Findings Of Hepatocellular Carcinoma Research Articles

Cannonball Pulmonary Metastases as Initial Presentation of Hepatocellular Carcinoma: A Case Report and Literature Review

BackgroundHepatocellular carcinoma is a major public health problem, as is considered the fastest growing cause of cancer-related death. Cannonball metastases as an initial finding in hepatocellular carcinoma are considered a rare phenomenon.Case PresentationA 59-year-old man presented to the outpatient clinic for subacute cough, asthenia, and involuntary weight loss. Chest X-ray showed multiple, round, bilateral pulmonary solid lesions. Contrast-enhanced computed tomography of the chest and abdomen revealed multiple bilateral, contrast-enhanced pulmonary nodules known as "cannonball" lesions and a heterogeneous lesion located in the right lobe of the liver with retroperitoneal lymphadenopathy. A biopsy was performed, and the histopathological result was compatible with metastatic poorly differentiated hepatocellular carcinoma. Due to the advanced stage of the disease, the patient received palliative care and expired two months later.ConclusionCannonball metastases in hepatocellular carcinoma are considered a rare finding and represents a poor prognosis. It is important to awaken the interest of clinicians in a timely diagnosis, as well as a possible suspicion of hepatocellular carcinoma in patients with this radiographic pattern.

Hepatocellular Carcinoma with Bile Duct Tumor Thrombus: A Case Report and Literature Review of 890 Patients Affected by Uncommon Primary Liver Tumor Presentation.

Bile duct tumor thrombus (BDTT) is an uncommon finding in hepatocellular carcinoma (HCC), potentially mimicking cholangiocarcinoma (CCA). Recent studies have suggested that HCC with BDTT could represent a prognostic factor. We report the case of a 47-year-old male patient admitted to the University Hospital of Bari with abdominal pain. Blood tests revealed the presence of an untreated hepatitis B virus infection (HBV), with normal liver function and without jaundice. Abdominal ultrasonography revealed a cirrhotic liver with a segmental dilatation of the third bile duct segment, confirmed by a CT scan and liver MRI, which also identified a heterologous mass. No other focal hepatic lesions were identified. A percutaneous ultrasound-guided needle biopsy was then performed, detecting a moderately differentiated HCC. Finally, the patient underwent a third hepatic segmentectomy, and the histopathological analysis confirmed the endobiliary localization of HCC. Subsequently, the patient experienced a nodular recurrence in the fourth hepatic segment, which was treated with ultrasound-guided percutaneous radiofrequency ablation (RFA). This case shows that HCC with BDTT can mimic different types of tumors. It also indicates the value of an early multidisciplinary patient assessment to obtain an accurate diagnosis of HCC with BDTT, which may have prognostic value that has not been recognized until now.

ASOCIACION DE LA CLASIFICACION LI-RADS 2018 CON LOS HALLAZGOS HISTOPATOLOGICOS DE CARCINOMA HEPATOCELULAR, EN EL CENTRO MEDICO NAVAL, PERIODO: ENERO 2016 - DICIEMBRE 2020

The LI-RADS Classification is an interpretation and reporting system to classify focal alterations of the liver with the risk of developing Hepatocellular Carcinoma, using a series of major criteria in Computed Tomography and Magnetic Resonance These findings can be classified into 5 categories.The objective of this thesis is to identify if there is an association between the LI-RADS 2018 classification and the histopathological results of patients with Hepatocellular Carcinoma from the Naval Medical Center. Materials And Methods:An observational, descriptive, cross-sectional, retrospective study was carried out from January 2016 to December 2020. In this study, 35 patients with a diagnosis of Hepatocellular Carcinoma were analyzed, who underwent Computed Tomography or Abdomino-pelvic Magnetic Resonance , to associate said pathology with imaging findings, complying with the most characteristic major criteria that allow staging in the LI-RADS 2018 System. Results:Of the 35 patients, 57% were women (n = 20), 43% were men (n = 15). Of the total number of patients, 80% were Beneficiaries and the method of obtaining the sample for all patients was closed biopsy with a percutaneous needle. The distribution of the 2018 LI-RADS scale in all patients with liver biopsy was: LI-RADS 1 n = 8 (22.8%), LI-RADS 2 n = 5 (14.2%), LI-RADS 3 n = 12 (34.2%), LI-RADS 4 n = 3 (8.5%), LI-RADS 5 n = 7 (20%). It was found that the LI-RADS 5 category obtained a value of p = 0.001, with a specificity of 100%, a sensitivity of 70%, a PPV of 100% and a NPV of 89%, with an incidence of 20%. Conclusions:This study shows, through the results obtained, that there is a positive association between the LI-RADS 2018 classification of the ACR and the histopathological findings of Hepatocellular Carcinoma.

