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Chaudhry H, Sohal A, Iqbal H, Chaudhary U, Roytman M. Unusual sites of hepatocellular carcinoma metastasis: Case report. SAGE Open Med Case Rep 2023; 11:2050313X231211709. [PMID: 38022862 PMCID: PMC10647942 DOI: 10.1177/2050313x231211709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Hepatocellular carcinoma is an increasingly frequent cause of cancer-related death. The majority of patients with hepatocellular carcinoma are asymptomatic. In rare cases, patients may present with symptoms of extrahepatic metastases. Early identification can lead to timely treatment and prevent poor outcomes. We report three cases of patients with hepatocellular carcinoma with unusual sites of metastasis, including clival, mandible, and cardiac involvement.
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Affiliation(s)
- Hunza Chaudhry
- Department of Internal Medicine, University of California San Francisco—Fresno, Fresno, CA, USA
| | | | - Humzah Iqbal
- Department of Internal Medicine, University of California San Francisco—Fresno, Fresno, CA, USA
| | - Uzair Chaudhary
- Department of Hematology and Oncology, University of California San Francisco—Fresno, Fresno, CA, USA
| | - Marina Roytman
- Division of Gastroenterology, Hepatology and Nutrition, University of California San Francisco—Fresno, Fresno, CA, USA
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2
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Shukla A, Jain A. Hepatocellular Carcinoma with Hepatic Vein and Inferior Vena Cava Invasion. J Clin Exp Hepatol 2023; 13:813-819. [PMID: 37693266 PMCID: PMC10482991 DOI: 10.1016/j.jceh.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/15/2023] [Indexed: 09/12/2023] Open
Abstract
Hepatocellular carcinoma (HCC) invades intrahepatic vessels causing tumor thrombosis. Infrequently, there is involvement of the hepatic vein (HV) and inferior vena cava (IVC). In this review, we summarize the epidemiology, classification, clinical features, and management of HCC with HV and IVC invasion. While the involvement of HV and IVC usually portends an overall poor survival, selected patients may be candidates for aggressive treatment and thus improving outcomes.
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Affiliation(s)
- Akash Shukla
- Department of Gastroenterology, G.S.Medical College and KEM Hospital, Mumbai, India
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3
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Haq MS, Fatima T, Caplan J. Hepatocellular Carcinoma With Cardiac Metastasis Presenting as Presyncope. Cureus 2022; 14:e24926. [PMID: 35698707 PMCID: PMC9187145 DOI: 10.7759/cureus.24926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 11/05/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a common primary tumor of the liver that is highly invasive and can even invade the portal and hepatic veins in later stages. In this report, we present one such rare case of HCC invading the right atrium. A 69-year-old male patient recently diagnosed with HCC secondary to hepatitis C presented to the hospital after experiencing an episode of near syncope. On examination, he had a distended abdomen consistent with ascites with positive fluid shift, elevated jugular vein distention (JVD), and bilateral pitting lower extremity edema. He had an elevated alkaline phosphatase of 298 U/L (34-104) with a total bilirubin of 2.7mg/dL (0.3-1) and a D-dimer of 1.67ugFEU/mL (<0.5). On admission, CT scan of the chest and abdomen showed extensive invasion of the liver by neoplasm and a large 7 cm mass extending from the intrahepatic inferior vena cava to the right atrium. A transthoracic echocardiogram confirmed this, which also better visualized the cardiac anatomy. Due to the extent of the disease, the patient ultimately opted for palliative care. The prognosis for patients with HCC who have an invasion of the right atrium remains dismal, with a median survival of only five months. Surgical extraction of the thrombus with resection of the tumor, liver transplantation, and systemic chemotherapy are some of the treatment modalities employed in such patients; however, historically, the median survival has remained only a few months. With the advent of new techniques and a better understanding of the disease, this seems to be changing and a curative approach can now be considered.
