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Jakimów K, Tekiela N, Kozak K, Peterek R, Kwaśniewska A, Pająk J, Chudek J. Misdiagnosis Based on Neoplastic Markers-Extremely High Alpha-Fetoprotein in Patients with Intrahepatic Cholangiocarcinoma with Literature Review of the Published Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1109. [PMID: 39064538 PMCID: PMC11279150 DOI: 10.3390/medicina60071109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/05/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024]
Abstract
Background: Alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA 19-9) are two tumor markers that are widely used in the differential diagnosis in patients with primary liver tumors. Very high levels of AFP are sporadically observed in patients with intrahepatic cholangiocarcinoma (ICC) and may cause an incorrect initial diagnosis of hepatocellular carcinoma (HCC). Methods: Two cases of tumors in cirrhotic livers were described, in which the initial diagnosis, based on very high AFP levels (Patient I: 10,464 ng/mL, Patient II: 2212 ng/mL, reference range: ≤8.04 ng/mL) was HCC. In addition, the PubMed database was searched for cases of ICC with elevated AFP. Discussion: In both individuals, liver cirrhosis was diagnosed, but there was no typical rapid "washout" in the contrast-enhanced computed tomography. Based on the histological assessment of samples obtained in the core biopsies, the initially assumed diagnosis of HCC was changed to ICC in both cases. Only nine cases of patients with ICC and high AFP levels were found in the PubMed database. The AFP levels ranged from slightly elevated to over 16,000 ng/mL. Conclusions: A very high AFP level does not necessarily correlate with the presence of HCC. Therefore, the diagnosis has to be verified histologically, when the radiological imaging is uncertain in patients with liver cirrhosis.
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Affiliation(s)
- Krzysztof Jakimów
- Student’s Scientific Association, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland; (N.T.); (K.K.); (R.P.)
| | - Natalia Tekiela
- Student’s Scientific Association, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland; (N.T.); (K.K.); (R.P.)
| | - Katarzyna Kozak
- Student’s Scientific Association, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland; (N.T.); (K.K.); (R.P.)
| | - Robert Peterek
- Student’s Scientific Association, Department of Internal Diseases and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland; (N.T.); (K.K.); (R.P.)
| | - Anna Kwaśniewska
- Department of Radiology, The Mielecki Hospital, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jacek Pająk
- Department of Pathomorphology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Jerzy Chudek
- Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, 40-055 Katowice, Poland
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Zhang H, Dong X, Ding X, Liu G, Yang F, Song Q, Sun H, Chen G, Li S, Li Y, Wang M, Guo T, Zhang Z, Li B, Yang L. Bufalin targeting CAMKK2 inhibits the occurrence and development of intrahepatic cholangiocarcinoma through Wnt/β-catenin signal pathway. J Transl Med 2023; 21:900. [PMID: 38082327 PMCID: PMC10714474 DOI: 10.1186/s12967-023-04613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/10/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (ICC) accounts for about 15% of primary liver cancer, and the incidence rate has been rising in recent years. Surgical resection is the best treatment for ICC, but the 5-year survival rate is less than 30%. ICC signature genes are crucial for the early diagnosis of ICC, so it is especially important to find its signature genes and therapeutic drug. Here, we studied that bufalin targeting CAMKK2 promotes mitochondrial dysfunction and inhibits the occurrence and metastasis of intrahepatic cholangiocarcinoma through Wnt/β-catenin signal pathway. METHODS IC50 of bufalin in ICC cells was determined by CCK8 and invasive and migratory abilities were verified by wound healing, cell cloning, transwell and Western blot. IF and IHC verified the expression of CAMKK2 between ICC patients and normal subjects. BLI and pull-down demonstrated the binding ability of bufalin and CAMKK2. Bioinformatics predicted whether CAMKK2 was related to the Wnt/β-catenin pathway. SKL2001, an activator of β-catenin, verified whether bufalin acted through this pathway. In vitro and in vivo experiments verified whether overexpression of CAMKK2 affects the proliferative and migratory effects of ICC. Transmission electron microscopy verified mitochondrial integrity. Associated Ca2+ levels verified the biological effects of ANXA2 on ICC. RESULTS It was found that bufalin inhibited the proliferation and migration of ICC, and CAMKK2 was highly expressed in ICC, and its high expression was positively correlated with poor prognosis.CAMKK2 is a direct target of bufalin, and is associated with the Wnt/β-catenin signaling pathway, which was dose-dependently decreased after bufalin treatment. In vitro and in vivo experiments verified that CAMKK2 overexpression promoted ICC proliferation and migration, and bufalin reversed this effect. CAMKK2 was associated with Ca2+, and changes in Ca2+ content induced changes in the protein content of ANXA2, which was dose-dependently decreasing in cytoplasmic ANXA2 and dose-dependently increasing in mitochondrial ANXA2 after bufalin treatment. In CAMKK2 overexpressing cells, ANXA2 was knocked down, and we found that reversal of CAMKK2 overexpression-induced enhancement of ICC proliferation and migration after siANXA2. CONCLUSIONS Our results suggest that bufalin targeting CAMKK2 promotes mitochondrial dysfunction and inhibits the proliferation and migration of intrahepatic cholangiocarcinoma through Wnt/β-catenin signal pathway. Thus, bufalin, as a drug, may also be used for cancer therapy in ICC in the future.
