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Song M, Tao Y, He K, Du M, Guo L, Hu C, Zhang W. Clear cell hepatocellular carcinoma: Gd-EOB-DTPA-enhanced MR imaging features and prognosis. Abdom Radiol (NY) 2024; 49:2606-2621. [PMID: 38557768 DOI: 10.1007/s00261-024-04263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To investigate imaging findings on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) and prognosis of clear cell hepatocellular carcinoma (CCHCC) comparing with non-otherwise specified hepatocellular carcinoma (NOS-HCC). METHODS The clinical, pathological and MR imaging features of 42 patients with CCHCC and 84 age-matched patients with NOS-HCC were retrospectively analyzed from January 2015 to October 2021. Univariate and multivariate logistic regression and Cox regression analyses were performed to identify independent diagnostic and prognostic factors for CCHCC. Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan-Meier analysis. RESULTS CCHCC showed fat content more frequently (P < 0.001) and relatively higher Edmondson tumor grade (P = 0.001) compared with NOS-HCC. The lesion-to-muscle ratio (LMR) and lesion-to-liver ratio (LLR) of CCHCC on pre-enhancement T1-weighted imaging (pre-T1WI) (P = 0.001, P = 0.003) and hepatobiliary phase (HBP) (P = 0.007, P = 0.048) were significantly higher than those of NOS-HCC. The area under the curve (AUC) for fat content, LLR on pre-T1WI and their combination with better diagnostic performance in predicting CCHCC were 0.678, 0.666, and 0.750, respectively. There was no statistically significant difference in clinical outcomes between CCHCC and NOS-HCC. Multivariate Cox analysis confirmed that tumor size > 2 cm and enhancing capsule were independent prognostic factors for DFS and OS among CCHCC patients. CONCLUSION Fat content and adjusted lesion signal intensity on pre-T1WI and HBP could be used to differentiate CCHCC from NOS-HCC. CCHCC had similar prognosis with NOS-HCC.
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Affiliation(s)
- Mingyue Song
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215028, China
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yuhao Tao
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215028, China
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Kuang He
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Mingzhan Du
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Lingchuan Guo
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Weiguo Zhang
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215028, China.
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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Hu X, Li X, Zhao W, Cai J, Wang P. Multimodal imaging findings of primary liver clear cell carcinoma: a case presentation. Front Med (Lausanne) 2024; 11:1408967. [PMID: 38818401 PMCID: PMC11137254 DOI: 10.3389/fmed.2024.1408967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
Primary clear cell carcinoma of liver (PCCCL) is a special and relatively rare subtype of hepatocellular carcinoma (HCC), which is more common in people over 50 years of age, with a preference for men and a history of hepatitis B or C and/or cirrhosis. Herein, we present a case of a 60-year-old woman who came to our hospital for medical help with right upper abdominal pain. The imaging examination showed a low-density mass in the right lobe of his liver. In contrast enhanced computed tomography (CT) or T1-weighted imaging, significant enhancement can appear around the tumor during the arterial phase, and over time, the degree of enhancement of the tumor gradually decreases. The lession showed obviously increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography/CT. These imaging findings contribute to the diagnosis of PCCCL and differentiate it from other types of liver tumors.
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Affiliation(s)
- Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaotian Li
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wei Zhao
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jiong Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Pan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Liu B, Li J, Yang X, Chen F, Zhang Y, Li H. Diagnosis of primary clear cell carcinoma of the liver based on Faster region-based convolutional neural network. Chin Med J (Engl) 2023; 136:2706-2711. [PMID: 37882066 PMCID: PMC10684187 DOI: 10.1097/cm9.0000000000002853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Distinguishing between primary clear cell carcinoma of the liver (PCCCL) and common hepatocellular carcinoma (CHCC) through traditional inspection methods before the operation is difficult. This study aimed to establish a Faster region-based convolutional neural network (RCNN) model for the accurate differential diagnosis of PCCCL and CHCC. METHODS In this study, we collected the data of 62 patients with PCCCL and 1079 patients with CHCC in Beijing YouAn Hospital from June 2012 to May 2020. A total of 109 patients with CHCC and 42 patients with PCCCL were randomly divided into the training validation set and the test set in a ratio of 4:1.The Faster RCNN was used for deep learning of patients' data in the training validation set, and established a convolutional neural network model to distinguish PCCCL and CHCC. The accuracy, average precision, and the recall of the model for diagnosing PCCCL and CHCC were used to evaluate the detection performance of the Faster RCNN algorithm. RESULTS A total of 4392 images of 121 patients (1032 images of 33 patients with PCCCL and 3360 images of 88 patients with CHCC) were uesd in test set for deep learning and establishing the model, and 1072 images of 30 patients (320 images of nine patients with PCCCL and 752 images of 21 patients with CHCC) were used to test the model. The accuracy of the model for accurately diagnosing PCCCL and CHCC was 0.962 (95% confidence interval [CI]: 0.931-0.992). The average precision of the model for diagnosing PCCCL was 0.908 (95% CI: 0.823-0.993) and that for diagnosing CHCC was 0.907 (95% CI: 0.823-0.993). The recall of the model for diagnosing PCCCL was 0.951 (95% CI: 0.916-0.985) and that for diagnosing CHCC was 0.960 (95% CI: 0.854-0.962). The time to make a diagnosis using the model took an average of 4 s for each patient. CONCLUSION The Faster RCNN model can accurately distinguish PCCCL and CHCC. This model could be important for clinicians to make appropriate treatment plans for patients with PCCCL or CHCC.