A Diagnostic Dilemma of Hepatocellular Carcinoma on a Background of Thalassemia

Purpose: Thalassemia (HbH) is a chronic condition that may have potential complications of liver cirrhosis secondary to iron overload or hepatitis. Iron deposition in the liver can mask the classic imaging findings of hepatocellular carcinoma. We report an interesting case with similar nature with diagnostic dilemma, where multiple imaging modalities were unable to delineate the nature of the liver nature, and the patient was eventually diagnosed with hepatocellular carcinoma, after percutaneous biopsy was performed. Method: A 61-year-old male, with background history of HbH disease and transfusion dependent, presented with an incidental finding of 2 liver nodules on an ultrasound scan after complaints of right hypochondrium pain. A computed tomography (CT) scan diagnosed one nodule as a flash-filling haemangioma but was inconclusive about the other larger nodule. A magnetic resonance imaging (MRI) scan was also inconclusive but gave the differentials of extramedullary haematopoiesis. A sulphur colloid scan did not show uptake, making extramedullary haematopoiesis less likely. Results: A percutaneous biopsy of the indeterminate liver nodule was performed, and the histology showed hepatocellular carcinoma. The patient underwent wedge resection of the hepatocellular carcinoma and recovered well post-operatively. Conclusion: In the event of inconclusive imaging in patients with significant risk factors for hepatocellular carcinoma, a percutaneous biopsy should be performed for definitive diagnosis.

MiR-185-5p targets ROCK2 and inhibits cell migration and invasion of hepatocellular carcinoma.

Previous studies demonstrated microRNA-185 (miR-185) as a tumor suppressive microRNA (miRNA) in various types of cancer. The current study aimed to verify this finding in hepatocellular carcinoma (HCC) and explored the downstream channel of miR-185-5p. We detected miR-185-5p and Rho-associated coiled-coil containing protein kinase 2 (ROCK2) mRNA and protein levels by reverse transcription-quantitative PCR (RT-qPCR) and western blotting in HCC tissues and cell lines. Luciferase reporter assay proved the direct relationship between miR-185-5p and ROCK2. Cell migration and invasion were assessed via Transwell assay. miR-185-5p level was reduced in HCC tissues and cell lines. miR-185-5p overexpression impeded migration and invasion of HCC cells. Moreover, miR-185-5p directly targeted ROCK2 which was repressed by miR-185-5p in HCC. In addition, ROCK2 contributed to cell metastasis of HCC. In summary, miR-185-5p inhibited cell metastasis of HCC by suppressing ROCK2. The novel miR-185/ROCK2 axis shows potential in improving the therapies of HCC and enhancing HCC survival.

