icteric type of HCC. For patients with the icteric type of HCC, curative liver resection can achieve a survival comparable to that in patients without jaundice. For patients with unresectable icteric type of HCC, treatment can provide improvement in patient's quality of life and survival.
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Affiliation(s)
- Eric C H Lai
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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99
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Jung AY, Lee JM, Choi SH, Kim SH, Lee JY, Kim SW, Han JK, Choi BI. CT features of an intraductal polypoid mass: Differentiation between hepatocellular carcinoma with bile duct tumor invasion and intraductal papillary cholangiocarcinoma. J Comput Assist Tomogr 2006; 30:173-81. [PMID: 16628028 DOI: 10.1097/00004728-200603000-00002] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the CT features capable of differentiating hepatocellular carcinoma (HCC) with bile duct tumor invasion (BDTI) from intraductal cholangiocarcinoma (IDCC). METHODS Multiphasic CT images of 14 patients with HCC with BDTI and 18 patients with IDCC were retrospectively reviewed. Analysis of the CT findings included the size, location, and margin of the intraductal mass, the enhancement pattern of intraductal lesions, degree of ductal dilatation, presence of downstream ductal dilatation and ductal wall thickening, presence of parenchymal mass and its size, continuity of parenchymal mass with intraductal mass, and liver cirrhosis. Objective evaluation of the enhancement patterns of intraductal tumors was done by measuring the CT attenuation coefficients of the tumors and the uninvolved hepatic parenchyma in each phase. Among these findings, statistically significant variables were then determined using Fisher exact test or Mann-Whitney test. RESULTS Significant variables that helped differentiating HCC with BDTI from IDCC included the presence of parenchymal mass, liver cirrhosis, and the hyperattenuating intraductal tumor on the hepatic arterial phase (HAP). On unenhanced images, the tumor-to-liver contrast of IDCC (16.7 +/- 8.1) was greater than that of HCC with BDTI (6.4 +/- 10.4), but on HAP, that of HCC with BDTI (26.5 +/- 28.2) was greater than that of IDCC (5.9 +/- 18.7) (P < 0.05). In addition, there was a significant difference in the enhancement ratio of the intraductal tumors on portal venous phase (PVP) between the 2 conditions (P = 0.003). CONCLUSIONS Several objective and subjective multiphasic CT findings may help differentiating HCC with BDTI from IDCC.
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Affiliation(s)
- Ah Young Jung
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea
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100
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Nakamuta M, Morizono S, Tanabe Y, Kajiwara E, Shimono J, Masumoto A, Maruyama T, Furusyo N, Nomura H, Sakai H, Takahashi K, Azuma K, Shimoda S, Kotoh K, Enjoji M, Hayashi J. Relationship between body surface area and ALT normalization after long-term lamivudine treatment. World J Gastroenterol 2006; 11:6948-53. [PMID: 16437598 PMCID: PMC4717036 DOI: 10.3748/wjg.v11.i44.6948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To further evaluate the relationship between BSA and the effects of lamivudine in a greater number of cases and over a longer period of observation than in our previous evaluation. METHODS We evaluated 249 patients with chronic hepatitis B. The effects of treatment for one year (n = 249), two years (n = 147), and three years (n = 72) were evaluated from the levels of serum ALT and HBV-DNA, as biological and virological effects (undetectable levels by PCR), respectively. Moreover, several variables that could influence the response to treatment, including ALT, albumin, bilirubin, platelet counts, BSA, HBV-DNA, and HBeAg were analyzed. RESULTS For 1-year treatment, multivariate analysis revealed that BSA (P = 0.0002) was the only factor for the biological effect, and that ALT (P = 0.0017), HBV-DNA (P = 0.0004), and HBeAg (P = 0.0021) were independent factors for the virological effect. For 2-year treatment, multivariate analysis again showed that BSA (P = 0.0147) was the only factor for the biological effect, and that ALT (P = 0.0192) and HBeAg (P = 0.0428) were independent factors for the virological effect. For 3-year treatment, multivariate analysis, however, could not reveal BSA (P = 0.0730) as a factor for the normalization of ALT levels. CONCLUSION BSA is a significant predictor for the normalizing the effect of lamivudine therapy on ALT for an initial 2-year period, suggesting that lamivudine dosage should be based on the individual BSA.
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Affiliation(s)
- Makoto Nakamuta
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-5282, Japan.
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