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4
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Wu K, Travaline CE, Elliot L. Right Atrial Tumor Invasion: A Rare Presentation of Hepatocellular Carcinoma. Cureus 2022; 14:e22901. [PMID: 35399442 PMCID: PMC8986503 DOI: 10.7759/cureus.22901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/09/2022] Open
Abstract
Metastatic hepatocellular carcinoma has been associated with a poor prognosis. Common areas of spread include the lungs, portal vein, and portal lymph nodes. Affected patients often have coexisting comorbidities, including cirrhosis, chronic hepatitis, and nonalcoholic fatty liver disease. Our case discusses a rare presentation of hepatocellular carcinoma that had spread to the right atrium, manifesting as acute heart failure in a patient with no history of liver disease. This case highlights the importance of recognizing unusual presentations of advanced hepatocellular carcinoma, as earlier detection can lead to improved patient outcomes.
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5
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Shih JM. Tumor Lysis Syndrome Following Thoracotomy Under Cardiopulmonary Bypass in a Case of Hepatocellular Carcinoma With Right Atrial and Inferior Vena Cava Tumor Thrombus. Cureus 2021; 13:e20311. [PMID: 35028211 PMCID: PMC8747989 DOI: 10.7759/cureus.20311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/07/2022] Open
Abstract
Tumor lysis syndrome (TLS) occurring after surgical resection of right atrium (RA) and inferior vena cava (IVC) tumor thrombus is a very rare but insidious condition. We report a case of hepatocellular carcinoma who developed TLS after uneventful excision of RA+IVC tumor thrombus under median sternotomy and cardiopulmonary bypass (CPB). Although the procedure was not expected to arouse massive tumor cell necrosis, post-operative course was complicated by metabolic acidosis, hypocalcemia, and progressive hyperkalemia indicative of TLS. Unfortunately, laboratory diagnosis of TLS was delayed under conditions of continuous renal replacement therapy (CRRT) for peri-operative acute renal failure. Despite all efforts, the patient died 36 hours after surgery due to lethal arrhythmia and disseminated infarction of the kidneys, spleen, and liver.
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Fleckenstein FN, Jonczyk M, Can E, Lüdemann WM, Savic L, Maleitzke T, Krenzien F, Gebauer B. Hepatocellular carcinoma tumor thrombus entering the right atrium treated with combining percutaneous and intravenous high-dose-rate brachytherapy: a case report. CVIR Endovasc 2021; 4:71. [PMID: 34618268 PMCID: PMC8497669 DOI: 10.1186/s42155-021-00259-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/16/2021] [Indexed: 12/28/2022] Open
Abstract
The presented report describes a case of a Hepatocellular carcinoma (HCC) tumor thrombus (TT) infiltrating the inferior vena cava (IVC) and the right atrium (RA) in a 66-year old male patient who initially presented with TT related symptoms. CT-guided high-dose-rate brachytherapy (HDRBT) was performed for both, the intraparenchymal primary and the TT. A marked improvement of the tumor-related symptoms and shrinkage of the tumor mass were achieved six months after treatment initiation. The combination of intravascular and percutaneous HDRBT demonstrating a promising approach to palliate tumor-related symptoms in advanced HCC with macrovascular invasion.
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Affiliation(s)
- F N Fleckenstein
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany.