17. Spectrum of contrast enhanced ultrasound findings in hepatocellular carcinoma treated with locoregional therapy

Background and Aims: Contrast enhanced ultrasound (CEUS) is an ultrasound imaging technique established for hepatic imaging. It has the ability to delineate the viable and non viable tissue in a malignant focal lesion [hepatocellular carcinoma (HCC)] subjected to locoregional therapy of transarterial chemoembolization, radiofrequency ablation or acetic acid ablation. We illustrate the spectrum of CEUS findings in HCC subjected to locoregional therapies. Methods: Patients who underwent locoregional therapy for focal HCC were subjected to CEUS after one month of therapy. CEUS was performed on Supersonic aixplorer ultrasound machine using ultrasound contrast (Sonovue, Bracco, Milan, Italy). About 2.4 ml of contrast was injected per nodule and the enhancement characteristics of the nodule was evaluated in 3 vascular phases- arterial (AP, at 15–25 s), venous (VP) at 45–90 s and delayed (DP, at 180 s). Cine recording was done. No enhancement or presence of any focus of enhancement in the treated tumor site was considered as complete response or residual disease (partial response) respectively as per the mRECIST criteria. The CEUS findings were co-related with multiphase computerized Tomography (MPCT)/Magnetic Resonance Imaging (MRI) liver. Results: CEUS could delineate the presence or absence of residual disease in treated patients of focal HCC. In patients with complete response, no enhancement was present at the tumor site and the entire treated tumor was seen as a well defined, uniformly hypodense lesion with smooth margins. In contrast, the residual disease (partial response) after treatment was seen as an enhancing (hyperdense) tissue located in different regions of the treated tumor. The findings were similar to that seen on MPCT or MRI liver. Conclusions: CEUS has the ability to assess therapeutic response in focal HCC subjected to locoregional therapy and the findings are akin to those seen on MPCT/MRI. The authors have none to declare.

Gadoxetic acid-enhanced magnetic resonance imaging reflects co-activation of β-catenin and hepatocyte nuclear factor 4α in hepatocellular carcinoma.

The aim of this study is to clarify the correlation of the co-activation of β-catenin and hepatocyte nuclear factor (HNF)4α with the findings of gadoxetic acid-enhanced magnetic resonance imaging (MRI), organic anion transporting polypeptide (OATP)1B3 expression, and histological findings in hepatocellular carcinoma (HCC). One hundred and ninety-six HCCs surgically resected from 174 patients were enrolled in this study. The HCCs were classified into four groups by immunohistochemical expression of β-catenin, glutamine synthetase (GS), and HNF4α: (i) β-catenin/GS (positive [+]) HNF4α (+); (ii) β-catenin/GS (+) HNF4α (negative [-]); (iii) β-catenin/GS (-) HNF4α (+); and (iv) β-catenin/GS (-) HNF4α (-). We compared the four groups in terms of the enhancement ratio on the hepatobiliary phase of gadoxetic acid-enhanced MRI, immunohistochemical organic anion transporter polypeptide (OATP)1B3 (a main uptake transporter of gadoxetic acid) expression and histological features, overall survival, and no recurrence survival. The Kruskal-Wallis test, Steel-Dwass multiple comparisons test, Fisher's exact test, and log-rank (Mantel-Cox) test were used for statistical analyses. Enhancement ratio on gadoxetic acid-enhanced MRI in HCC with β-catenin/GS (+) HNF4α (+) was significantly higher than those of the other three groups (P < 0.001). The OATP1B3 grade was also significantly higher in HCC with β-catenin/GS (+) HNF4α (+) (P < 0.001). Hepatocellular carcinoma with β-catenin/GS (+) HNF4α (+) showed the highest differentiation grade as compared to the other groups (P < 0.004). There were no significant differences in portal vein invasion, macroscopic growth pattern, or prognosis analyses between the four groups. Co-activation of β-catenin and HNF4α would promote OATP1B3 expression, and consequently higher enhancement ratio on gadoxetic acid-enhanced MRI and higher differentiation grade in HCC.

Atypical Magnetic Resonance Imaging Findings in Hepatocellular Carcinoma

Magnetic resonance imaging (MRI) is currently the modality of choice to evaluate liver lesions in patients with cirrhosis and hepatitis B and C. Hepatocellular carcinoma demonstrates typical imaging findings on contrast-enhanced MRI, which are usually diagnostic. Unfortunately, a subgroup of hepatocellular carcinoma presents with atypical imaging features, and awareness of these atypical presentations is important in ensuring early diagnosis and optimal patient outcomes. Herein, we review some of the more common atypical presentations with a focus on MRI.