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Affiliation(s)
- Bin Liu
- Department of Radiology, Beijing YouAn Hospital Capital Medical University, Beijing 100069, China
- Department of Radiology, Civil Aviation General Hospital, Beijing 100123, China
| | - Jianfei Li
- Extenics Specialized Committee, Chinese Association of Artificial Intelligence, Beijing 100876, China
| | - Xue Yang
- Department of Radiology, Beijing YouAn Hospital Capital Medical University, Beijing 100069, China
| | - Feng Chen
- Department of Radiology, Beijing YouAn Hospital Capital Medical University, Beijing 100069, China
| | - Yanyan Zhang
- Department of Radiology, Beijing YouAn Hospital Capital Medical University, Beijing 100069, China
| | - Hongjun Li
- Department of Radiology, Beijing YouAn Hospital Capital Medical University, Beijing 100069, China
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Renzulli M, Braccischi L, D'Errico A, Pecorelli A, Brandi N, Golfieri R, Albertini E, Vasuri F. State-of-the-art review on the correlations between pathological and magnetic resonance features of cirrhotic nodules. Histol Histopathol 2022; 37:1151-1165. [PMID: 35770721 DOI: 10.14670/hh-18-487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hepatocellular carcinoma (HCC) has become the second greatest cause of cancer-related mortality worldwide and the newest advancements in liver imaging have improved the diagnosis of both overt malignancies and premalignant lesions, such as cirrhotic or dysplastic nodules, which is crucial to improve overall patient survival rate and to choose the best treatment options. The role of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) has grown in the last 20 years. In particular, the introduction of hepatospecific contrast agents has strongly increased the definition of precursor nodules and detection of high-grade dysplastic nodules and early HCCs. Nevertheless, the diagnosis of liver tumours in cirrhotic patients sometimes remains challenging for radiologists, thus, in doubtful cases, biopsy and histological analysis become critical in clinical practice. This current review briefly summarizes the history of imaging and histology for HCC, covering the newest techniques and their limits. Then, the article discusses the links between radiological and pathological characteristics of liver lesions in cirrhotic patients, by describing the multistep process of hepatocarcinogenesis. Explaining the evolution of pathologic change from cirrhotic nodules to malignancy, the list of analyzed lesions provides regenerative nodules, low-grade and high-grade dysplastic nodules, small HCC and progressed HCC, including common subtypes (steatohepatitic HCC, scirrhous HCC, macrotrabecular massive HCC) and more rare forms (clear cell HCC, chromophobe HCC, neutrophil-rich HCC, lymphocyte-rich HCC, fibrolamellar HCC). The last chapter covers the importance of the new integrated morphological-molecular classification and its association with radiological features.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Lorenzo Braccischi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Antonietta D'Errico
- Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Anna Pecorelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia
| | - Elisa Albertini
- Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Vasuri
- Pathology Unit, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Sweed D, Sweed E, Moaz I, Mosbeh A, Fayed Y, Elhamed SMA, Sweed E, Macshut M, Abdelsattar S, Kilany S, Saied SA, Badr R, Abdallah MS, Ehsan N. The clinicopathological and prognostic factors of hepatocellular carcinoma: a 10-year tertiary center experience in Egypt. World J Surg Oncol 2022; 20:298. [PMID: 36117166 PMCID: PMC9484175 DOI: 10.1186/s12957-022-02764-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/06/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) remains a major health problem despite the emergence of several preventive and therapeutic modalities. HCC has heterogeneous and wide morpho-molecular patterns, resulting in unique clinical and prognostic criteria. Therefore, we aimed to study the clinical and pathological criteria of HCC to update the morpho-molecular classifications and provide a guide to the diagnosis of this disease. METHODS Five hundred thirty pathologically analyzed HCC cases were included in this study. The clinical and survival data of these cases were collected. RESULTS Hepatitis C virus is still the dominant cause of HCC in Egypt. Post-direct-acting antiviral agent HCC showed an aggressive course compared to interferon-related HCC. Old age, male gender, elevated alpha-fetoprotein level, tumor size, and background liver were important prognostic parameters. Special HCC variants have characteristic clinical, laboratory, radiological, prognostic, and survival data. Tumor-infiltrating lymphocytes rather than neutrophil-rich HCC have an excellent prognosis. CONCLUSIONS HCC is a heterogenous tumor with diverse clinical, pathological, and prognostic parameters. Incorporating the clinicopathological profile per specific subtype is essential in the treatment decision of patients with HCC. TRIAL REGISTRATION This was a retrospective study that included 530 HCC cases eligible for analysis. The cases were obtained from the archives of the Pathology Department, during the period between January 2010 and December 2019. Clinical and survival data were collected from the patients' medical records after approval by the institutional review board (IRB No. 246/2021) of Liver National Institute, Menoufia University. The research followed the guidelines outlined in the Declaration of Helsinki and registered on ClinicalTrials.gov (NCT05047146).