| | - M Jonczyk
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - E Can
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W M Lüdemann
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Savic
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - T Maleitzke
- Berlin Institute of Health (BIH), Berlin, Germany.,Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Julius Wolff Institute. Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F Krenzien
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - B Gebauer
- Department of Diagnostic and Interventional Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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7
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Rusu CB, Gorbatâi L, Szatmari L, Koren R, Bungărdean CI, Feciche BO, Bumbuluţ C, Andraş IM, Rahotă R, Telecan T, Coman I, Rath-Wolfson L, Crişan N. Leiomyosarcoma of the inferior vena cava. Our experience and a review of the literature. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:227-233. [PMID: 32747914 PMCID: PMC7728114 DOI: 10.47162/rjme.61.1.25] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignant tumor, accounting for 2% of all LMSs. Less than 400 cases have been reported in literature. Computed tomography (CT) is the most accurate imaging method in assessing the location of the tumor within the IVC and magnetic resonance imaging (MRI) accurately identifies its extent and the potential for surgical resection. We present the case of a patient with inferior vena cava leiomyosarcoma (IVCL), for whom the pathological diagnosis was different from the initially expected one, the tumor appearance on pre-operative imaging mimicking renal cell carcinoma. The intraoperative difficulty of approaching renal hilum and IVC was a factor suggesting the vascular origin of the tumor, which was confirmed at pathological analysis. The extensive defect in the IVC after tumor excision led to the decision of complete transverse suturing of IVC, as significant collateral venous circulation was already present. Because IVCL is a rare disease, there is scarce data regarding the prognosis and treatment options. Long-term survival depends on the extent of the surgery. The need of vascular reconstruction is not always mandatory. Despite high recurrence rates, no consensus regarding adjuvant treatment exists yet. A multidisciplinary approach including surgical oncologists and vascular surgeons is mandatory to achieve the best patient outcomes. Perioperative planning, coordination and adherence to oncological techniques are critical.
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Affiliation(s)
- Cristian Bogdan Rusu
- Department of Urology, Iuliu Haţieganu University of Medicine and Pharmacy, Municipal Clinical Hospital, Cluj-Napoca, Romania;
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8
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Tuxun T, Apaer S, Yao G, Wang Z, Gu S, Zeng Q, Aizezijiang A, Wu J, Anweier N, Zhao J, Li T. Atrial reconstruction, distal gastrectomy with Ante-situm liver resection and autotransplantation for hepatocellular carcinoma with atrial tumor thrombus: A case report. Medicine (Baltimore) 2021; 100:e25780. [PMID: 34106611 PMCID: PMC8133267 DOI: 10.1097/md.0000000000025780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022] Open
Abstract
RATIONALE Hepatocellular with tumor thrombi extending into 3 hepatic veins (HVs) and right atrium presents as a real clinical challenge. We report the first documented case of surgical resection of an advanced hepatocellular carcinoma (HCC) with extensive invasion to distal stomach, atrium and hepatic vasculatures. PATIENT CONCERNS We present a case of 48-years old man with abdominal mass accompanying shortness of breath after activities. DIAGNOSES Preoperative examination revealed giant HCC with tumor thrombi extending into portal vein, HVs, inferior vena cava, and atrium. INTERVENTIONS Distal stomach involvement was confirmed at surgery and, distal gastrectomy, atrial reconstruction and ante-situm liver resection and autotransplantation under cardio-pulmonary bypass were performed. OUTCOMES The operation time was 490 minutes, extracorporeal circulation time 124 minutes, and anhepatic time 40 minutes. Postoperative follow-up revealed normal hepatic and cardiac function with no sign of recurrence. LESSONS This case illustrates that the extensive invasion of HCC to major vasculature and adjacent organs may not necessarily preclude the liver autotransplantation with multi-visceral resection as the treatment option of extremely advanced HCC patients.