Pretreatment Microbubble-Induced Enhancement in Hepatocellular Carcinoma Predicts Intrahepatic Distant Recurrence After Radiofrequency Ablation

The purpose of this study is to examine whether pretreatment findings in hepatocellular carcinoma (HCC) using contrast-enhanced ultrasound can predict local or distant recurrence after radiofrequency ablation (RFA). Subjects of the prospective study were 54 patients with HCC lesions treated by RFA. Intensity differences between lesion and liver parenchyma at early arterial (4 seconds) and peak enhancement times and washout at late phase were provided on contrast-enhanced sonograms with perflubutane microbubble agent. The pretreatment findings were examined with respect to intrahepatic local and distant recurrence. Univariate analysis showed that intensity differences at the early arterial time (hazard ratio [HR], 2.2; 95% CI, 1.0-4.6; p = 0.042) and lesion frequency (HR, 2.3; 95% CI, 1.0-5.0; p = 0.044) were risk factors for distant recurrence. Multivariate analysis showed that intensity differences at the early arterial time (HR, 2.7; 95% CI, 1.2-5.8; p = 0.014) and lesion frequency (HR, 2.9; 95% CI, 1.3-6.5; p = 0.015) were risk factors for distant recurrence. The cumulative distant recurrence rate for patients with intensity differences at the early arterial time was greater at less than 10 dB than at 10 dB or higher (33.3% and 91.3% vs 23.9% and 65.1% at 1 and 2 years, respectively; p = 0.035). The cumulative distant recurrence rate was 16.5% and 61.1% at 1 and 2 years, respectively, in patients with solitary lesions and 54.7% and 77.4% at 1 and 2 years, respectively, in patients with multiple lesions (p = 0.0296). No pretreatment findings were predictive for local recurrence. HCC lesions with gradual enhancement in the early arterial time displayed potential distant recurrence risk after RFA, requiring careful posttreatment surveillance.

Sorafenib Inhibits Hypoxia-Inducible Factor-1α Synthesis: Implications for Antiangiogenic Activity in Hepatocellular Carcinoma

The overexpression of hypoxia-inducible factor 1α (HIF-1α) is a common finding in hepatocellular carcinoma (HCC), and it leads to angiogenesis and poor prognosis. Sorafenib, a multikinase inhibitor, has shown significant improvement in survival in patients with advanced HCC in clinical trials. However, the mechanisms that account for the antiangiogenic efficiency of sorafenib have not been fully elucidated. The present study aims to explore the effect of sorafenib on HIF-1α expression and activation in HCC cells and xenografts. HCC cells and xenografts were treated with sorafenib or vehicles. Western blotting and quantitative PCR array were used to determine protein and mRNA expression, respectively. HIF-1α activity, de novo protein synthesis, and VEGF secretions were determined using assay kits. Sorafenib dose dependently decreased the hypoxia-induced accumulation and activation of HIF-1α protein. Further analysis revealed that such reduction of HIF-1α was associated with the inhibition of HIF-1α protein synthesis rather than the promotion of HIF-1α protein degradation or the reduction of HIF-1α mRNA. Moreover, the phosphorylation levels of mTOR, extracellular signal-regulated kinase (ERK), p70S6K, RP-S6, 4E-BP1, and eIF4E were significantly suppressed by sorafenib. In vivo studies further confirmed the inhibitory effect of sorafenib on the expression of HIF-1α and VEGF proteins, leading to a decrease in tumor vascularization and growth of the xenografts. Sorafenib-mediated inhibition of HIF-1α synthesis is associated with previously undefined pathways in which mTOR/p70S6K/4E-BP1 and ERK phosphorylation are downregulated. Our preclinical data expand our understanding of sorafenib's antiangiogenic mechanism of action by inhibiting HIF-1α and VEGF protein expression.