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Affiliation(s)
- Dina Sweed
- grid.411775.10000 0004 0621 4712Pathology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Enas Sweed
- grid.411660.40000 0004 0621 2741Radiology Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Inas Moaz
- grid.411775.10000 0004 0621 4712Epidemiology, and Preventive Medicine Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Asmaa Mosbeh
- grid.411775.10000 0004 0621 4712Pathology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Yahya Fayed
- grid.411775.10000 0004 0621 4712Hepatopancreatobiliary Surgery Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Sara Mohamed Abd Elhamed
- grid.411775.10000 0004 0621 4712Pathology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Eman Sweed
- grid.411775.10000 0004 0621 4712Clinical Pharmacology Department, Faculty of Medicine, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Mahmoud Macshut
- grid.411775.10000 0004 0621 4712Hepatopancreatobiliary Surgery Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Shimaa Abdelsattar
- grid.411775.10000 0004 0621 4712Clinical Biochemistry and Molecular Diagnostics Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Shimaa Kilany
- grid.411775.10000 0004 0621 4712Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Sara A. Saied
- grid.411775.10000 0004 0621 4712Clinical Pathology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Reda Badr
- grid.411775.10000 0004 0621 4712Hepatology and Gastroenterology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
| | - Mahmoud S. Abdallah
- grid.449877.10000 0004 4652 351XClinical Pharmacy, Faculty of Pharmacy, University of Sadat City, Sadat City, Menoufia Egypt
| | - Nermine Ehsan
- grid.411775.10000 0004 0621 4712Pathology Department, National Liver Institute, Menoufia University, Shebin Elkom, Menoufia Egypt
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Katabathina VS, Khanna L, Surabhi VR, Minervini M, Shanbhogue K, Dasyam AK, Prasad SR. Morphomolecular Classification Update on Hepatocellular Adenoma, Hepatocellular Carcinoma, and Intrahepatic Cholangiocarcinoma. Radiographics 2022; 42:1338-1357. [PMID: 35776676 DOI: 10.1148/rg.210206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hepatocellular adenomas (HCAs), hepatocellular carcinomas (HCCs), and intrahepatic cholangiocarcinomas (iCCAs) are a highly heterogeneous group of liver tumors with diverse pathomolecular features and prognoses. High-throughput gene sequencing techniques have allowed discovery of distinct genetic and molecular underpinnings of these tumors and identified distinct subtypes that demonstrate varied clinicobiologic behaviors, imaging findings, and complications. The combination of histopathologic findings and molecular profiling form the basis for the morphomolecular classification of liver tumors. Distinct HCA subtypes with characteristic imaging findings and complications include HNF1A-inactivated, inflammatory, β-catenin-activated, β-catenin-activated inflammatory, and sonic hedgehog HCAs. HCCs can be grouped into proliferative and nonproliferative subtypes. Proliferative HCCs include macrotrabecular-massive, TP53-mutated, scirrhous, clear cell, fibrolamellar, and sarcomatoid HCCs and combined HCC-cholangiocarcinoma. Steatohepatitic and β-catenin-mutated HCCs constitute the nonproliferative subtypes. iCCAs are classified as small-duct and large-duct types on the basis of the level of bile duct involvement, with significant differences in pathogenesis, molecular signatures, imaging findings, and biologic behaviors. Cross-sectional imaging modalities, including multiphase CT and multiparametric MRI, play an essential role in diagnosis, staging, treatment response assessment, and surveillance. Select imaging phenotypes can be correlated with genetic abnormalities, and identification of surrogate imaging markers may help avoid genetic testing. Improved understanding of morphomolecular features of liver tumors has opened new areas of research in the targeted therapeutics and management guidelines. The purpose of this article is to review imaging findings of select morphomolecular subtypes of HCAs, HCCs, and iCCAs and discuss therapeutic and prognostic implications. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Venkata S Katabathina
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Lokesh Khanna
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Venkateswar R Surabhi
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Marta Minervini
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Krishna Shanbhogue
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Anil K Dasyam
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
| | - Srinivasa R Prasad
- From the Department of Radiology, University of Texas Health at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 (V.S.K., L.K.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (V.R.S., S.R.P.); Departments of Pathology (M.M.) and Radiology (A.K.D.), University of Pittsburgh Medical Center, Pittsburgh, Pa; and Department of Radiology, NYU Medical Center, New York, NY (K.S.)
