Appearance Of Hepatocellular Carcinoma Research Articles

Seven gene signature explores the impact of DAAs on the appearance of hepatocellular carcinoma in HCV infected patients

HCV damages the hepatocytes ending with hepatocellular carcinoma (HCC). The direct-acting antivirals (DAAs) treatment has raised hopes for reducing the incidence of HCC. However, several scientific debate regarding the impact of DAAs on the occurrence of HCC in patients with cirrhosis. We aimed to study the Cirrhosis Risk Score (CRS), several clinical factors and tumor characteristics between patients who developed HCC either with or without DAAs treatment “DAA-exposed HCC patients” and “DAA-unexposed HCC patients”. MethodsCRS was assessed via genotyping by allelic discrimination assays in HCV patients who developed de novo HCC (with DAAs (DAA-exposed HCC patients, n = 50), and without DAAs treatment (DAA-unexposed HCC patients, n = 40)). APRI, FIB-4 scores, and tumor characteristics were assessed. ResultsAround 60% and 48% of DAA-exposed HCC patients and DAA-unexposed HCC patients; respectively had high CRS scores without significant difference. DAA-exposed HCC patients showed elevated Albumin, Hemoglobin and decreased ALT, AST compared with DAA-unexposed HCC patients (P = 0.002, 0.04, <0.001 and 0.006; respectively). FIB4 and APRI didn't reach the statistical difference between the studied groups. DAA-exposed HCC patients have higher overall survival (OS) than DAA-unexposed HCC patients (median: 30 & 15 months; respectively (p = 0.019)). Moreover, no significant differences were observed between the two groups in their focal lesion characteristics. ConclusionAll studied patients are genetically predisposed to develop HCC. Moreover, DAAs significantly improved the OS and the biochemical parameters. No differences between the two groups were detected regarding their tumor characteristics. Accordingly, the appearance of HCC after treatment is attributed to the natural course of cirrhosis.

Seven Gene Signature Explores the Impact of DAAs on the Appearance of Hepatocellular Carcinoma in HCV Infected Patients

Seven Gene Signature Explores the Impact of DAAs on the Appearance of Hepatocellular Carcinoma in HCV Infected Patients

Hepatic Metastasis from Hepatoid Adenocarcinoma of the Stomach Mimicking Hepatocellular Carcinoma: Diagnostic Challenge

Hepatoid adenocarcinoma (HAC) is a unique type of extrahepatic adenocarcinoma that histologically mimics the appearance of hepatocellular carcinoma (HCC). Hepatoid adenocarcinoma of the stomach has a poor prognosis with increased potential for liver metastasis. HCC and HAC share clinicopathological and immunohistochemical features. The diagnosis of metastatic hepatoid adenocarcinoma to the liver is challenging. It is often misdiagnosed as hepatocellular carcinoma. The diagnostic dilemma is more

Understanding the Role of Perilipin 5 in Non-Alcoholic Fatty Liver Disease and Its Role in Hepatocellular Carcinoma: A Review of Novel Insights.

Consumption of high-calorie foods, such as diets rich in fats, is an important factor leading to the development of steatohepatitis. Several studies have suggested how lipid accumulation creates a lipotoxic microenvironment for cells, leading cells to deregulate their transcriptional and translational activity. This deregulation induces the development of liver diseases such as non-alcoholic fatty liver disease (NAFLD) and subsequently also the appearance of hepatocellular carcinoma (HCC) which is one of the deadliest types of cancers worldwide. Understanding its pathology and studying new biomarkers with better specificity in predicting disease prognosis can help in the personalized treatment of the disease. In this setting, understanding the link between NAFLD and HCC progression, the differentiation of each stage in between as well as the mechanisms underlying this process, are vital for development of new treatments and in exploring new therapeutic targets. Perilipins are a family of five closely related proteins expressed on the surface of lipid droplets (LD) in several tissues acting in several pathways involved in lipid metabolism. Recent studies have shown that Plin5 depletion acts protectively in the pathogenesis of liver injury underpinning the importance of pathways associated with PLIN5. PLIN5 expression is involved in pro-inflammatory cytokine regulation and mitochondrial damage, as well as endoplasmic reticulum (ER) stress, making it critical target of the NAFLD-HCC studies. The aim of this review is to dissect the recent findings and functions of PLIN5 in lipid metabolism, metabolic disorders, and NAFLD as well as the progression of NAFLD to HCC.