Hepatocelluar Carcinoma in an Accessory Lobe of the Liver Revealed by 11C-Acetate PET With a Negative Finding on FDG Imaging

An accessory lobe of the liver is a rare congenital anomaly, which is very difficult to diagnose preoperatively. Hepatocellular carcinoma in an accessory lobe of the liver is much rarer. We report here our findings of hepatocellular carcinoma in an accessory left lobe on 11C-acetate PET/CT images in a 67-year-old man who had both an unremarkable diagnostic contrast abdominal CT and a negative FDG PET/CT scan before the 11C-acetate PET/CT study.

CT CHARACTERISTICS OF PRIMARY HEPATIC MASS LESIONS IN DOGS

Little information is available on the relationship between computed tomography (CT) imaging findings and the pathologic diagnosis of canine hepatic tumors. Our purpose was to clarify the characteristic features of CT findings in liver tumors in dogs. Data from 33 dogs with either a hepatocellular carcinoma, n = 14, hepatocellular adenoma, n = 14, or nodular hyperplasia, n = 5 were summarized from medical records. CT features for each histologic diagnosis were characterized and analyzed statistically. Common findings in hepatocellular carcinoma included central (79%, P = 0.0030) and marginal enhancement (93%, P = 0.00043) in the arterial phase, cyst-like lesions (93%), capsule formation (93%), and hypoattenuation in the portal (86%), and equilibrium phases (93%). Hepatic adenoma was characterized by a characteristic diffuse enhancement pattern during the arterial phase (57%, P = 0.013), which was also found in nodular hyperplasia (60%), but never in hepatocellular carcinoma. Nodular hyperplasia was less likely to have a capsule structure (20%, P = 0.0087). Mass size was significantly smaller in nodular hyperplasia than in hepatocellular carcinoma and hepatic adenoma (P = 0.0033 and 0.038, respectively). Hyperattenuation in the arterial and the portal phase i.e. contrast retention, was more frequent in hepatic adenoma than in the other groups (P = 0.037 and 0.037, respectively). Nodular hyperplasia was more frequently isoattenuating in the equilibrium phase (P = 0.043).

Hepatocellular Carcinoma With Bile Duct Tumor Thrombus

This purpose of this study was to analyze the computed tomography (CT) findings of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) and explore their correlations with pathological manifestations. The clinical data, CT findings, and pathological manifestations of the 16 HCC patients with BDTT were retrospectively reviewed. All cases were pathologically proven. Most HCCs showed hyperattenuation at hepatic arterial phase (HAP) (14/16) and hypoattenuation at portal venous phase (PVP) (12/16) and equilibrium phase (9/10), and the presence of rapid washout of contrast material was noted in 11 cases. The BDTT presented as cordlike masses in the dilated bile ducts, and mostly showed hyperattenuation at HAP (12/16) and hypoattenuation at PVP (13/16) and equilibrium phase (10/10), and the presence of rapid washout of contrast material was noted in 10 cases. Four cases of BDTT showed homogeneous enhancement, which were mainly consisted of cancer cells; 9 cases showed heterogeneous enhancement, which were mainly consisted of cancer cells with flakes of necrotic tissues or abundant red blood cells. Bile duct tumor thrombus was composed of 2 different pathological tissues in 3 cases, proximal part of BDTT was composed of tumor tissue, which was uniformly enhanced on dynamic enhanced CT, whereas the distal part was composed of necrotic or debris tissue without enhancement. Hepatocellular carcinoma lesion and soft-tissue mass in the bile ducts with bilary dilation are usually depicted on dynamic enhanced CT in HCC patients with BDTT. Early enhancement at HAP and rapid washout of contrast material at PVP are the characteristic findings of HCC and BDTT. Dynamic contrast CT examination is very valuable for diagnosing this disease.