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Variant Hepatocellular Carcinoma Subtypes According to the 2019 WHO Classification: An Imaging-Focused Review. AJR Am J Roentgenol 2022; 219:212-223. [PMID: 35170359 DOI: 10.2214/ajr.21.26982] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The 2019 5th edition of the WHO Classification of Digestive System Tumors estimates that up to 35% of hepatocellular carcinomas (HCCs) can be classified as one of eight subtypes defined by molecular characteristics: steatohepatitic, clear cell, macrotrabecular massive, scirrhous, chromophobe, fibrolamellar, neutrophil-rich, and lymphocyte-rich HCC. Due to their distinct cellular and architectural characteristics, these subtypes may not display the classic MRI features of HCC of arterial phase hyperenhancement (APHE) and washout appearance, creating challenges in noninvasively diagnosing such lesions as HCC. Moreover, certain subtypes with atypical imaging features have a worse prognosis than other HCCs. A range of distinguishing imaging features may help raise suspicion that a liver lesion represents one of these HCC subtypes. In this review, we describe the MRI features that have been reported in association with various HCC subtypes according to the 2019 WHO classification, with attention to current understanding of these subtypes' pathologic and molecular bases and relevance to clinical practice. Imaging findings that differentiate the subtypes from benign liver lesions and non-HCC malignancies are highlighted. Familiarity with these subtypes and their imaging features may allow the radiologist to suggest their presence, though histologic analysis remains needed to establish the diagnosis.
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Jain A, Mazer B, Deng Y, Ciarleglio M, Jain D, Taddei T, Zhang X. Hepatocellular Carcinoma: Does the Background Liver With or Without Cirrhosis Matter? Am J Clin Pathol 2022; 157:305-313. [PMID: 34542582 DOI: 10.1093/ajcp/aqab125] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The pathologic differences between hepatocellular carcinoma (HCC) arising in noncirrhotic and cirrhotic livers have not been well studied. METHODS We performed a retrospective analysis of 378 HCC cases (95 in noncirrhotic, 283 in cirrhotic livers) from pathology archives (2010-2017). RESULTS Patients without cirrhosis were more likely to have hepatitis B (13.68% vs 2.83%, P < .001) or no known liver disease (30.53% vs 4.24%, P < .001), while hepatitis C was more common in patients with cirrhosis (65.72% vs 30.53%, P < .001). HCCs in noncirrhotic livers were larger in size (P < .001); were more likely to have a macrotrabecular histologic pattern (13.68% vs 4.95%, P < .01); were more likely to have fibrolamellar (3.16% vs 0%, P = .02), macrotrabecular-massive (13.68% vs 6.01%, P = .03), and clear cell (16.84% vs 6.71%, P < .01) subtypes; have a higher histologic grade (P < .01); be anaplastic tumor cells (P < .001); have a higher rate of vascular invasion (P < .01); and have a higher tumor stage (P = .04). CONCLUSIONS The findings indicate that HCCs in noncirrhotic livers demonstrate a larger tumor size; have a more macrotrabecular histologic pattern; have fibrolamellar, macrotrabecular-massive, and clear cell subtypes; have a higher tumor grade and stage; have a higher rate of vascular invasion; and have more anaplastic tumor cells compared with cirrhotic livers. Further studies to explore different pathways that promote oncogenesis in noncirrhotic livers are needed to better understand the pathogenesis of HCC.
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Affiliation(s)
| | | | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, CT, USA
| | | | | | - Tamar Taddei
- Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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Deng Y, Zhu S, Yan W, Qi L, Chen Z, Ma L. Influence of clear cell carcinoma on the post-hepatectomy prognosis of patients with hepatocellular carcinoma. Future Oncol 2021; 18:543-552. [PMID: 34878322 DOI: 10.2217/fon-2021-0381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The authors aimed to identify factors that independently influence the survival of patients with primary clear cell carcinoma of the liver (PCCCL). Methods: A total of 470 patients with hepatocellular carcinoma were retrospectively analyzed. Multivariate Cox analysis was used to identify potential factors associated with prognosis of PCCCL. Results: Patients with PCCCL showed significantly higher disease-free survival (DFS) and overall survival (OS) compared with patients with non-clear cell hepatocellular carcinoma. Multivariate analysis revealed that AFP level, tumor size, liver cirrhosis and portal vein tumor thrombosis were risk factors for DFS. Tumor size, capsule formation and Ki-67 were risk factors for OS. Satellite nodules acted as a protective factor for DFS and OS. Conclusion: PCCCL is associated with better prognosis in hepatocellular carcinoma. Tumor size and satellite nodules may be independent predictors of OS and DFS.