Assessment of factors affecting washout appearance of hepatocellular carcinoma on CT.

To identify independent imaging and histopathologic factors that affect washout appearance of hepatocellular carcinoma (HCC) in CT images. This retrospective study included 264 patients who had undergone surgical resection for treatment-naïve single HCC between January 2014 and December 2015 and had available preoperative multiphasic CT images. Two reviewers evaluated the CT imaging features of HCC using LI-RADS v2018. The "washout" was visually assessed in portal venous or equilibrium phases. Depending on the presence of washout appearance of HCC, all patients were divided into "washout" (n = 228) and "no washout" (n = 36) groups. Multivariable logistic regression analysis was used to identify factors associated with the absence of washout appearance of HCC. A total of 264 HCCs (median size, 2.6 cm) were analyzed. Histologically proven hepatic steatosis (macrovesicular steatosis ≥ 5%) (odds ratio [OR], 2.65; 95% confidence interval [CI], 1.05-6.74; p = 0.040), tumor capsule on histopathology (OR, 0.17; 95% CI, 0.06-0.50; p = 0.001), and mosaic appearance on CT image (OR, 0.34; 95% CI, 0.14-0.85; p = 0.021) were independent factors associated with the absence of washout appearance of HCC. In 189 patients with available unenhanced CT images, CT-diagnosed hepatic steatosis was also an independent factor for the absence of washout appearance of HCC (OR, 9.26; 95% CI, 3.06-28.02; p < 0.001). Washout appearance of HCC in CT images could be obscured in both histologically proven hepatic steatosis and CT-diagnosed hepatic steatosis, and could be enhanced with tumor capsule on histopathology and mosaic appearance on CT image. • Hepatic steatosis is an independent factor related to the absence of washout appearance of hepatocellular carcinoma in CT images, in both histologically proven hepatic steatosis and CT-diagnosed hepatic steatosis. • Both histologically proven hepatic steatosis and CT-diagnosed hepatic steatosis have higher odds of absence of washout appearance of hepatocellular carcinoma compared to non-steatotic liver. • Tumor capsule on histopathology and mosaic appearance on CT image are independent factors that enhance the probability that washout appearance of hepatocellular carcinoma is visible.

Radiological appearance of hepatocellular carcinoma predicts the response to trans-arterial chemoembolization in patients undergoing liver transplantation

BackgroundThe ultimate goal of locoregional therapy (LRT) to the liver is to induce total tumor necrosis. Trans-arterial chemoembolization (TACE) is the mainstay bridging therapy for patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT). However, tumor response rate is variable. The purpose of this study was to correlate HCC radiological appearance with level of tumor necrosis during explant analysis from patients undergoing LT who received pre-LT TACE.MethodsFrom January 2000 to December 2018, a total of 66 patients with HCC who had been treated prior to LT by means of TACE were analyzed. Diagnosis of HCC was made based on AASLD guidelines and confirmed via histopathology explant analysis. Radiologic tumor response after TACE was based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Degree of tumor necrosis was determined by histopathology analysis of liver explants. HCC radiological appearances on CT before TACE were assessed and correlated with histological findings after LT.ResultsEighty nine TACE procedures (1.35 ± 0.67; 1–4) were performed, of which 18 were repeated TACE (27.3%) procedures. In 56.1% of the patients, ≥90% (near-complete) tumor necrosis was achieved. Concordance between mRECIST criteria and pathology was observed in 63% of the patients, with an underestimation of tumor response in 18 (27%) patients and an overestimation in 6 (9.1%). Near-complete tumor necrosis upon pathological analysis was associated with tumor hyper-enhancement in the arterial phase (P = 0.002), “typical tumor enhancement” (P = 0.010) and smooth tumor margins (p = 0.011). The multivariate analysis showed that well circumscribed HCCs with smooth margins and arterial hyper-enhancement independently correlated with post-TACE near-complete histological tumor necrosis.ConclusionsThe well circumscribed HCC lesions with arterial hyper-enhancement are more susceptible to TACE than lesions with arterial phase iso or hypo-enhancement and lesions with infiltrative appearance. Pre-TACE CT imaging may ease the selection of an optimal treatment strategy for bridging patients with HCC to liver transplantation.