Differential Roles of Insulin-like Growth Factor Receptor- and Insulin Receptor-mediated Signaling in the Phenotypes of Hepatocellular Carcinoma Cells

Intrahepatic and extrahepatic metastases are common findings in hepatocellular carcinoma (HCC). Insulin-like growth factor 2 (IGF2) expression is frequently induced in HCC, and serum IGF2 levels correlate with the presence of extrahepatic metastases. Yet, the role of IGF-induced signaling in the dissemination of HCC remains unclear. We have previously observed elevated IGF2 levels in tumors with metastatic potential in an HCC mouse model. Here, we demonstrate that inhibition of IGF2, or its receptor IGF1R, impairs the migration and invasion activities of murine HCC cells. Furthermore, inhibition of IGF1R also impairs the ability of HCC cells to colonize the lungs after introduction into the circulation through the tail vein but does not impair subcutaneous tumor growth. Collectively, these findings suggest that IGF1R-mediated signaling plays a causative role in tumor dissemination but is not required for tumor growth per se. Although previous studies indicate that IGF ligands can signal through IGF1R/insulin receptor (IR) heterodimers, and IR-A homodimers, we demonstrate that the IR is not required for invasion and metastasis by HCC cells. Finally, we identify matrix metalloproteinase 2 as a mediator of the invasive phenotype downstream of IGF1R-induced signaling. Thus, our studies demonstrate the importance of IGF2-induced signaling in the dissemination of HCC cells.

Hepatocellular carcinoma on MR diffusion weighted imaging and dynamic contrast-enhanced imaging

Objective To evaluate the findings of hepatocellular carcinoma (HCC) on DWI and dynamic Gd-DTPA-enhanced MR imaging. Methods Eighty one patients with chronic hepatitis or liver cirrhosis underwent both DWI and dynamic Gd-DTPA-enhanced MRI studies of the liver for HCC detection. MR data of were retrospectively analyzed. Two observers determined in consensus the location and the number of focal lesions. The signal manifestation of the lesions on DWI and dynamic Gd-DTPA-enhanced MR imaging were analyzed. Results DWI and Gd-DTPA-enhanced MR images detected 122 HCCs and 14 benign lesions. One hundred and sixteen HCCs(95.1%) showed hyperintensity on DWI and 6 HCCs in patients with severe cirrhosis showed isointensity. One hundred and five HCCs (86. 1%) revealed hypointensity, 11 HCCs (9.0%) showed is)intensity and 6 HCCs (4.9%) exhibited hyperintensity on T1weighted images. On Gd-DTPA-enhanced MR images,101 HCCs(82. 8%) were significantly enhanced on arterial phase and 99 HCCs showed hypointensity on portal and equilibrium phases. Twenty HCCs (16. 4%), 18 of 20 less than 20 mm in diameter, showed isointensity on arterial phase and hyperintensity on DWL Eight of 14 benign lesions showed hyperintensity and 6 isointensity on DWI. Five benign lesions ,with hypointensity on T1 weighted images without contrast and hyperintensity on DWI showed no enhancement on Gd-DTPA-enhanced MR images;6 benign lesions with isointensity on both T1 weighted imaging without contrast and DWI exhibited avid enhancement on arterial phase and isointensty on portal and equilibrium phases;one of the two benign lesions, with isointensity before and after contrast images and hyperintentiy on DWI, was a regenerative nodule;another regenerative nodule with hyperintensity on both T1 weighted images without contrast and DWI was greatly enhanced on arterial phase and showed isointensity on portal and equilibrium phases. Conclusions Most of the HCCs were greatly enhanced on arterial phase on Gd-DTPA-enhanced MR imaging and some smaller HCCs showed isointensity on arterial phase and hyperintensity on DWI. The combination of DWI and Gd-DTPA-enhanced MR imaging may help to accurately diagnose HCCs. Key words: Liver neoplasms; Diffusion magnetic resonance imaging

Current staging of hepatocellular carcinoma: imaging implications

The incidence of hepatocellular carcinoma has been rising in the USA in the past two decades. Hepatocellular carcinoma primarily affects older people and reaches its highest prevalence among those aged between 50 and 70 years. Chronic infection by the hepatitis B virus is the most common cause of this disease. Since hepatocellular carcinoma is an indolent tumor, it has a low life expectancy. In patients with suspected hepatocellular carcinoma, CT, MRI, and ultrasound techniques are useful for formulating the diagnosis based on vascularity and specific enhancement features. In this paper we will discuss the multimodal approach for diagnosis and surveillance of hepatocellular carcinoma. We will also furnish the latest staging and treatment, epidemiology, clinical presentation, pathology and laboratory findings in hepatocellular carcinoma.