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Affiliation(s)
- Yongheng Deng
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, China
| | - Shaoliang Zhu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, China
| | - Wen Yan
- Clinical School of Medicine, Jiamusi University, China
| | - Lunan Qi
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, China
| | - Zushun Chen
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, China
| | - Liang Ma
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, China
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10
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Bello HR, Mahdi ZK, Lui SK, Nandwana SB, Harri PA, Davarpanah AH. Hepatocellular Carcinoma With Atypical Imaging Features: Review of the Morphologic Hepatocellular Carcinoma Subtypes With Radiology-Pathology Correlation. J Magn Reson Imaging 2021; 55:681-697. [PMID: 33682266 DOI: 10.1002/jmri.27553] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/17/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the fastest growing cause of cancer death in the United States with the incidence rate more than doubling in 20 years. HCC is unique since a noninvasive diagnosis can be achieved with imaging alone when specific clinical criteria and imaging characteristics are met, obviating the need for tissue sampling. However, HCC is a highly heterogeneous neoplasm. Atypical HCC subtypes vary significantly in their morphology, which can be attributed to specific histologic and molecular features, and can cause deviations from the classic imaging characteristics. The different morphologic subtypes of HCC frequently present a diagnostic challenge for radiologists and pathologists since their imaging and pathologic features can overlap with those of non-HCC malignancies. Identifying an atypical subtype can have important clinical implications. Liver transplant, albeit a scarce and limited resource, is the optimal treatment for conventional HCC, potentially curing both the tumor and the underlying pre-malignant condition. Some HCC subtypes as well as mimickers are associated with unacceptably high recurrence and poor outcome after transplant, and there remains limited data on the role and prognosis of liver transplantation for treatment of rare HCC subtypes. Other subtypes tend to recur later than classic HCC, potentially requiring a different follow-up scheme. This review will discuss the appearance of different HCC subtypes in relation to their histopathologic features. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Hernan R Bello
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Zaid K Mahdi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Shu K Lui
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sadhna B Nandwana
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Peter A Harri
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amir H Davarpanah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Zhang Z, Xie H, Chen P, Cao P. Development and Identification of a Nomogram Prognostic Model for Patients with Primary Clear Cell Carcinoma of the Liver. Med Sci Monit 2020; 26:e919789. [PMID: 31969554 PMCID: PMC6996864 DOI: 10.12659/msm.919789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary clear cell carcinoma of the liver (PCCCL) is an infrequent variant of primary hepatocellular carcinoma (HCC), we retrospectively performed a large population-based cohort study to elucidate the relationships between demographic, carcinoma- and therapy-specific variables and overall survival (OS). MATERIAL AND METHODS The Surveillance, Epidemiology and End Results (SEER) database was queried to extract data on 419 patients with pathologically confirmed PCCCL from 1988 to 2015. A nomogram with good accuracy was formulated to predict long-term survival of PCCCL patients. RESULTS The OS for PCCCL patients was 25.6 months (95% confidence interval [CI]: 22.2-29 months), the overall 1-year, 3-year, and 5-year survival rates were 59.5%, 39.3%, and 29.9%, respectively. Log-rank analysis revealed that there was no statistically significant discrepancy in clinical outcome between PCCCL and common-type HCC after propensity-matched analysis. Multivariate Cox analysis confirmed that larger lesions (>96 mm), distant metastases and elevated alpha-fetoprotein (AFP) levels were independent prognostic factors for undesirable outcome. Conversely, surgery was an independent protective factor (hazard ratio [HR]=0.23, 95% CI 0.17-0.31), which significantly boosted OS by virtually 35 months (47.3 months versus 12.7 months, P<0.001). Radiotherapy or chemotherapy was not associated with OS for PCCCL patients (both P>0.05). The nomogram incorporated 4 independent prognostic factors and its concordance index for predicting survival was 0.761. CONCLUSIONS The prognosis of PCCCL resembled that of common-type HCC. Larger lesions, distant metastases, and enhanced AFP levels were associated with unsatisfactory prognosis. Surgery fulfill favorable prognosis while radiotherapy or chemotherapy exerted no significant effects on survival.
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Affiliation(s)
- Ziying Zhang
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Hui Xie
- Department of Thoracic and Cardiovascular Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China (mainland)
| | - Peng Chen
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Peiguo Cao
- Department of Oncology, Third Xiangya Hospital, Central South University, Changsha, Hunan, China (mainland)
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12
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A case of primary clear cell hepatocellular carcinoma comprised mostly of clear cells. Radiol Case Rep 2019; 14:1377-1381. [PMID: 31695824 PMCID: PMC6823767 DOI: 10.1016/j.radcr.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 01/26/2023] Open
Abstract
Clear cell hepatocellular carcinoma (CHCC) is defined as a tumor which contains more than 50% of clear cells. However, CHCC with more than 90% of clear cells are extremely rare. We report a case of a 65-year-old woman who was found to have a solitary mass, which was histologically diagnosed as clear cell hepatocellular carcinoma composed of 90% or more clear cells. The tumor presented rim arterial phase hyperenhancement in computed tomography, magnetic resonance imaging, and computed tomography during hepatic arteriography, and was classified as LR-M category according to The Liver Imaging Reporting and Data System version 2018(LI-RADS v2018). This tumor may mimic other tumors with similar radiographic features, such as intrahepatic cholangiocellular carcinoma and metastatic tumor.
