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Akbar N, Adeel M, Tasneem AA, Sanjani SR, Khan SA, Majid Z, Luck N. Ectopic Hepatocellular Carcinoma Manifesting as Paraspinal Mass: An Unusual Entity. ACG Case Rep J 2023; 10:e01160. [PMID: 37799483 PMCID: PMC10550042 DOI: 10.14309/crj.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- Nishat Akbar
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Pakistan
| | - Muhammad Adeel
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Pakistan
| | - Abbas Ali Tasneem
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Pakistan
| | - Shahrukh Reza Sanjani
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Pakistan
| | - Shoaib Ahmed Khan
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Pakistan
| | - Zain Majid
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Pakistan
| | - Nasir Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Pakistan
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Ahn KH, Ryu HS, Han MS, Choi YD, Joo SP. Spontaneous Acute Epidural Hematoma Associated With Metastatic Hepatocellular Carcinoma: A Case Report. Korean J Neurotrauma 2023; 19:384-392. [PMID: 37840619 PMCID: PMC10567519 DOI: 10.13004/kjnt.2023.19.e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/31/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023] Open
Abstract
Spontaneous acute epidural hematoma (AEDH) co-occurring with metastatic hepatocellular carcinoma (HCC) of the skull is rare, with only 7 documented cases in existing literature. This report describes the case of a 42-year-old man who presented with decreased consciousness following intermittent headaches following minor head trauma. Computed tomography imaging revealed an AEDH, prompting surgical intervention. Despite preliminary assumptions linking the causes of the trauma, surgical exploration revealed no evidence of traumatic injury. Instead, an infiltrative soft-tissue mass within the skull was identified. Histopathological examination confirmed that the mass was a metastatic HCC. Despite the successful hematoma evacuation, the patient's neurological status did not improve. This case underscores the importance of considering metastatic disease in the differential diagnosis of AEDH, particularly in patients with a history of malignant tumors, irrespective of prior indications of bone metastasis. Furthermore, it emphasizes the need to enhance diagnostic and therapeutic strategies for such complex cases.
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Affiliation(s)
- Kang hee Ahn
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Han Seung Ryu
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Yoo Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea
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Hendi Z, Asadi Sarabi P, Hay D, Vosough M. XBP1 as a novel molecular target to attenuate drug resistance in hepatocellular carcinoma. Expert Opin Ther Targets 2023; 27:1207-1215. [PMID: 38078890 DOI: 10.1080/14728222.2023.2293746] [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: 09/13/2023] [Accepted: 12/07/2023] [Indexed: 12/31/2023]
Abstract
INTRODUCTION Despite improvements in clinical management of hepatocellular carcinoma (HCC), prognosis remains poor with a 5-year survival rate less than 40%. Drug resistance in HCC makes it challenging to treat; therefore, it is imperative to develop new therapeutic strategies. Higher expression of X-box binding protein 1 (XBP1) in tumor cells is highly correlated with poor prognosis. In tumor cells, XBP1 modulates the unfolded protein response (UPR) to restore homeostasis in endoplasmic reticulum. Targeting XBP1 could be a promising therapeutic strategy to overcome HCC resistance and improve the survival rate of patients. AREAS COVERED This review provides the recent evidence that indicates XBP1 is involved in HCC drug resistance via DNA damage response, drug inactivation, and inhibition of apoptosis. In addition, the potential roles of XBP1 in inducing resistance in HCC cells were highlighted, and we showed how its inhibition could sensitize tumor cells to controlled cell death. EXPERT OPINION Due to the diversity in molecular mechanism of multidrug-resistance, targeting one specific pathway is inadequate. XBP1 inhibition could be a potential therapeutic target to overcome verity of resistance mechanisms. The main function of this transcription factor in HCC treatment response is an attractive area for further studies and should be discussed more.
