Pattern Of Hepatocellular Carcinoma Research Articles

A nomogram for preoperative prediction of vessels encapsulating tumor clusters (VETC) pattern and prognosis of hepatocellular carcinoma

BackgroundVessels encapsulating tumor clusters (VETC) pattern of hepatocellular carcinoma (HCC) are associated with unfavorable prognosis. This study aimed to establish a nomogram model to predict VETC patterns based on preoperative CT imaging features. Patients and methodsPatients who underwent surgical resection between January 1, 2016 and August 31, 2022 were retrospectively included. Predictors associated with VETC pattern were determined by using logistic regression analyses, and a nomogram model was constructed. Prognostic factors associated with recurrence-free survival (RFS) after surgical resection were identified by using Cox regression analyses. ResultsA total of 84 patients were included for CT analysis. All patients underwent radical surgical resection. AST/ALT >1.07(odds ratio [OR], 4.91; 95 ​% CI: 1.11, 21.68; P ​< ​0.05), intratumoral necrosis (OR, 4.99; 95 ​% CI: 1.25, 19.99; P ​< ​0.05) and enhancing capsule (OR, 3.32; 95 ​% CI: 1.27, 8.94; P ​< ​0.05) were independent predictors of VETC pattern. These features were used for the construction of nomogram model, which showed comparable prediction performance, with AUC value of 0.767 (95%CI [0.662, 0.852]). CK19 status (Hazard ratio [HR], 2.02; 95 ​% CI: 1.06, 3.86; P ​< ​0.05), the number of tumors (HR, 3.31; 95 ​% CI: 1.47, 7.45; P ​< ​0.05) and VETC pattern (HR, 2.52; 95 ​% CI: 1.31, 4.86; P ​< ​0.05) were independent predictors of postoperative RFS. ConclusionA nomogram model based on preoperative CT imaging features could be used for the characterization of VETC pattern, and has prognostic significance for postoperative RFS in patients with HCC.

Immunophenotypes and Tumor Immune Microenvironment in Hepatocellular Carcinoma With Macrotrabecular Massive and Vessels Encapsulating Tumor Clusters.

Recently, vessels encapsulating tumor clusters (VETC) pattern and macrotrabecular massive (MTM) pattern of hepatocellular carcinoma (HCC) have been reported as aggressive histological types. These histological patterns showed an immunosuppressive tumor immune microenvironment (TIME). Since there have been no reports on the differences of these two subtypes simultaneously, this study examined the immunophenotypes and TIME of MTM-HCC and VETC-HCC immunohistochemically. Seventy-four cases of previously diagnosed HCC, including 32 MTM-HCCs, 21 VETC-HCCs, and 21 conventional HCCs, were enrolled in immunohistochemical analysis. We conducted immunohistochemical analysis. We found that MTM-HCC showed less frequent expression of HepPar-1, which is one of the most common hepatocytic markers. In MTM-HCC, the frequency of high expression levels of Keratin19, carbonic anhydrase (CA) IX, and PD-L1 was higher compared to VETC-HCC and conventional HCC. PD-L1 expression was found in 34.4% of MTM-HCC, 0% of VETC-HCC, and 19.0% of conventional HCC. The rate of PD-L1 expression in MTM-HCC was significantly higher than the others (p=0.0015). PD-L1 expression was significantly associated with epithelial cell adhesion molecules and CA IX expression, which are representative markers of tumor stemness and hypoxic conditions, respectively. The CD8 infiltration in VETC-HCC was significantly lower than that in conventional HCC. MTM-HCC had different immunophenotypes and TIMEs compared to HCC with the VETC pattern. Although both had immunosuppressive TIME, the elements forming TIME were quite different. To enhance the immune checkpoint inhibitor efficacy, changing TIME from a suppressive to an active form is essential.

Preoperative CT for Characterization of Aggressive Macrotrabecular-Massive Subtype and Vessels That Encapsulate Tumor Clusters Pattern in Hepatocellular Carcinoma.