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Kothadia JP, Kaur N, Arju R, Dakhel M, Giashuddin S. Primary Clear Cell Carcinoma of the Non-cirrhotic Liver Presenting as an Acute Abdomen: a Case Report and Review of the Literature. J Gastrointest Cancer 2019; 48:211-216. [PMID: 27194053 DOI: 10.1007/s12029-016-9831-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Jiten P Kothadia
- Department of Gastroenterology and Hepatology, The University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Navneet Kaur
- Department of Internal Medicine, The Brooklyn Hospital Center, An academic Affiliate of Icahn School of Medicine at Mount Sinai, 121 DeKalb Ave, Brooklyn, NY, 11201, USA
| | - Rezina Arju
- Department of Internal Medicine, The Brooklyn Hospital Center, An academic Affiliate of Icahn School of Medicine at Mount Sinai, 121 DeKalb Ave, Brooklyn, NY, 11201, USA
| | - Mahmoud Dakhel
- Department of Radiology, The Brooklyn Hospital Center, An academic Affiliate of Icahn School of Medicine at Mount Sinai, 121 DeKalb Ave, Brooklyn, NY, 11201, USA
| | - Shah Giashuddin
- Department of Pathology and Laboratory Medicine, The Brooklyn Hospital Center, An academic Affiliate of Icahn School of Medicine at Mount Sinai, 121 DeKalb Ave, Brooklyn, NY, 11201, USA.
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Sun L, Chen H, Xiao Z, Guo W, Lin L. Sunitinib-and-Chinese herbal medicine-based systematic treatment clinically cured a patient with multiple metastatic primary clear cell carcinoma of the liver: a case report. Onco Targets Ther 2019; 12:2823-2828. [PMID: 31043795 PMCID: PMC6469470 DOI: 10.2147/ott.s197923] [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] [Indexed: 12/30/2022] Open
Abstract
Primary clear cell carcinoma of the liver (PCCCL) is a rare and special type of primary hepatocellular carcinoma. However, treatment methods for multiple metastatic PCCCL are lacking. Here, we report the case of a 55-year-old male PCCCL patient with multiple metastatic lesions who was clinically cured by sunitinib-based systematic treatment. This patient was diagnosed with PCCCL in Liver Segment 7, Child–Pugh A liver function, Stage A in November 16, 2009, and received radical excision of the cancer immediately. His disease recurred with multiple metastatic lesions in the liver and other parts of the body, including the retroperitoneal lymph nodes, lung and bilateral adrenal nodules in June 29, 2012. The biopsy results showed that the lung mass was lung metastasis of PCCCL. With Child–Pugh A liver function, Stage C of PCCCL was diagnosed. Sunitinib (37.5 mg, oral, once a day [qd]) in combination with Chinese herbal medicine (CHM) was given. The tumor size steadily reduced, and the lesions were no longer obvious in May 21, 2014. The patient had multiple metastases and is in complete response (CR) state until now. He is considered as clinically cured. From the initial diagnosis of PCCCL, the survival period reached 8 years.