Atypical Appearance of Hepatocellular Carcinoma and Its Mimickers: How to Solve Challenging Cases Using Gadoxetic Acid-Enhanced Liver Magnetic Resonance Imaging.

Hepatocellular carcinoma (HCC) can be diagnosed noninvasively with contrast-enhanced dynamic computed tomography, magnetic resonance imaging, or ultrasonography on the basis of its hallmark imaging features of arterial phase hyperenhancement and washout on portal or delayed phase images. However, approximately 40% of HCCs show atypical imaging features, posing a significant diagnostic challenge for radiologists. Another challenge for radiologists in clinical practice is the presentation of many HCC mimickers such as intrahepatic cholangiocarcinoma, combined HCC-cholangiocarcinoma, arterioportal shunt, and hemangioma in the cirrhotic liver. The differentiation of HCCs from these mimickers on preoperative imaging studies is of critical importance. Hence, we will review the typical and atypical imaging features of HCCs and the imaging features of its common mimickers. In addition, we will discuss how to solve these challenges in practice.

The capsule appearance of hepatocellular carcinoma in gadoxetic acid-enhanced MR imaging: Correlation with pathology and dynamic CT.

This study aimed to evaluate the capability of gadoxetic acid-enhanced MR (GAeMR) to detect presence of capsule appearance in hepatocellular carcinoma (HCC), and to correlate it with dynamic computed tomography (CT) and pathological features.Sixty-three patients (54: 9 = M: F, mean age 55.8) surgically confirmed HCCs with preoperative CT and GAeMR were included in this retrospective study. Two readers evaluated presence of capsule appearances on CT and GAeMR images in each phase including precontrast (Pre), portal phase (PP), delayed phase (DP), transitional phase (TP), and hepatobiliary phase (HBP). Histologic capsule was compared with CT and GAeMR. Diagnostic performance of CT and GAeMR of each phase for histologic capsule was evaluated and compared by receiver operating characteristic curve. Interobserver agreement was assessed with kappa statistics.Histologically the capsule was complete in 12.7% (8/63) and incomplete in 60.3% (38/63). Four cases (6.3%) were pseudocapsule. Interobserver agreement for capsule appearance on GAeMR was good in Pre (κ = 0.684), moderate in PP (κ = 0.434), poor in TP (κ = 0.187), fair in HBP (κ = 0.395), and moderate on CT in PP (κ = 0.476) and DP (κ = 0.485). Diagnostic performance and sensitivity for the histologic capsule in DP on CT was highest among PP on CT and other phases on GAeMR. DP on CT images showed a higher Az value than PP on CT images with statistical significance (P < .001). PP on MR images revealed higher Az value than PP on CT images.The capsule appearance was most frequently observed in the DP on CT with highest diagnostic performance, and so DP images should be obtained on CT study for liver mass categorization. GAeMR yielded comparable capsule appearance to CT with moderate interobserver agreement. Considering hypointense rim on the HBP as fibrous capsule on pathology should be refrained, and so further study is warranted to correlate HBP hypointense rim with pathologic findings.

New Imaging in Gastrointestinal Tract.