Background Macrotrabecular-massive (MTM) subtype and vessels encapsulating tumor clusters (VETC) pattern of hepatocellular carcinoma (HCC) are associated with unfavorable prognosis. Purpose To estimate the potential of preoperative CT in the prediction of MTM subtype and VETC pattern. Materials and Methods Patients who underwent surgical resection or liver transplant and preoperative CT for HCC between January 2015 and June 2018 were retrospectively included in the primary cohort. CT imaging features were evaluated by two radiologists. Predictors associated with the MTM subtype or VETC pattern were determined by using logistic regression analyses and the performance was tested in a validation cohort. Prognostic factors associated with early recurrence after surgical resection were identified by using Cox regression analyses. Results The primary cohort included 170 patients (median age, 55 years; interquartile range, 48-63 years; 152 men). Serum α-fetoprotein level higher than 100 ng/mL (odds ratio [OR], 4.3; 95% CI: 2.1, 9.2; P < .001), intratumor necrosis (OR, 5.2; 95% CI: 2.5, 11.0; P < .001), and intratumor hemorrhage (OR, 5.4; 95% CI: 1.3, 23.3; P = .02) were independent predictors for MTM subtype, whereas tumor size greater than 5 cm (OR, 3.8; 95% CI: 1.7, 8.1; P = .001) and intratumor necrosis (OR, 2.1; 95% CI: 1.0, 4.4; P = .045) were independent predictors for VETC pattern. These features were used for the construction of ANH and SN scores (where A is α-fetoprotein level, N is necrosis, H is hemorrhage, and S is size), respectively, which showed comparable prediction performance in the primary and validation cohorts. Preoperative high ANH and high SN phenotype (hazard ratio, 1.9; 95% CI: 1.2, 3.0; P = .01) was independently associated with early recurrence after surgical resection. Conclusion Preoperative CT features could be used for the characterization of macrotrabecular-massive subtype and vessels that encapsulate tumor clusters pattern and were of prognostic significance for early recurrence in patients with hepatocellular carcinoma. Online supplemental material is available for this article. See also the editorial by Yoon and Kim in this issue. Published under a CC BY 4.0 license.

Clinical and Pathological Attributes of Hepatocellular Carcinoma Showing Lack of Restricted Diffusion on Magnetic Resonance Imaging

Objective: To correlate non-restricted diffusion magnetic resonance imaging (MRI) patterns of hepatocellular carcinoma (HCC), with histopathology and clinical outcome.Material and Methods: We retrospectively evaluated pre-treatment MRIs showing non-restricted diffusion HCC lesions (≥1-centimeter), excluding lesions with poor quality/non-available diffusion weighted imaging (DWI). Three radiologists evaluated 37 lesions in 27 patients, for: T1-weighted (T1W)/T2-weighted (T2W) characteristics, arterial enhancement, washout on portal venous/delayed phase, capsular enhancement, intralesional fat component and presence of cirrhosis. Histopathological reports were categorized as: well/moderate/poorly differentiated. Kaplan-Meier survival analysis was calculated for clinical outcome.Results: From a total of 37 lesions, 24 lesions had available pathological grading, which revealed well and moderately differentiated equally (12 lesions each). None of the non-restricted diffusion HCCs were poorly differentiated. Thirty-five of the 37 lesions (94.6%) showed arterial enhancement with washout; 34 lesions (91.9%) were T2W hypo-/isointense, 33 esions (89.2%) were T1W iso-/hyperintense, 19 lesions (51.4%) showed capsular enhancement and 8 lesions (21.6%) had intralesional fat. These findings in the well and moderately differentiated groups were not significantly different (p-value 0.178-1.000). Overall mean-survival was 6.972 years (95% confidence interval (CI); 5.3-8.6). The 1-year, overall survival rate was 83.6% and for 3-years was 67.9%. Mean survival of well and moderately differentiated groups were 6.88 and 7.23 years (95% CI 5.7-8.0 and 4.4-10.1), respectively (p-value=0.319).Conclusion: DWI may help to predict histological grading of HCC and clinical outcome. We found that non-restricted diffusion HCCs were histologically well or moderately differentiated, with no significant difference of imaging findings and survival rates between the two groups. No poorly differentiated lesions were seen in our non-restricted HCC cohort.

Coexpression of CMTM6 and PD-L1 as a predictor of poor prognosis in macrotrabecular-massive hepatocellular carcinoma