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Affiliation(s)
- Tuerhongjiang Tuxun
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
| | - Shadike Apaer
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
| | - Gang Yao
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
| | - Zhipeng Wang
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
| | - Shensen Gu
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
| | - Qi Zeng
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
| | - Aidan Aizezijiang
- School of Language, Shanghai University of International Business and Economics, China
| | - Jing Wu
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
| | - Nuerzhatijiang Anweier
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
| | - Jinming Zhao
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
| | - Tao Li
- Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University
- Clinical Research Center of Hydatid and Hepatobiliary Disease, The 1st Affiliated Hospital of Xinjiang Medical University
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9
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Liu B, Li H, Guo J, Duan Y, Li C, Chen J, Zheng J, Li W. The development of a predictive risk model on post-ablation hemobilia: a multicenter matched case-control study. Br J Radiol 2020; 94:20200163. [PMID: 33353395 PMCID: PMC7934286 DOI: 10.1259/bjr.20200163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: This study aimed to develop a predictive risk model for post-ablation hemobilia. Methods: This was a retrospective, multicenter, matched case–control study. The case group comprised patients with hepatocellular carcinoma who developed post-ablation hemobilia (n = 21); the control group (n = 63) comprised patients with hepatocellular carcinoma but no post-ablation hemobilia; for each case, we included three controls matched for age, sex, platelet count, year of ablation therapy, and center. Univariate and multivariate regression analyses were performed to identify the risk factors for hemobilia. A risk score model was developed based on adjusted odds ratios (ORs). Results: The independent risk factors for occurrence of post-ablation hemobilia were maximum tumor diameter >47 mm [OR = 5.983, 95% CI (1.134–31.551)] and minimum distance from the applicator to the portal trunk ≤8 mm [OR = 4.821, 95% CI (1.225–18.975)]. The risk model was developed using the adjusted ORs; thus a score of 6 was assigned to the former and a score of 5 for the latter. The area under the curve of this risk model was 0.76. Significant hemodynamic instability and inaccurate embolization might increase the risk of recurrence of hemobilia. Conclusion: Tumor size >47 mm and distance of the applicator from the portal trunk ≤8 mm are independent risk factors for hemobilia. A predictive risk model for post-ablation hemobilia was developed using these risk factors. Advances in knowledge: This is the first study that developed a risk score model of post-ablation hemobilia. Risk factors of the recurrence of post-ablation hemobilia were also been identified.
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Affiliation(s)
- Bozhi Liu
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Honglu Li
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jiang Guo
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Youjia Duan
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Changqing Li
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jinglong Chen
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jiasheng Zheng
- Oncology and Hepatobiliary Minimally Invasive Interventional Center, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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10
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Mavroudis A, Cholongitas E. Long-Term Survival under Arterial Chemoembolization and Sorafenib of a Patient with Hepatocellular Carcinoma and Tumor Atrial Thrombus: A Case Report and Literature Review. Gastrointest Tumors 2020; 7:156-162. [PMID: 33173780 DOI: 10.1159/000509186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is considered to be the fourth most frequent cause of cancer-associated death globally. HCC might be associated, especially in advanced stages, with the formation of tumor thrombus (TT), which can be located in the portal vein, as well as in hepatic and/or inferior vena cava (IVC) veins. Nevertheless, the extension of TT to the right atrium (RA) is infrequent with an unfavorable prognosis. We present a rare case of a male patient with HCC and IVC TT extending to the RA. The atrial thrombus was the first manifestation of HCC diagnosed by cardiac ultrasound. So far, the patient has undergone 4 courses of transarterial chemoembolization in combination with systemic therapy with sorafenib, and under this therapeutic approach long-term survival has been achieved.
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Affiliation(s)
- Andreas Mavroudis
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos Cholongitas
- First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
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11
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Hepatocellular carcinoma with right atrial tumor thrombus. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 59:153-161. [PMID: 33152793 DOI: 10.1055/a-1275-3780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hepatocellular carcinoma with right atrial tumor thrombus is uncommon but with a dismal prognosis. METHODS By comprehensive retrieval of literature published between 2000 and 2019, 53 reports were obtained with 187 patients recruited into this study. The extracted data included patient characteristics, tumor characteristics, treatment, follow-up and outcomes. Statistical analyses applied were student t, Fisher exact and I2 tests. Patients were devided into 6 groups according to treatment of choices: transarterial chemoembolization (TACE), surgery, radiotherapy, chemotherapy, interventional treatment and supportive care. RESULTS The overall survival rate of this cohort was 40.8 %. The survival rate of patients receiving TACE was 33.3 % and that of surgical patients was 41.9 %. The survival time of patients with TACE was longer than surgical patients, but lack of a statistical significance. Patients had a follow-up of 15.7 ± 16.6 (median 10) months. The patients receiving radiotherapy had the longest follow-up among all groups. Intra- and/or extrahepatic recurrence of hepatocellular carcinoma was the major morbidity. The mortality rates in a decremental sequence for patients receiving different treatments were supportive care > radiotherapy > surgery > TACE > interventional treatment. No difference was found in mortality between patients reported from case reports and those from non-case reports. CONCLUSIONS Advanced hepatocellular carcinoma with right atrial thrombus is an aggressive malignancy. Based on the results of median survival time, radiotherapy and TACE seemed to be associated with an improved prognosis and possible better survival.