Pathologies of gastrointestinal tract are various and affect patients of different ages. Both of these conditions influence the imaging modalities of gastrointestinal tract that underwent relevant changes during recent years. Magnetic Resonance (MR) and Computed Tomography (CT) techniques, optimised for gastrointestinal imaging, are playing today an increasing role in the evaluation of gastrointestinal disorders, and several studies have shown the advantage of these techniques over tradition barium fluoroscopic examinations secondary to improvements in spatial and temporal resolution combined with improved bowel distending agents. Based on recent literature and guidelines, there is a change of paradigms regarding the diagnosis of esophagus and gastrointestinal cancer towards CT, whereas for small bowel imaging in inflammatory disease MRI with a new focus on Diffusion Weighted Imaging (DWI) are the most important imaging modalities, because DWI can be easily implemented in standard MRI for routine use to further enhance the diagnostic accuracy in disease assessment [1–4]. CT and MRI play an important role also in functional disorders. In particular, the recent development of faster MRI pulse sequences provides rapid, real-time imaging of the gastrointestinal tract, pinpointing areas of stricture and providing valuable information on motility. This special issue is devoted to current and emerging techniques in gastrointestinal tract, focusing on some selected topics that are both interesting and challenging: neoplastic pathologies, chronic inflammatory diseases, functional pathologies, and nontraumatic emergency causing occlusion. The first section covers cross-sectional imaging of the gastrointestinal tract in neoplastic disease, including lymphoma, both through a review (“Radiological Features of Gastrointestinal Lymphoma” by G. Lo Re et al.) and through an original paper (“Staging of Primary Abdominal Lymphomas: Comparison of Whole-Body MRI with Diffusion-Weighted Imaging and 18F-FDG-PET/CT” by A. Stecco et al.) and small-bowel neoplasms (“Small-Bowel Neoplasms: Role of MRI Enteroclysis” by A. Faggian et al.). The imaging of hepatocellular carcinoma after locoregional treatments is also reviewed (“CT Appearance of Hepatocellular Carcinoma after Locoregional Treatments: A Comprehensive Review” by D. Marin et al.). Cross-sectional imaging modalities are fundamental also in the management of patients with inflammatory bowel disease (IBD) from the first diagnosis and throughout the entire course of the disease. In this sense, MRI, owing to the lack of ionizing radiation, represents the main technique in young patients with IBD who may require multiple studies over a lifetime. New imaging of chronic inflammatory pathologies is focused on Crohn's disease, where the imaging is essential also in scoring the activity of disease (“3D-EAUS and MRI in the Activity of Anal Fistulas in Crohn's Disease” by M. E. Alabiso et al.; “Assessment of Disease Activity in Small Bowel Crohn's Disease: Comparison between Endoscopy and Magnetic Resonance Enterography Using Mria and Modified Mria Score” by A. Scardapane et al.). Some functional pathologies are also discussed: achalasia and pelvic floor disfunction (“Imaging in the Evaluation of Endoscopic or Surgical Treatment for Achalasia” by D. Palladino et al.; “MR Imaging in Diagnosis of Pelvic Floor Descent: Supine versus Sitting Position” by F. Iacobellis et al.). Finally nontraumatic emergency causing occlusion is discussed in three different papers, with emphasis on the role of MDCT and dynamic MRI (“Intussusception in Adults: The Role of MDCT in the Identification of the Site and Cause of Obstruction” by V. Valentini et al.; “A Novel Diagnostic Aid for Detection of Intra-Abdominal Adhesions to the Anterior Abdominal Wall Using Dynamic Magnetic Resonance Imaging” by D. Randall et al.; “Adhesions to Mesh after Ventral Hernia Mesh Repair are Detected by MRI but Are Not a Cause of Long Term Chronic Abdominal Pain” by O. Langbach et al.). The contributions of this special issue could stimulate the spread of new imaging modalities in daily practice, pinpoint technical aspects, and share some strategies to optimise CT and MR protocols. Roberto Grassi Antonio Pinto Lorenzo Mannelli Daniele Marin Maria Antonietta Mazzei

Inexplicable Outcome of Early Appearance of Hepatocellular Carcinoma in the Allograft After Deceased Donor Liver Transplantation: A Case Report