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Affiliation(s)
- Huhu Zhang
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China
| | - Xiaolei Dong
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China
| | - Xiaoyan Ding
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China
| | - Guoxiang Liu
- Department of Clinical Laboratory, Weifang People's Hospital, 151, Guangwen Street, Weifang, 261041, China
| | - Fanghao Yang
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China
| | - Qinghang Song
- Health Science Center, Qingdao University, Qingdao, 266071, China
| | - Hongxiao Sun
- Heart Center, Women and Children's Hospital, Qingdao University, 6, Tongfu Road, Qingdao, 266034, China
| | - Guang Chen
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China
| | - Shuang Li
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China
| | - Ya Li
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China
| | - Mengjun Wang
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China
| | - Tingting Guo
- Health Science Center, Qingdao University, Qingdao, 266071, China
| | - Zhe Zhang
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China
| | - Bing Li
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China.
- Department of Hematology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| | - Lina Yang
- Department of Genetics and Cell Biology, Basic Medical College, Qingdao University, Qingdao, 266071, China.
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Romero AL, Romero J, Lee J, Iqbal U, Masood A, Koomson A, Muniba N. Pyoderma Gangrenosum as a Harbinger of Adult T-Cell Leukemia-Lymphoma. J Community Hosp Intern Med Perspect 2023; 13:49-54. [PMID: 37168058 PMCID: PMC10589024 DOI: 10.55729/2000-9666.1167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 03/13/2023] Open
Abstract
Adult T-cell leukemia-lymphoma (ATLL) is a malignancy of mature T lymphocytes caused by chronic human T-lymphotropic virus, type I (HTLV-I) infection. Up to one third of cases of ATLL can present with skin involvement-oftentimes there may only be skin involvement. Rare cutaneous presentations can further obscure the diagnosis, create diagnostic dilemma, and delay the institution of appropriate therapy. We present a case of ATLL where the initial lesion at presentation was pyoderma gangrenosum (PG). To our knowledge, there are no reported cases of ATLL presenting as PG.
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Affiliation(s)
- Ana L. Romero
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Jesus Romero
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Janice Lee
- Internal Medicine Department, St. George’s School of Medicine,
Grenada
| | - Unzela Iqbal
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Abdullah Masood
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
| | - Angela Koomson
- Internal Medicine Department, St. George’s School of Medicine,
Grenada
| | - Naqi Muniba
- Internal Medicine Department, RWJBarnabas Health/Trinitas Regional Medical Center, Elizabeth, NJ,
USA
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Kingham TP, Aveson VG, Wei AC, Castellanos JA, Allen PJ, Nussbaum DP, Hu Y, D'Angelica MI. Surgical management of biliary malignancy. Curr Probl Surg 2021; 58:100854. [PMID: 33531120 PMCID: PMC8022290 DOI: 10.1016/j.cpsurg.2020.100854] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Victoria G Aveson
- New York Presbyterian Hospital-Weill Cornel Medical Center, New York, NY
| | - Alice C Wei
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Peter J Allen
- Duke Cancer Center, Chief, Division of Surgical Oncology, Duke University School of Medicine, Durham, NC
| | | | - Yinin Hu
- Division of Surgical Oncology, University of Maryland, Baltimore, MD
| | - Michael I D'Angelica
- Memorial Sloan Kettering Cancer Center, Professor of Surgery, Weill Medical College of Cornell University, New York, NY..
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Shao S, Shan Q, Zheng N, Wang B, Wang J. Role of Intravoxel Incoherent Motion in Discriminating Hepatitis B Virus-Related Intrahepatic Mass-Forming Cholangiocarcinoma from Hepatocellular Carcinoma Based on Liver Imaging Reporting and Data System v2018. Cancer Biother Radiopharm 2019; 34:511-518. [PMID: 31314589 DOI: 10.1089/cbr.2019.2799] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Backgroud: Intravoxel incoherent motion (IVIM) could be used to characterize benign and malignant hepatic lesions and predict the histological grade of hepatocellular carcinoma (HCC). To evaluate IVIM-derived parameters for differentiating between hepatitis B virus (HBV)-related intrahepatic mass-forming cholangiocarcinoma (IMCC) and HCC based on the Liver Imaging Reporting and Data System (LI-RADS) v2018. Materials and Methods: 20 IMCC patients and one-to-one matched control HCC patients were retrospectively assessed. IVIM scanning with 11 b-values (from 0 to 1500 s/mm2) was obtained using a 3.0-T magnetic resonance scanner. Apparent diffusion coefficient (ADC) and IVIM parameters, including diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f), were compared between IMCC and HCC. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performances of ADC, D, f, and D*. The LI-RADS features and a final category were also compared using LI-RADS v2018. Results: ADC and D were significantly higher in IMCC than in HCC (p = 0.012 and p = 0.007, respectively); f was significantly higher in HCC than in IMCC (p = 0.004). The area under the ROC curve values for ADC, D, and f for differentiating HBV-related IMCC from HCC were 0.724, 0.753, and 0.741, respectively. Conclusion: The majority of HBV-related IMCCs can be categorized as LR-M by using LI-RADS. However, atypical IMCCs may be classified as non-LR-M. ADC, D, and f values may be helpful in differentiating HBV-related IMCC from HCC, and similar diagnostic performances were obtained for these values.
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Affiliation(s)
- Shuo Shao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, P.R. China.,Department of Radiology, Jining No. 1 People's Hospital, Jining, P.R. China
| | - Qungang Shan
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), Guangzhou, P.R. China
| | - Ning Zheng
- Department of Radiology, Jining No. 1 People's Hospital, Jining, P.R. China
| | - Bin Wang
- Medical Imaging Research Institute, Binzhou Medical University, Yantai, P.R. China
| | - Jin Wang
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-sen University (SYSU), Guangzhou, P.R. China
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