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12
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Girardet R, Boughdad S, Digklia A, Beigelman C, Meyer M, Schaefer N, Vermersch M, Hocquelet A, Tsoumakidou G, Denys A, Duran R. Transarterial Radioembolization for the Treatment of Advanced Hepatocellular Carcinoma Invading the Right Atrium. Cardiovasc Intervent Radiol 2020; 43:1712-1715. [PMID: 32761249 PMCID: PMC7591430 DOI: 10.1007/s00270-020-02605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
Hepatocellular carcinoma (HCC) has the tendency to invade the portal and/or hepatic venous system. The invasion of the right atrium is uncommonly observed and constitutes a treatment challenge. We report the case of a patient with HCC invading the right atrium treated with 90Yttrium-transarterial radioembolization (90Y-TARE). Following the treatment, organizing pneumonia secondary to nivolumab occurred, raising the question of an interaction between 90Y-TARE and nivolumab.
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Affiliation(s)
- Raphaël Girardet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Antonia Digklia
- Department of Medical Oncology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Catherine Beigelman
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Marie Meyer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Niklaus Schaefer
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Mathilde Vermersch
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Arnaud Hocquelet
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Georgia Tsoumakidou
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Alban Denys
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Rafael Duran
- Department of Radiology and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Xia Y, Zhang J, Ni X. Diagnosis, treatment and prognosis of hepatocellular carcinoma with inferior vena cava/right atrium tumor thrombus. Oncol Lett 2020; 20:101. [PMID: 32831920 PMCID: PMC7439153 DOI: 10.3892/ol.2020.11962] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 06/26/2020] [Indexed: 02/06/2023] Open
Abstract
Although tumor thrombus (TT) infringement of the inferior vena cava (IVC) and right atrium (RA) is rarely observed in hepatocellular carcinoma (HCC), the prognosis for this condition is extremely poor, with a median survival time of several months, given that the condition is often diagnosed at an advanced tumor stage or combined with multiple systemic metastases. Furthermore, there is no established effective treatment for the condition. However, some investigators insist that active treatment, including surgery, chemotherapy (systemic or intra-arterial), radiation therapy, best supportive care or a combination of these, may help prolong overall survival time in these patients. The management of patients with advanced HCC and a TT extending into the RA and IVC is extremely difficult and risky. To this end, the present review assessed the literature on the clinical features and treatments of this condition in recent years, with the aim of providing assistance for clinical work.
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Affiliation(s)
- Yinchuan Xia
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
| | - Junqi Zhang
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
| | - Xiaoling Ni
- Department of Oncology, Bazhong Central Hospital, Bazhong, Sichuan 636000, P.R. China
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14
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Aly R, Gupta S, Gupta R, Jorge VM, Ebraheem A. Hepatocellular Carcinoma Presenting With Inferior Vena Cava Tumor Thrombus Extending to the Right Atrium: A Case Report. Cureus 2020; 12:e9421. [PMID: 32754419 PMCID: PMC7387077 DOI: 10.7759/cureus.9421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver tumor, and its incidence has been on the rise worldwide. It is a common cause of cancer-related death. HCC carries a poor prognosis and is challenging to manage, especially when diagnosed in advanced stages. We present a rare case of HCC in liver cirrhosis secondary to viral hepatitis C (HCV) infection, presenting with large tumor thrombus extending to the right atrium treated with lenvatinib.