Sonographic Characterisation of Hepatocellular Carcinoma at Time of Diagnosis

Hepatocellular carcinoma (HCC) is a malignant liver tumour with a high prevalence world-wide. For screening procedures conventional transabdominal B-mode ultrasound and AFP determination are commonly used. We investigated 100 consecutive patients with histologically proven hepatocellular carcinoma in order to evaluate sonographic characteristics in unselected patients and to compare native and contrast-enhanced ultrasonographic techniques. We investigated 100 consecutive patients with hepatocellular carcinoma at time of diagnosis with respect to echogenicity, patterns of vascularity, and portal/hepatic vein thrombosis. In addition to B-mode and native power Doppler sonography, contrast-enhanced power Doppler sonography with SHU 508A was used in 65 patients. The ultrasound appearance with conventional B-mode of hepatocellular carcinoma was hypoechoic in 48 % of the cases, isoechoic in 9 %, hyperechoic in 19 %, and in 25 % a mixture between hyper- and hypoechoic appearance was found compared to the surrounding liver tissue. Contrast-enhanced power Doppler sonography with SHU 508A changed the pattern of tumour vascularity in 27 % of patients into hypervascular, mainly in small lesions. At the time of diagnosis, the most commonly observed finding in hepatocellular carcinoma is that they appear hypervascular, independent of their size. The use of ultrasound contrast media should be considered to achieve characterisation of liver nodules in cirrhotic livers because they can improve the evaluation of tumour vascularity. Hypovascular HCC are found in about 10 % even after the administration of a contrast agent.

CT findings in hepatocellular carcinoma: correlation of tumor characteristics with causative factors, tumor size, and histologic tumor grade.

To determine computed tomographic (CT) findings of hepatocellular carcinoma (HCC) in a predominantly non-Asian population and to assess any morphologic differences with respect to causative factors, tumor size, and histologic grade. Clinical history, pathology reports, histologic specimens, and CT findings in 100 patients with HCC were reviewed. All patients underwent contrast material-enhanced incremental dynamic CT. Findings were agreed on by consensus. The mosaic pattern was seen in 46% of cases, venous invasion in 33%, and tumor encapsulation in 31%; frequencies were similar to those reported with Asian patients. A mosaic pattern was more common in patients with larger tumors (P = .036). Venous invasion was more common in patients with alcohol-induced cirrhosis (P = .003) and in those with higher grade tumors (P = .043). Tumor encapsulation was more common in patients with lower grade tumors (P = .012). Reported morphologic differences between non-Asian and Asian patients with HCC may be due to differences in underlying liver disease, tumor size, and histologic grade.

Effect of Transcatheter Arterial Embolization according to Angiographic Findings in Hepatocellular Carcinoma

Effect of Transcatheter Arterial Embolization according to Angiographic Findings in Hepatocellular Carcinoma

Expression of mutant p53 protein in hepatocellular carcinoma.

p53 mutations are a common genetic finding in hepatocellular carcinoma from areas of high aflatoxin exposure. Recent small studies have shown that p53 gene mutations may be less common in areas with a low prevalence of hepatocellular carcinoma such as Great Britain. The protein product of mutant p53 can be detected immunohistochemically because of its longer half life in comparison with native protein. This study used a novel monoclonal antibody DO-7, raised against recombinant p53 and effective in routinely processed biopsy specimen tissue, to detect the mutant protein in a series of 45 cases of hepatocellular carcinoma occurring in white subjects resident in the United Kingdom. Focal nuclear labelling was seen in four cases (9%); surrounding cirrhotic tissue in one of these was negative for p53 expression. This study shows that p53 mutations are a rare event in hepatocarcinogenesis in Great Britain, an area of low aflatoxin exposure, and supports the concept of geographical variations in the cause and pathogenesis of hepatocellular carcinoma.