The “macrotrabecular-massive” (MTM) pattern of hepatocellular carcinoma (HCC) has been suggested to represent a distinct HCC subtype and is associated with specific molecular features. Since the immune microenvironment is heterogenous in HCC, it is important to evaluate the immune microenvironment of this novel variant. CMTM6, a key regulator of PD-L1, is an important immunocheckpoint inhibitor. This study aimed to evaluate the prognostic effect of CMTM6/PD-L1 coexpression and its relationship with inflammatory cells in HCC. We analyzed 619 HCC patients and tumors were classified into MTM and non-MTM HCC subtypes. The expression levels of CMTM6 and PD-L1 in tumor and inflammatory cells were evaluated by immunohistochemistry. The density of inflammatory cells in the cancer cell nest was calculated. Tumoral PD-L1 expression and inflammatory cell density were higher in the MTM type than in the non-MTM type. CMTM6-high expression was significantly associated with shorter OS and DFS than CMTM6-low expression in the whole HCC patient population and the MTM HCC patient population. Moreover, MTM HCC patients with CMTM6/PD-L1 coexpression experienced a higher risk of HCC progression and death. In addition, CMTM6/PD-L1 coexpression was shown to be related to a high density of inflammatory cells. Notably, a new immune classification, based on CMTM6/PD-L1 coexpression and inflammatory cells, successfully stratified OS and DFS in MTM HCC. CMTM6/PD-L1 coexpression has an adverse effect on the prognosis of HCC patients, especially MTM HCC patients. Our study provides evidence for the combination of immune status assessment with anti-CMTM6 and anti-PD-L1 therapy in MTM HCC patients.

Patterns of Hepatocellular Carcinoma on Computed Tomography at Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia.

Hepatocellular cancer is the commonest liver cancer which contributes to a high incidence of morbidity and mortality in both developed and developing countries. Despite the anticipated high burden of the disease in the country, there is paucity of data on the associated risk factors and its pattern on imaging. The aim of this study was to assess Computed Tomography patterns and the risk factors of hepatocellular carcinoma. A cross-sectional, prospective study on patients with a diagnosis of HCC on Computed Tomography examination, at Tikur Anbessa Specialized Hospital from July, 2016 to July, 2017. All patients who had characteristic Computed Tomography features and those who were diagnosed by Fine needle aspiration cytology (FNAC)/biopsy and had Computed Tomography examination were included in the study. Risk factors identified were reviewed from patients' medical records. A total of 70(n=70) patients were included in the study. The mean age was 50 ± 16 years. Fifty-seven (81.4%) of the participants were males, and 13(18.6%) were females. Forty-five (64.3%) of them came from urban areas and 25(35.7%) of them were from rural areas. The lesions were focal in 52(74.3%) and infiltrative in 18(25.7%) of the cases. Vascular invasion and distant metastases were seen in 49(70%) and 17(24.3%) respectively. Twenty-nine (41%) had negative hepatitis markers, and 13(19%) were not investigated for hepatitis infection. The majority of the patients presented with advanced disease such as vascular invasion and metastases. The major risk factors such as hepatitis infection were negative in significant number of patients. The risk factors in our setting should be studied further. Moreover, high-risk group selection and screening is essential to diagnose HCC early.

Different clinical patterns of hepatocellular carcinoma (HCC) in patients with NAFLD and HCV related chronic liver disease

Different clinical patterns of hepatocellular carcinoma (HCC) in patients with NAFLD and HCV related chronic liver disease

Clinical patterns of hepatocellular carcinoma (HCC) in non alcoholic fatty liver disease (NAFLD): a multicenter case-control study

the AFP, the poorer the prognosis, but no good evidence in the literature exists on the minority of patients with HCC who do not secrete AFP. Our aim was to analyse this sub-group of patients from a cohort with advanced HCC treated with Sorafenib, and assess survival outcomes. Methods: Consecutive patients with a confirmed diagnosis of HCC as per AASLD criteria, treated with Sorafenib at Queen Elizabeth Hospital Birmingham UK, between April 2009 and March 2014 were included in the analysis. We took our local reference range of 400ng/ml (HR: 1.02, p = 0.89). The Kaplan–Meier curve presented shows the separation of survival curves for the 3 groups. Conclusions: There is very little published in the literature about the AFP non-secretor HCC sub-group. Our data shows that this sub-group has better prognosis compared to patients with AFP secretory HCC. We believe that this data is important for clinicians and patients for prognostication and decision making. P0340 CLINICAL PATTERNS OF HEPATOCELLULAR CARCINOMA (HCC) IN NON ALCOHOLIC FATTY LIVER DISEASE (NAFLD): A MULTICENTER CASE–CONTROL STUDY F. Piscaglia, G. Svegliati Baroni, A. Barchetti, A. Pecorelli, S. Marinelli, C. Tiribelli, S. Bellentani, HCC-NAFLD Italian Study (full list exceeds available space) Bolondi L, Zoli M, Trevisani F, Malagotti D, Bugianesi E, Vanni E, Mezzabotta L, Cabibbo G, Petta S, Fracanzani A, Fargion S, Marra F, Fani B, Sacco R, Morisco F, Caporaso F, Guarino M, et al.. Dpt of Medical and Surgical Sciences, University of Bologna, Uni of Internal Medicine, University of Bologna, Bologna, Gastroenterology, University of Ancona, Ancona, Liver Research Center, Science Park – Basovizza Campus, Trieste, Italy E-mail: fabio.piscaglia@unibo.it