BackgroundThis case represents the earliest appearance of de novo HCC after liver transplantation (OLT) compared with cases of previously reported literatures. Case ReportA 45-year-old man underwent deceased donor OLT owing to decompensated liver cirrhosis. He had YMDD viral mutation and hepatitis B (HBV) and C (HCV) coinfection but no tumor was found in the liver on MRI before OLT. The donor was a healthy young female donor who was HCV and HBV negative. There was no tumor in the explant liver. After OLT, HCV RNA and hepatitis B surface antigen became undetectable with DNA-positive HBV. Nine months after OLT, a computed tomography (CT) scan was performed owing to abdominal pain, detecting a mass occupying the right lobe that depicted enhanced characteristics typical of HCC. The chest CT demonstrated metastatic lung nodules in the right basal lower lobe. Fluorescence in situ hybridization showed tumor cells from the recipient. ConclusionsTo the best of our knowledge, this is the first report of de novo hepatocellular carcinoma that has emerged within a short period of undergoing OLT.

Appearance of hepatocellular carcinoma on gadoxetic acid-enhanced hepato-biliary phase MR imaging: a systematic review.

To perform a systematic review of the contrast behaviour of HCC on Gd-EOB-DTPA hepato-biliary phase MRI. This review was completed in accordance with the recommendations outlined in the preferred reporting items for systematic reviews statement. In all reports, qualitative analysis of signal intensity (SI) of HCC on hepato-biliary phase was performed: the relative SI of HCC. When available, a quantitative analysis of tumour enhancement was evaluated. A total of 106 studies were retrieved, of which 41 met the inclusion criteria. The total number of patients was 2550, with 3132 HCC. MRI showed 3110 HCC (22 non-detected). 2692/3110 (87 %) HCC were hypointense on Gd-EOB-DTPA-enhanced hepatocyte-phase MRI, 134 (4 %) isointense; 106 (3 %) hyperintense and 178 (6 %) iso-hyperintense. In 26 articles, 1653 HCCs were classified as follows: 519 well-differentiated, 883 moderately differentiated, 251 poorly differentiated. Among well-differentiated HCC, 445 (86 %) were hypointense, 12 isointense (2 %), 9 hyperintense (2 %), 53 iso/hyperintense (10 %). Among moderately differentiated HCC, 774 (88 %) were hypointense, 8 isointense (1 %), 27 hyperintense (3 %), 74 iso/hyperintense (8 %). Among poorly differentiated HCCs, 245 (98 %) were hypointense, one isointense, one hyperintense and four iso-hyperintense (2 %). We found a Chi-square (χ (2)) equivalent to 25,082 (p < 0.001). The percentage of lesions iso/hyper/iso-hyper is the same when considering well-differentiated and moderately differentiated HCC; when considering poorly differentiated HCC, the percentage of lesions iso/hyper/iso-hyper is significantly lower. Conversely, the percentage of lesions hypointense is significantly more represented in poorly differentiated HCC compared to well-differentiated and moderately differentiated HCC.

CT Appearance of Hepatocellular Carcinoma after Locoregional Treatments: A Comprehensive Review.

Hepatocellular carcinoma (HCC) is a major health problem worldwide, affecting more than 600,000 new patients per year. Curative treatments are available in a small percentage of patients, while most of them present in stages requiring locoregional treatments such as thermoablation, transarterial chemoembolization, and/or radioembolization. These therapies result in specific imaging features that the general radiologist has to be aware of in order to assess the response to treatment and to correctly manage the follow-up of treated patients. Multiphasic helical computed tomography has become a popular imaging modality for detecting hypervascular tumors and characterizing liver lesions. On this basis, many staging and diagnostic systems have been proposed for evaluating response to all different existing strategies. Radiofrequencies and microwaves generate thermoablation of tumors, and transarterial chemoembolization exploits the double effect of the locoregional administration of drugs and embolizing particles. Eventually radioembolization uses a beta-emitting isotope to induce necrosis. Therefore, the aim of this comprehensive review is to analyze and compare CT imaging appearance of HCC after various locoregional treatments, with regard to specific indications for all possible procedures.