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Affiliation(s)
- Lingling Sun
- Oncology Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China, .,Integrative Medicine Department, First Clinical School, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China,
| | - Hanrui Chen
- Oncology Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China, .,Integrative Medicine Department, First Clinical School, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China,
| | - Zhiwei Xiao
- Oncology Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China, .,Integrative Medicine Department, First Clinical School, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China,
| | - Wei Guo
- Integrative Medicine Department, First Clinical School, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China,
| | - Lizhu Lin
- Oncology Department, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China, .,Integrative Medicine Department, First Clinical School, Guangzhou University of Chinese Medicine, Guangdong, People's Republic of China,
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15
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Xu W, Ge P, Liao W, Ren J, Yang H, Xu H, Sang X, Lu X, Zhong S, Mao Y. Edmondson grade predicts survival of patients with primary clear cell carcinoma of liver after curative resection: A retrospective study with long-term follow-up. Asia Pac J Clin Oncol 2016; 13:e312-e320. [PMID: 27098441 DOI: 10.1111/ajco.12494] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 02/19/2016] [Accepted: 03/13/2016] [Indexed: 12/13/2022]
Abstract
AIM Primary clear cell carcinoma of liver (PCCCL) is a specific and rare subtype of primary hepatocellular carcinoma (HCC). We performed a retrospective study with long-term follow-up to investigate predictive factors and prognosis of intrahepatic recurrences of PCCCL after radical resection. METHODS We retrospectively analyzed records of 38 patients with PCCCL who were diagnosed at Peking Union Medical College Hospital between January 1989 and September 2010, with a long-term follow up to January 2015, to determine their clinical characteristics and postoperative survival. The data were compared with 400 patients received radical hepatectomy for common type hepatocellular carcinoma (CHCC) during the study period. RESULTS PCCCL tumors were smaller than those of CHCC (P < 0.001) and the incidence of vascular invasion of tumors in PCCCL group was significantly lower than that in CHCC (P = 0.029). The 1-, 3-, and 5-year overall survival (OS) for PCCCL patients were 94.6%, 67.3%, and 58.5%, respectively; 1-, 3-, and 5-year disease-free survival (DFS) were 89.2%, 54.1%, and 48.6%, respectively. Both OS and DFS were significantly better for PCCCL patients than for CHCC (P = 0.039 and 0.044). Cox modeling showed high Edmondson grade to be the only independent predictive factor for survival of PCCCL patients, which were different from those of CHCC. CONCLUSIONS PCCCL is a less malignant subtype of HCC than CHCC, patients with PCCCL likely have later intrahepatic recurrences and a better prognosis. Edmondson grade predicts survival of patients with PCCCL after curative resection; those with higher Edmondson grades may require more careful follow-up and aggressive post-hepatectomy therapy.
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Affiliation(s)
- Wei Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Penglei Ge
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenjun Liao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinjun Ren
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huayu Yang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinting Sang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Lu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shouxian Zhong
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhang W, Wang Q, Jiang YX, Lu Q, Yu WJ, Liu Y, Liu YL, Zhao H, Zhuang J, Li YJ. Simultaneous double primary clear cell carcinomas of liver and kidney: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:995-999. [PMID: 25755808 PMCID: PMC4348813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/02/2014] [Indexed: 06/04/2023]
Abstract
Reported herein are simultaneous double primary clear cell carcinomas arising from liver and kidney. A 63-year-old man underwent a partial wedge nephrectomy of the right kidney in a surgical resection for hepatocellular carcinoma. Coincidently, on histology the tumors in liver and kidney were consisted of clear cancer cells, which arranged in haphazardly intermixed pattern without capsules. Immunohistochemically, the clear neoplastic cells in the liver were positive for HepPar-1, GPC3, and negative for nephrogenic markers; however, renal clear neoplastic cells were positive for CD10, RCC and Pax-8, but negative to liver-derived markers. These findings led to the diagnosis of simultaneous double primary clear cell carcinomas of kidney and liver. Multiple primary carcinomas of kidney and liver, especially both are primary clear cell carcinomas, are extremely rare neoplasms, only 1 case has been reported previously until now. To our knowledge, this is a report of multiple primary carcinomas arising from the liver and kidney and reminders us of differentiation diagnosis with carcinoma metastasis.
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Affiliation(s)
- Wei Zhang
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Qiang Wang
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Yan-Xia Jiang
- Department of Pathology, Affiliated Hospital of Medical College, Qingdao UniversityQingdao 266003, China
| | - Qing Lu
- Medical Affairs Department, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Wen-Juan Yu
- Medical Affairs Department, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Yan Liu
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Yu-Lin Liu
- Department of Clinical Laboratory, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Hui Zhao
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Jie Zhuang
- Department of Pathology, 401 Hospital of People’s Liberation ArmyQingdao 266071, China
| | - Yu-Jun Li
- Department of Pathology, Affiliated Hospital of Medical College, Qingdao UniversityQingdao 266003, China
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17
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Wang H, Tan B, Zhao B, Gong G, Xu Z. CT findings of primary clear cell carcinoma of liver: with analysis of 19 cases and review of the literature. ACTA ACUST UNITED AC 2014; 39:736-43. [PMID: 24549879 DOI: 10.1007/s00261-014-0104-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To analyze CT characteristics of primary clear cell carcinoma of the liver (PCCCL) and improve the current understanding and diagnose accuracy of the tumor. METHODS Pre- and post-contrast CT images of 19 patients with pathology proven PCCCL were retrospectively analyzed. The clinical data and CT findings as well as relevant literature reports were reviewed. RESULTS Thirteen patients were tested positive for HBsAg, and two patients were positive for HCVAb. The serum alpha-fetoprotein (AFP) levels of most tumors (14/19) were ≤20 ng/ml with 14 cases were associated with liver cirrhosis. All lesions were solitary intraparenchymal mass lesions which have well-defined boarders. On pre-contrast CT scans, 15 lesions appeared as hypo-attenuation and four lesions appeared as isointensity to the adjacent liver parenchyma. On post-contrast CT scans, 16 lesions showed avid enhancement on the hepatic arterial phase, of which 6 lesions were hypo-attenuation, and 10 lesions remained slightly hyper-attenuation or iso-attenuation on the portal venous phase images. Three lesions showed only mild enhancement on the hepatic arterial phase and hypo-attenuation on the portal venous phase. All lesions demonstrated hypointensity on the equilibrium phase. There are 12 lesions showed pseudocapsules. None of patients showed signs of portal vein thrombosis. There was no distal metastasis except only one patient had lymph node metastasis. CONCLUSION The characteristics of CT imaging of PCCCL, such as tend to form pseudocapsules and less involved with vascular invasion, could be useful in differentiating from common type hepatocellular carcinoma (CHCC). Some CT imaging characteristics of PCCCL are similar to CHCC, such as prone to occur in patients with liver cirrhosis and early enhancement pattern on the hepatic arterial phase as well as hypo-attenuation on the equilibrium phase. Those features could be useful in differentiating PCCCL from other liver tumors, such as hemangioma and hepatic metastases.