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Affiliation(s)
- Zahra Hendi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
- Department of Animal Biology-Cell and Developmental, Faculty of Basic Sciences and Advanced Technologies in Biology, University of Science and Culture, Tehran, Iran
| | - Pedram Asadi Sarabi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
| | - David Hay
- Centre for Regenerative Medicine, Institute for Regeneration and Repair, The University of Edinburgh, Edinburgh BioQuarter, Edinburgh, UK
| | - Massoud Vosough
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
- Experimental Cancer Medicine, Institution for Laboratory Medicine, Karolinska Institutet and Karolinska University Hospital-Huddinge, Huddinge, Sweden
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John AR, Dwivedi S, Varghese J, Walia GK. Metastatic Hepatocellular Carcinoma Masquerading as an Expansile Osteolytic Lesion in Scapula: A Rare Case of Isolated Appendicular Skeletal Metastatic Involvement of Hepatocellular Carcinoma at Initial Presentation. World J Nucl Med 2023; 22:55-58. [PMID: 36923980 PMCID: PMC10010855 DOI: 10.1055/s-0042-1757288] [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] [Indexed: 03/18/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is known to be the most common primary tumor of the liver and is also the fifth most common cancer in the world. Chronic hepatitis B and C along with type 2 diabetes mellitus and alcoholic liver disease are quite well-known risk factors for HCC, and it is uncommon in the noncirrhotic liver. HCC favors spreading as multifocal intrahepatic lesions and potential vascular invasion, and extrahepatic spread is uncommon. Skeletal metastasis from HCC occurs infrequently compared to other cancers and is common in the axial skeleton. Metastatic involvement of the appendicular skeleton is a rare entity, and the initial presentation of HCC as metastatic involvement of the appendicular skeleton is even rarer. We report a case of HCC with incidentally detected cirrhosis and chronic hepatitis B infection presenting with pain in the left shoulder.
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Affiliation(s)
- Arun Ravi John
- Department of Nuclear Medicine, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Surjeet Dwivedi
- Department of Surgical Oncology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Jeenu Varghese
- Department of Pathology, Command Hospital Air Force, Bengaluru, Karnataka, India
| | - Gurpreet Kaur Walia
- Department of Pathology, Command Hospital Air Force, Bengaluru, Karnataka, India
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Akutsu N, Kawakami Y, Numata Y, Hirano T, Wagatsuma K, Ishigami K, Sasaki S, Nakase H. A case of hepatocellular carcinoma with long-term survival by multidisciplinary treatment for cranial and skeletal muscle metastases. Clin J Gastroenterol 2022; 15:960-967. [DOI: 10.1007/s12328-022-01669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
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KOUTSERIMPAS C, DARGARAS N, NAOUM S, ARKOUDIS NA, BAFALOUKOS D, KOUREA H, SAMONIS G. Soleus Muscle Single Metastasis from Hepatocellular Carcinoma. MAEDICA 2022; 17:714-719. [PMID: 36540597 PMCID: PMC9720651 DOI: 10.26574/maedica.2022.17.3.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Extrahepatic metastases of hepatocellular carcinoma (HCC) are associated with poor prognosis, while such lesions in skeletal muscles are extremely rare. A unique case of skeletal metastasis in the soleus muscle in a 76-year-old male patient with HCC is reported. The patient presented with a painful palpable mass in his left calf. Magnetic resonance imaging (MRI) revealed a contrast-enhancing lesion in the soleus muscle, while core needle biopsy showed metastatic lesion from the HCC. Due to the poor overall condition of the patient, no further treatment was performed, while he passed away three months later. Hepatocellular carcinoma represents an aggressive tumor, with poor prognosis, especially in cases of extra-hepatic metastases. Such lesions have a reported incidence of about 15%. Extra-hepatic metastasis to the skeletal muscles is extremely rare, with only 21 more such cases reported in the literature so far. No clear therapeutic strategies exist for such cases. Thus, it is of utmost importance to detect similar cases in early stages for a possible better prognosis and clearer understanding of the therapeutic options, including surgical and loco-regional treatments.