Hepatocellular Carcinoma in Chronic Hepatitis C in the Absence of Advanced Fibrosis or Cirrhosis

The objective of our study was to describe the cross-sectional imaging appearance of hepatocellular carcinoma (HCC) in patients with chronic hepatitis C virus (HCV) infection in the absence of advanced fibrosis and cirrhosis. This study is a retrospective review of our surgical database to identify patients with chronic HCV infection and HCC who underwent hepatectomy and who had undergone preoperative CT or MRI. Only patients with a Metavir fibrosis score of F0, F1, or F2 on pathology were included. Patients with hepatitis B virus coinfection or other causes of chronic liver disease and patients with histopathologic evidence of advanced fibrosis or cirrhosis (Metavir scores F3 and F4) were excluded. Contrast-enhanced CT or MRI examinations performed within 2 months before surgery were reviewed for the number, size, and location of tumors; tumor enhancement characteristics; and presence of macrovascular invasion. Two hundred forty-five resections of HCC in patients with HCV were performed in our institution from 1987 to 2012. Of this group, 26 patients (10.6%) had a Metavir fibrosis score of F0, F1, or F2; of those patients, 19 (18 men and one woman; 18 non-Asian patients and one Asian patient; mean age, 64 years) had imaging studies available for review. Twenty-one HCCs (mean size, 4.5 cm; range, 0.9-14.8 cm) were evaluated at imaging. Typical wash-in and washout characteristics were seen in 16 of 19 viable lesions (84.2%). The remaining two HCCs were completely necrotic after transarterial chemoembolization. Eighteen patients had a solitary tumor. Most tumors (15/21, 71.4%) developed in the right hepatic lobe. HCC can develop in patients with chronic HCV without advanced fibrosis or cirrhosis, most frequently in older non-Asian men, and usually appears as a large solitary tumor with a typical wash-in-washout enhancement pattern.

Hepatocellular Carcinoma: Imaging Patterns on Gadoxetic Acid–enhanced MR Images and Their Value as an Imaging Biomarker

To investigate the patterns of imaging appearance of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced magnetic resonance (MR) images and to assess their potential value as prognostic markers of HCC associated with tumor recurrence after surgery. The institutional review board approved this retrospective study and informed consent was waived. A total of 216 patients with 304 pathologically proved HCCs underwent gadoxetic acid-enhanced MR imaging prior to surgery and were included in the study. Two reviewers, blinded to the clinical data, evaluated in consensus the imaging patterns of HCC according to enhancement patterns on dynamic phase images and signal intensity on hepatobiliary phase (HBP) images. The association of imaging features with clinical-pathologic findings was evaluated by using the Student t test, χ(2) test, Mann-Whitney U test, and linear-by-linear association. The dependence of time to tumor recurrence (TTR) after surgery was evaluated by using the Kaplan-Meier method, log-rank test, and Cox proportional hazard model. HCCs with atypical enhancement pattern (P = .0167, P = .0450, P < .0001, respectively) and iso- to hyperintensity on HBP images (P = .0001, P = .0002, P < .0001, respectively) had smaller tumor size, lower histologic grade, and worse Child-Pugh class. The log-rank test (P = .0064) and Cox proportional hazards model (hazard ratio, 5.676; P = .0158) revealed that HCCs with iso- to hyperintensity on HBP images had significantly longer TTR than HCCs with hypointensity on HBP images. HCCs can be classified into several imaging patterns on gadoxetic acid-enhanced MR images, which are associated with tumor aggressiveness and outcome. In addition, iso- to hyperintensity on HBP images may be a useful imaging biomarker to indicate longer TTR after surgery. .

Abstract C90: Gross appearance of hepatocellular carcinoma reflects expression of cancer stem cells, epithelial-mesenchymal transition, and hypoxia-related genes