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15
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Palliative External Beam Radiation Therapy for Hepatocellular Carcinoma With Right Atrial Tumor Thrombus. Pract Radiat Oncol 2020; 10:e183-e187. [PMID: 31931178 DOI: 10.1016/j.prro.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 12/25/2022]
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16
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A Rare Case of Intracardiac Extension of Hepatocellular Carcinoma in a Child. Case Rep Oncol Med 2019; 2019:4783595. [PMID: 31885971 PMCID: PMC6915120 DOI: 10.1155/2019/4783595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/06/2019] [Indexed: 11/18/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common malignancy found in men and ninth most common in women, out of which 72.5% reported cases are from Asia. In children, it accounts for <2% cases worldwide with even rarer incidence of 1.2% involving intracardial extension. However, it presents with a high mortality rate with mean survival ranging from 1 to 4 months. The present case is an extremely rare case of intracardiac extension of HCC in a 3.5-year-old Asian girl with no history of hepatitis B infection presented at an advanced stage of HCC who succumbed within one month of presentation to the hospital.
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Zhou B, Chen E, Chen J, Zhang J, Zhang N, Chen Z. Overexpression of proteinase inhibitor 9 is associated with poor prognosis in human hepatocellular carcinoma and with proliferation and apoptosis in HepG2 cells in vitro. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:3719-3727. [PMID: 31933760 PMCID: PMC6949766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
Excessive proteinase inhibitor 9 (PI9) levels predict a poor outcome for patients with several tumor types. We compared the expression of PI9 in HepG2 cells and in 21 pairs of tumor and peritumor tissue samples using western blotting. Immunohistochemical staining was used to detect PI9 expression in 105 cases of hepatocellular carcinoma (HCC) and in 20 adjacent normal liver tissues. Changes in the degree of apoptosis and proliferation were determined before and after transfection with pcDNA3.1-PI9 and small interfering (si)RNA-PI9 using MTT analysis, colony formation assay, and flow cytometry. The correlation between PI9 expression and prognosis was determined in a large HCC patient cohort (n=105). Western blotting showed that PI9 expression was significantly higher in tumor tissues than in adjacent tissues. PI9 immunohistochemical staining was positive in 78.1% of HCC tissues, which was significantly higher than that seen in adjacent normal liver tissue (35%). PI9 expression in HCC correlated closely with the extent of tumor differentiation, tumor-node-metastasis staging, and tumor size. Cox regression analysis demonstrated that PI9 is an independent predictor of prognosis in patients with HCC, and is related to overall survival. The apoptosis of HepG2 cells was significantly increased following PI9 up-regulation and significantly decreased after siRNA interference against PI9 expression. Cell proliferation was significantly decreased following PI9 up-regulation and significantly increased after siRNA interference of PI9 expression. PI9 appears to contribute to the apoptosis of HCC, and could be an independent predictor of recurrence and a suitable pharmaceutical target in patients with HCC.
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Affiliation(s)
- Bin Zhou
- Department of General Surgery, Suzhou Wuzhong People’s HospitalSuzhou, Jiangsu Province, China
| | - Erlin Chen
- Department of General Surgery, Affiliated Hospital of Nantong UniversityNantong, Jiangsu Province, China
| | - Jiahui Chen
- Department of Cardiology, Zhongshan HospitalShanghai, China
| | - Juan Zhang
- Department of Rehabilitation, Suzhou Wuzhong People’s HospitalSuzhou, Jiangsu Province, China
| | - Nannan Zhang
- Department of General Surgery, Nantong Tongzhou People’s HospitalNantong, Jiangsu Province, China
| | - Zhong Chen
- Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Research Institute of Hepatobiliary Surgery of Nantong UniversityNantong, Jiangsu Province, China
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Shui Y, Zhu X, Wu J, Liang T, Wei Q. Stereotactic body radiotherapy as the initial treatment for hepatocellular carcinoma with extensive inferior vena cava and atrium tumor thrombus. Onco Targets Ther 2019; 12:5299-5303. [PMID: 31308700 PMCID: PMC6614854 DOI: 10.2147/ott.s208560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/06/2019] [Indexed: 12/14/2022] Open
Abstract
Hepatocellular carcinoma (HCC) with inferior vena cava (IVC) tumor thrombus rarely occurs, its prognosis is extremely poor. A 49-year-old locally advanced HCC male with tumor thrombus extension into the IVC and the right atrium was successfully treated with stereotactic body radiotherapy (SBRT). A radiation dose of 40 Gy/5 fractions was delivered to the thrombus in 5 days. Contrast-enhanced magnetic resonance imaging one month after SBRT demonstrated no thrombus in IVC and the right atrium, and the huge lesion on right lobe also shrank. No severe adverse effect, eg, pulmonary embolism, was encountered. After controlling the thrombus, this patient has the opportunity to receive subsequent transarterial chemoembolization procedure in time, and avoided disease progression outside the irradiation volume. We reported a HCC case with extensive IVC and atrium tumor thrombus successfully treated by SBRT, the effectiveness and potential severe adverse effects were discussed.