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Affiliation(s)
- Christos KOUTSERIMPAS
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Greece
| | - Nikolaos DARGARAS
- Department of Anesthesiology, “251” Hellenic Air Force General Hospital of Athens, Greece
| | - Symeon NAOUM
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Greece
| | | | | | - Helen KOUREA
- Department of Pathology, University of Patras School of Medicine, Patras, Greece
| | - George SAMONIS
- First Oncology Department, Metropolitan Hospital, Neon Faliron, Athens, Greece,Department of Medicine, University of Crete, Heraklion, Greece
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Nakayama A, Arai J, Otoyama Y, Sugiura I, Nakajima Y, Kajiwara A, Ichikawa Y, Uozumi S, Shimozuma Y, Uchikoshi M, Sakaki M, Tazawa S, Shiozawa E, Yamochi T, Takimoto M, Yoshida H. Muscular Metastasis of Hepatocellular Carcinoma: Case Report and Literature Review. Intern Med 2022; 61:189-196. [PMID: 34219106 PMCID: PMC8851169 DOI: 10.2169/internalmedicine.7200-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are few case reports of hepatocellular carcinoma (HCC) metastasis to the skeletal muscle. A 78-year-old man developed a mass in the right shoulder. Washout of contrast medium during contrast-enhanced ultrasonography (CEUS) in both the primary HCC and the metastatic site was detected. Several nodules were scattered throughout the liver on an autopsy. In addition, the moderately differentiated HCC had metastasized to the right teres major muscle. Rare muscular metastasis should be considered if a hepatic tumor is moderately or poorly differentiated HCC. Early washout during CEUS is consistent with a pathological diagnosis of moderately or poorly differentiated HCC.
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Affiliation(s)
- Akihiro Nakayama
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Jun Arai
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Yumi Otoyama
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Ikuya Sugiura
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Yoko Nakajima
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Atsushi Kajiwara
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Yuki Ichikawa
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Shojiro Uozumi
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Yuu Shimozuma
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Manabu Uchikoshi
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Masashi Sakaki
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Sakiko Tazawa
- Division of Pathology, Department of Medicine, Showa University School of Medicine, Japan
| | - Eisuke Shiozawa
- Division of Pathology, Department of Medicine, Showa University School of Medicine, Japan
| | - Toshiko Yamochi
- Division of Pathology, Department of Medicine, Showa University School of Medicine, Japan
| | - Masafumi Takimoto
- Division of Pathology, Department of Medicine, Showa University School of Medicine, Japan
| | - Hitoshi Yoshida
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
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Targe M, Yasam VR, Nagarkar R. Hepatocellular carcinoma with uncommon sites of metastasis: a rare case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00612-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hepatocellular carcinoma (HCC) is a highly malignant tumor, causing both intrahepatic and extrahepatic metastases. The extrahepatic metastasis occurs in one-third of patients with HCC and it is associated with a poor prognosis. The most common sites of extrahepatic metastasis are lung, regional lymph nodes, bone, adrenal glands, and peritoneum/omentum. Detection of such extrahepatic metastasis plays a vital role in the staging and treatment planning of HCC.
Case presentation
A 60-year-old man was presented to our centre with loss of apetite, generalised weakness, and weight loss. Abdominal examination revealed a firm lump in the right hypochondrium. CT findings revealed a large well-defined hypodense mass in almost entire right lobe of the liver. A well-defined oval, heterogeneously enhancing soft tissue mass lesions were also noted in both adrenal glands and psoas muscles. For histopathological diagnosis, percutaneous ultrasound-guided truecut biopsy was done from right lobe liver mass confirming well differentiated HCC.
Conclusions
In the present case report, we present an extremely rare and unique case of HCC with disseminated skeletal muscle metastasis with concomitant bilateral axillary lymph node metastasis. It is crucial for radiologists to detect such extrahepatic sites of metastasis initially at the time of diagnosis for accurate staging and treatment planning for a better prognosis.