Abstract The molecular background for the various gross appearances of hepatocellular carcinoma (HCC) have not yet been clarified, although the prognostic value thereof has been previously reported. Accordingly, in the present study, differences in the expression of cancer stem cells (CSC), epithelial-mesenchymal transition (EMT), and hypoxia related genes, according to the gross type of HCC, were evaluated in two independent cohorts composed of surgically resected HCCs (Cohort 1, n=99; cohort 2, n=110). The gross appearances of HCC were evaluated according to the “General Rules for the Clinical and Pathological Study of Primary Liver Cancer” set by the Liver Cancer Study Group of Japan, and categorized into single nodular (SN) type, single nodular type with extranodular growth (SNEG) type, confluent multinodular (CM) type, and infiltrative (IF) type. Additionally, transcription levels of CSC related genes (EpCAM, Oct3/4, Nanog), EMT regulator (Snail, Twist), and hypoxia related genes (HIF1α, CA9) were evaluated in cohort 1, and the protein expressions of EpCAM and CA9 were evaluated in cohort 2. Clinicopathologic findings, including vascular invasion and capsule formation, as well as prognosis, were also compared according to the gross types of HCC. As observed in this study, IF type HCCs were associated with more frequent portal vein invasion, tumor multiplicity and lack of capsule formation, compared to the other types of HCC (P&amp;lt;0.05 for all), in cohort 1; a similar trend was also identified in cohort 2. In cohort 1, IF type HCCs demonstrated significantly higher transcription levels of EpCAM, Snail and HIF1α (P&amp;lt;0.05 for all) than SN type HCCs. Moreover, the transcription level of HIF1α was also higher in IF type HCCs than both SNEG and CM type HCCs. SN type HCCs exhibited lower transcription levels of EpCAM and Snail compared to CM type and IF type HCCs. In cohort 2, CA9 protein expression was more frequently noted in IF type HCCs than other types of HCC (P&amp;lt;0.05 at all). The expression levels of CSC, EMT and hypoxia related genes showed a tendency to increase in SN, SNEG, CM and IF type HCCs, in that order as like the invasive pathological properties of the HCCs. IF type HCCs showed significantly decreased disease free survival and overall survival in comparison to the other types of HCC in both cohorts 1 and 2. In conclusion, our study demonstrated that IF type HCCs are associated with an increased expression of CSCs, EMT, and hypoxia related genes, all of which are potentially related to their invasive nature and poor prognosis. Citation Format: Hyungjin Rhee, Na Deuk Chae, Park Young Nyun. Gross appearance of hepatocellular carcinoma reflects expression of cancer stem cells, epithelial-mesenchymal transition, and hypoxia-related genes. [abstract]. In: Proceedings of the AACR Special Conference on Tumor Invasion and Metastasis; Jan 20-23, 2013; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2013;73(3 Suppl):Abstract nr C90.

Hepatocellular carcinoma with blood supply from parasitized omental artery: Angiographic appearance and chemoembolization

To analyze angiographic appearance of hepatocellular carcinoma (HCC) with blood supply from parasitized omental artery (POA), and evaluate the technical feasibility, safety and therapeutic efficacy of chemo-embolization via the POAs. A total of 1,221 HCC patients who had undergone chemoembolization procedures were evaluated retrospectively. The evaluated indexes included the incidence rate of POAs, success rate of superselective catheterization, post-reaction after chemoembolization, and the cumulative survival rates. Totally 1,221 HCC patients had undergone 3,639 chemoembolization procedures, and 32 patients with POAs were enrolled, with 97 POAs found in 76 angiography procedures, giving an incidence rate of 2.09%. POA was observed mostly at the right lobe and left medial lobe except the segment II, and 62 POAs underwent superselective catheterization with microcatheter, giving a success rate of 63.9%. The angiographic appearance was: (1) hypertrophic POAs participating in tumor staining (n=28); (2) stiff and distorted POA (n=11), displaced due to tumor's oppression (n=8); and (3) defective tumor staining close to either gastrocolic omentum distribution or liver capsule (n=7). In 19 patients, chemoembolization via POAs was performed successfully (A group), while the remaining 13 patients failed (B group). Except 1 acute edema pancreatitis case, no serious complication was recorded. The cumulative survival rates of 6-, 12-, 18- and 24-month were 78.9%, 47.4%, 31.6% and 21.1% respectively for A group; correspondingly, 61.5%, 30.8%, 15.4% and 7.7%% for B group, in which 2 patients died of ruptured HCC. Chemoembolization with microcatheter via POAs is a relatively safe, feasible and valuable method.