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Affiliation(s)
- Yongjie Shui
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Xiaoping Zhu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Jianjun Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China
| | - Qichun Wei
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, People's Republic of China.,Ministry of Education Key Laboratory of Cancer Prevention and Intervention, Zhejiang University Cancer Institute, Hangzhou 310009, People's Republic of China
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Numan L, Asif S, Abughanimeh OK. Hepatocellular Carcinoma with Tumor Thrombus Extending from the Portal Vein to the Right Atrium. Cureus 2019; 11:e4689. [PMID: 31338266 PMCID: PMC6639066 DOI: 10.7759/cureus.4689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Tumor thrombus formation in advanced HCC stages is common and usually involves the hepatic or portal veins. The formation of tumor thrombus is considered a poor prognostic factor. Herein, we report a rare case wherein the thrombus extended to the inferior vena cava (IVC) reaching the right atrium without affecting the hemodynamic status. This is a 59-year-old male who presented with melena. He was found to have grade 3 esophageal varices with findings suggestive of recent bleeding associated with a large amount of blood in the gastric body that required banding. Computed tomography (CT) of the abdomen and pelvis showed multiple liver masses with an intraluminal IVC mass extending from the hepatic vein into the right atrium. A CT scan of the chest confirmed the presence of a tumor thrombus in the IVC extending to the right atrium. The patient declines surgical intervention and he was discharged. Unfortunately, he passed after a short period of time. In conclusion, tumor thrombus formation is common in HCC. However, expansion of the thrombus to IVC and right atrium is rare and indicates poor prognosis.
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Affiliation(s)
- Laith Numan
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Samia Asif
- Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, USA
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Gatti P, Giorgio A, Ciracì E, Roberto I, Anglani A, Sergio S, Rizzello F, Giorgio V, Semeraro S. Hepatocellular carcinoma tumor thrombus entering the inferior vena cava treated with percutaneous RF ablation: a case report. J Ultrasound 2019; 22:363-370. [PMID: 30864004 DOI: 10.1007/s40477-019-00361-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/23/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is the most common form of liver cancer. In advanced cancer stages (metastatic disease and/or vascular invasion), the generally accepted standard of care is systemic therapy using sorafenib as first-line treatment and, recently, regorafenib and nivolumab as second-line treatment, but the quality of life and the prognosis of patients remain very poor. Our paper reports a case of US-guided radiofrequency ablation (RFA) of both intraparenchymal HCC and inferior vena cava tumor thrombus. METHODS We treated a patient with HCC associated with tumor thrombus extending into vena cava after failure of sorafenib therapy using US-guided radiofrequency ablation (RFA). RESULTS A good radiological and clinical response was observed in association with excellent tolerability. The patient has been followed up for 15 months from the ablation, is alive, and is in a good clinical condition without evidence of tumor recurrence. CONCLUSION This is the first case in which this minimally invasive percutaneous procedure has been successfully used to treat an HCC thrombus entering the vena cava.