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Affiliation(s)
- Haiyan Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jingwu Road No.324, Jinan, People's Republic of China, 250021
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Xun Q, Li Y, Yang H, Li J, Hu C. Metastatic hepatic clear cell carcinoma presenting as lump in the hilum of the lung: a case report and review of the literature. J Thorac Dis 2014; 5:E232-5. [PMID: 24416522 DOI: 10.3978/j.issn.2072-1439.2013.11.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/22/2013] [Indexed: 11/14/2022]
Abstract
We report a case of a 52-year-old Chinese woman with a history of primary hepatic cell carcinoma who presented with chest pain, cough, expectoration and bloody phlegm. Chest computer tomography (CT) revealed a 6.2 cm × 6.8 cm shallow lobulated irregular shaped mass in the hilum of the right lung. Bronchoscopy and CT guided lung biopsy was performed. Histopathological and immunohistochemical examinations of biopsies revealed the diagnosis of lung metastatic hepatic clear cell carcinoma. This case is thought to be extremely rare.
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Affiliation(s)
- Qiufen Xun
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuanyuan Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Huaping Yang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jingxia Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
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Chishima F, Kato-Suzuki E, Ichikawa G, Hayashi C, Ohni S, Yamamoto T. Rare case of primary peritoneal pregnancy infiltrated into the Gerota's fascia of the right kidney. J Obstet Gynaecol Res 2012; 39:1073-6. [DOI: 10.1111/j.1447-0756.2012.02057.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 09/18/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Fumihisa Chishima
- Department of Obstetrics and Gynecology; Nihon University School of Medicine; Tokyo; Japan
| | - Erina Kato-Suzuki
- Department of Obstetrics and Gynecology; Nihon University School of Medicine; Tokyo; Japan
| | - Go Ichikawa
- Department of Obstetrics and Gynecology; Nihon University School of Medicine; Tokyo; Japan
| | - Chuyu Hayashi
- Department of Obstetrics and Gynecology; Nihon University School of Medicine; Tokyo; Japan
| | - Sumie Ohni
- Department of Pathology; Nihon University School of Medicine; Tokyo; Japan
| | - Tatsuo Yamamoto
- Department of Obstetrics and Gynecology; Nihon University School of Medicine; Tokyo; Japan
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Rare hepatic malignant tumors: dynamic CT, MRI, and clinicopathologic features: with analysis of 54 cases and review of the literature. ACTA ACUST UNITED AC 2012; 38:511-26. [DOI: 10.1007/s00261-012-9918-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Kida K, Oida T, Mimatsu K, Kano H, Kawasaki A, Fukino N, Kuboi Y. Hand-assisted laparoscopic hepatectomy for primary clear cell hepatocellular carcinoma of the liver. Case Rep Gastroenterol 2012; 6:328-32. [PMID: 22754494 PMCID: PMC3383238 DOI: 10.1159/000339460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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 a case of primary clear cell hepatocellular carcinoma of the liver (PCCCL) for which we performed hand-assisted laparoscopic hepatectomy. A 71-year-old female with hepatitis C infection and diabetes mellitus was admitted to our department for a hepatic tumor with gallstone. Abdominal computed tomography revealed a tumor 25 mm in diameter on the surface in segment 5 of the liver. The imaging results suggested small hepatocellular carcinoma located on the surface in segment 5 of the liver, and we performed laparoscopic surgery aiming at a minimally invasive procedure. We performed laparoscopic cholecystectomy and hand-assisted laparoscopic hepatectomy. Histopathological findings showed moderately differentiated hepatocellular carcinoma, and as the proportion of clear cells was 75%, the tumor was diagnosed as PCCCL. This is the first report of hand-assisted laparoscopic hepatectomy for PCCCL. Laparoscopic hepatectomy is a useful minimally invasive surgical procedure when the tumor is located on the surface of the liver.
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Affiliation(s)
- Kazutoshi Kida
- Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan
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