Dysplastic hepatic nodules: Radiological abnormalities and histopathological correlations

Pathological studies of explanted cirrhotic livers have made it possible to define precisely the principal morphological characteristics of the transitional stages of the regenerative nodule to dysplastic nodule to hepatocellular carcinoma. The aim of our study was to examine the imaging features of histologically proven dysplastic nodules and to compare them with their histopathological features. A large majority (63%) of the dysplastic nodules in our series was hypervascular and 16% had the classic appearance of hepatocellular carcinoma. Even if the management of a high-grade dysplastic nodule differs little from that of a hepatocellular carcinoma, it is important to remember that not all hypervascular nodules in a cirrhotic liver are necessarily a hepatocellular carcinoma or a high-grade dysplastic nodule.

Enhancement pattern and appearance of hepatocellularcarcinoma through triple-phase MDCT

Enhancement pattern and appearance of hepatocellularcarcinoma through triple-phase MDCT

Efficacy and safety of addition of minor bloodletting (petit phlebotomy) in hepatitis C virus-infected patients receiving regular glycyrrhizin injections

Hepatoprotective therapies that include regular glycyrrhizin injections (GIs) are beneficial for chronic hepatitis C patients, but are sometimes insufficient for normalizing serum alanine aminotransferase (ALT) levels. Here, we evaluated whether the addition of minor bloodletting, named petit phlebotomy (PP), prior to each GI could further reduce serum ALT concentrations in such patients. Seventy-six hepatitis C virus (HCV)-infected patients receiving regular GI, with persistently abnormal serum ALT levels, were randomly divided into GI + PP and GI groups and monitored for 12 months. PP was performed before every GI to a total 60 ml of blood a week. The primary PP endpoint was a serum ferritin level of less than 20 ng/ml. PP was suspended upon reaching the endpoint, but was resumed as needed. The efficacy of the addition of PP was evaluated by measuring changes in serum ALT levels. Two patients in each group dropped out because of the appearance of hepatocellular carcinoma. The remainder completed the 12-month treatment with no serious adverse events. Serum ALT and ferritin levels were significantly decreased in the GI + PP group (from 67 +/- 34 to 44 +/- 14 U/l and from 163 +/- 127 to 25 +/- 21 ng/ml, respectively, both P < 0.001), but these changes were not seen in the GI group. Although 20 patients in the GI + PP group had compensated cirrhosis, no significant reductions in serum albumin concentrations were observed. The addition of PP is effective and safe for improving serum aminotransferase levels in HCV-infected patients receiving regular GI, even in those with compensated cirrhosis.

Diabetes mellitus increases the risk of hepatocarcinogenesis in patients with alcoholic cirrhosis: A preliminary report

Diabetes mellitus (DM) has been reported to increase the risk of hepatocellular carcinogenesis in chronic liver diseases. This study aims to elucidate whether DM is an independent risk factor for the appearance of hepatocellular carcinoma (HCC) in patients with alcoholic cirrhosis. Forty-seven patients with alcoholic cirrhosis were retrospectively observed for a median of 6.8 years. The patients showed a history of heavy alcohol intake of 500 kg or more until the diagnosis of cirrhosis, and no patients had hepatitis B surface antigen, hepatitis B virus DNA measured by nested polymerase chain reaction, or antihepatitis C virus. During the observation period, HCC developed in nine patients (19.1%). Cumulative appearance rates of HCC were 10.5%, 23.8% and 33.3% at the end of the fifth, 10th and 15th years, respectively. When they were divided into two groups according to the association of diabetes, carcinogenesis rates in patients with (n = 11) and without (n = 36) DM, cumulative carcinogenesis rates were 32.7% and 3.2% at the end of fifth year, 32.7% and 20.2% at the tenth year, and 66.3% and 20.2% at the 15th year, respectively. Crude carcinogenesis rate in the patient with DM was significantly higher than that of patients without DM (P = 0.0034). Multivariate analysis disclosed a higher age (hazard ratio 28.1, P = 0.007), and association of DM (hazard ratio 21.7, P = 0.006) significantly affected future carcinogenesis rate. DM seemed to be an independent risk factor for hepatocarcinogenesis in the cohort study of patients with alcoholic cirrhosis.