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Boldo E, Santafe A, Mayol A, Lozoya R, Coret A, Escribano D, Fortea-Sanchis C, Muñoz A, Pastor JC, Perez de Lucia G, Bosch N. Rare Site Hepatocellular Carcinoma Metastasis. J Hepatocell Carcinoma 2020; 7:39-44. [PMID: 32274362 PMCID: PMC7104197 DOI: 10.2147/jhc.s238963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/25/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Besides more common sites such as lung or peritoneum, hepatocellular carcinoma (HCC) can metastatize to rare sites. We report herein a new metastatic site of HCC: the nail-bed. We also review other recently reported rare site HCC metastases (RSHM). Case Report A 66-year-old woman with a 12-year history of resected-stage IA HCC who later presented lung, spleen and brain metastases treated with surgery, systemic therapies (sorafenib, sunitinib, capecitabine) and radiotherapy. The patient was referred to us because of a painful and rapidly evolving mass in the nail-bed of the left thumb. Biopsy confirmed nail-bed HCC metastasis, and the finger was amputated. The patient died few weeks later. Conclusion This case was an opportunity for us to review RSHM. This type of metastasis seems to be an early event, in the context of advanced stage HCC with elevated protein induced by vitamin K absence-II (PIVKA II). The Lee nomogram is useful in detecting patients at high risk of developing RSHM. We would suggest insisting on systemic treatment in these metastatic patients although overall survival after RSHM diagnosis is poor.
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Affiliation(s)
- Enrique Boldo
- Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
| | - Ana Santafe
- Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
| | - Araceli Mayol
- Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
| | - Rafael Lozoya
- Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
| | - Alba Coret
- Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
| | - Diana Escribano
- Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
| | - Carlos Fortea-Sanchis
- Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
| | - Andres Muñoz
- Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
| | - Juan Carlos Pastor
- Department of Surgery, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
| | | | - Nuria Bosch
- Pathology Department, Consorcio Hospitalario Provincial de Castellon, Castellon, Spain
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Chan S, Leow WQ. Sudden Collapse due to Medullary and Cervical Cord Infarction-An Unusual Presentation of Hepatocellular Carcinoma. J Forensic Sci 2018; 64:925-929. [PMID: 30352122 DOI: 10.1111/1556-4029.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/11/2018] [Accepted: 09/26/2018] [Indexed: 11/29/2022]
Abstract
Hepatocellular carcinoma (HCC) is a common cancer worldwide with a great potential for metastatic spread. Hepatocellular carcinoma often arises in people with underlying viral hepatitides or liver cirrhosis and may present in various ways including abdominal pain, liver mass, and signs of hepatocellular decompensation. Many tumors may have metastasized to other organs such as the lungs, lymph nodes, bone, and adrenal glands at the time of diagnosis. However, it is uncommon for HCC to present purely due to its metastasis, such as spinal cord compression from vertebral metastasis. Here, an unusual presentation of a sudden cardiovascular collapse due to medullary and cervical cord infarction from compression of the cervical cord is presented. The importance of clinical investigations, the usefulness of postmortem computed tomography scans, and the examination of the cervical spine and cervical cord in people with no obvious cause of death after standard autopsy procedures are emphasized.
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Affiliation(s)
- Shijia Chan
- Forensic Medicine Division, Health Sciences Authority, 11 Outram Road, Singapore, 169078, Singapore
| | - Wei Qiang Leow
- Department of Anatomical Pathology, Singapore General Hospital, 20 College Road, Singapore, 169856, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
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Solitary Extrahepatic Intramuscular Metastasis from Cryptogenic Hepatocellular Carcinoma. ACG Case Rep J 2018; 5:e64. [PMID: 30238018 PMCID: PMC6137291 DOI: 10.14309/crj.2018.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/25/2018] [Indexed: 11/17/2022] Open
Abstract
Although hepatocellular carcinoma (HCC) recurrence after curative resection is not uncommon, it primarily recurs in the liver prior to metastatic progression. We report a case of resected pT2N0 cryptogenic HCC that recurred in the superior paracervical musculature without evident intrahepatic recurrence. The patient also developed cervical spine instability requiring urgent neurosurgery. Cryptogenic HCC is thought to arise from non-alcoholic fatty liver disease even without cirrhosis. Unfortunately, it also portends a worse prognosis compared to HCC of other etiologies. This highlights the aggressive behavior of cryptogenic HCC, which warrants further research as non-alcoholic fatty liver disease becomes increasingly common.
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Isolated Peritoneal Recurrence After Liver Resection for Hepatocellular Carcinoma. J Gastrointest Cancer 2018; 50:678-680. [PMID: 29740789 DOI: 10.1007/s12029-018-0113-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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