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Affiliation(s)
- Pietro Gatti
- Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy
| | - Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | - Emanuela Ciracì
- Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy
| | - Italia Roberto
- Internal Medicine Division, Ostuni Hospital, Ostuni, BR, Italy
| | | | - Spano Sergio
- Interventional Radiology Unit, Perrino Hospital, Brindisi, Italy
| | - Fernando Rizzello
- Anesthesiology and Reanimation Unit, Ostuni Hospital, Ostuni, BR, Italy
| | - Valentina Giorgio
- Pediatric Gastroenterology Unit, Policlinico Gemelli, Sacred Heart University, Rome, Italy
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Pandit N, Jaiswal LS, Shrestha V, Awale L, Adhikary S. Undifferentiated embryonal sarcoma of liver in an adult with spontaneous rupture and tumour thrombus in the right atrium. ANZ J Surg 2018; 89:E396-E397. [PMID: 29785758 DOI: 10.1111/ans.14670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/13/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Narendra Pandit
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Lokesh S Jaiswal
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Vijay Shrestha
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Lalijan Awale
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - Shailesh Adhikary
- Department of Surgery, B P Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
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Wang Y, Ma L, Sheng S, Yuan Z, Zheng J, Li W. Combination therapy of TACE and CT-guided partial hepatic segment ablation for liver cancer. MINIM INVASIV THER 2018; 27:355-364. [PMID: 29671661 DOI: 10.1080/13645706.2018.1462833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Yang Wang
- Center of Interventional Oncology and Liver Diseases, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Liang Ma
- Center of Interventional Oncology and Liver Diseases, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Shoupeng Sheng
- Center of Interventional Oncology and Liver Diseases, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Zhuhui Yuan
- Center of Interventional Oncology and Liver Diseases, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Jiasheng Zheng
- Center of Interventional Oncology and Liver Diseases, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
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Wang Y, Jiang S, Cao Z, Xie C, Li W, Ma Y, Zhang J, Lin L. Detecting the location and significance of Ezrin protein expression in hepatocellular carcinoma. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:248-254. [PMID: 31938107 PMCID: PMC6957936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/07/2017] [Indexed: 06/10/2023]
Abstract
To explore the characteristics of localization and prognostic implication of Ezrin expression in HCC, 92 cases of HCC meeting strict follow-up criteria were selected for immunohistochemical staining of Ezrin protein. Correlations between Ezrin expression and clinicopathological features of HCC were evaluated using Chi-square tests, survival rates were calculated using the Kaplan-Meier method, and the relationship between prognostic factors and patient overallsurvival was analyzed using Cox proportional hazard analysis. In results, Ezrin protein was mainly expressed in the inner side of the cell membrane of the adjacent non tumor tissues, and diffusely expressed in cytoplasm of HCC tissues. There was an obviously difference between the benign and malignant tissues about the location of Ezrin expression. Ezrin strong-expression rates were significantly higher in HCC samples compared with the adjacent non tumor tissues (P<0.05). The Ezrin strong-expression rate was closely related with the differentiation (P<0.01), AJCC stage and metastasis of HCC (P<0.05, respectively). Therefore, the sub-cellular localization of Ezrin protein in the liver cells will be changed in the process of the transformation from the benign to malignant, and Ezrin plays an important role in the progression of HCC.
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Affiliation(s)
- Yan Wang
- Institute of Molecular Medicine, Medical College of Eastern Liaoning UniversityDandong 118003, China
| | - Shaochen Jiang
- Liaoning Coloproctological Hospital, The Third Affiliated Hospital of Liaoning University of Traditional MedicineShenyang 110000, China
| | - Zhongliang Cao
- Department of General Surgery, Dandong Center HospitalDandong 118002, China
| | - Chunxiao Xie
- Department of Emergency, Dandong First HospitalDandong 118001, China
| | - Weidong Li
- Department of Anesthesiology, Dandong First HospitalDandong 118001, China
| | - Yibing Ma
- Department of Pathology, Dandong Center HospitalDandong 118002, China
| | - Jinhui Zhang
- Institute of Molecular Medicine, Medical College of Eastern Liaoning UniversityDandong 118003, China
| | - Lijuan Lin
- Institute of Molecular Medicine, Medical College of Eastern Liaoning UniversityDandong 118003, China
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