337. Imaging patterns of hepatocellular carcinoma and response to Yttrium 90

Please provide a structured abstract of 150 to 250 words which should be divided into the following sections:  Purpose (stating the main purposes and research question)  Methods  Results  Conclusions

Hepatocellular carcinoma 20mm or smaller in cirrhosis patients: early magnetic resonance enhancement by gadoxetic acid compared with gadopentetate dimeglumine.

To evaluate the differences in enhancement pattern of hepatocellular carcinoma (HCC) 20mm or smaller and enhancement effects of hepatic vessels on early dynamic contrast-enhanced magnetic resonance imaging (MRI) obtained with gadoxetic acid and gadopentetate dimeglumine in the same patients with cirrhosis. We reviewed MR images using gadoxetic acid and gadopentetate dimeglumine in the same 34 patients with 42 histologically confirmed HCCs (median diameter, 14.5mm). The percentage enhancements (PEs) of HCC, the hepatic artery and portal vein and relative contrasts (RCs) between HCC and the liver were calculated and analyzed statistically. The PEs of HCC, the hepatic artery and portal vein were significantly lower for gadoxetic acid in comparison with gadopentetate dimeglumine in the arterial phase (p=0.0256 for HCC, p<0.0001 for hepatic artery) and portal phase (p<0.0001 for HCC, portal vein). The RC between HCC and the liver was significantly lower for gadoxetic acid in comparison with gadopentetate dimeglumine in the arterial phase (p=0.0422), but was not significantly different in the portal phase (p=0.1133). Forty-one of the 42 (97.62%) nodules showed arterial hypervascularization. Of these, 31 (75.61%) nodules were hypointense in the portal phase for gadoxetic acid, and 22 (53.66%) were hypointense for gadopentetate dimeglumine (p=0.038). Compared with gadopentetate dimeglumine, gadoxetic acid-enhanced MRI demonstrated a different enhancement pattern of inferior arterial enhancement and was more rapidly hypointense in the portal phase for HCC. It showed markedly lower enhancement for hepatic artery and portal vein in the patients with cirrhosis.

Contrast Enhanced Ultrasonography for the Evaluation of Coil Embolization of Splenic Artery Aneurysm

A 65-year-old woman with compensated liver cirrhosis secondary to hepatitis C virus infection was under surveillance for early detection of hepatocellular carcinoma with ultrasonography and, due to suboptimal ultrasound feasability, at longer intervals with computed tomography (CT). During follow-up, a splenic artery aneurysm appeared and progressively increased from 18 mm to ≈30 mm in diameter over a 9-month interval. The patient had severe splenomegaly secondary to portal hypertension and hypersplenism with a low platelet count (≈30.000/mL). Percutaneous arterial embolization was proposed to the patient1 because severe portal hypertension was considered a contraindication to surgical splenectomy. Embolization was carried out, preceded by platelet infusion, using “fibered” coils and interlocking detachable coils without complications. Eight weeks later, the patient underwent abdominal CT as part of the surveillance program for hepatocellular carcinoma; no nodule with pattern of hepatocellular carcinoma was identified; at the splenic level, frank metallic artifacts were evident and prevented assessment of treatment efficacy (Figure 1) as described in previous reports from the literature with this technique.2 Figure 1. CT scan of the upper abdomen at a level passing through the treated splenic aneurysm. Arrows, metallic artifacts (similar to rays departing from the coils) don’t allow adequate assessment of treatment efficacy. To investigate the splenic aneurysm status, an attempt was made with conventional ultrasound (Figure 2) and color duplex-doppler ultrasonography, which failed to provide definitive and unquestionable information about the success of the embolization. Doppler ultrasound …

Fine needle aspiration: emphasis on the use of cell blocks

The major limitation of cytological preparations from fine needle aspiration (FNA), i.e. poor preservation of tissue architecture, could be circumventd by the use of cell blocks (CB). The 21-gauge needle yielded more and larger tissue of fragments suitable for histology with no increased risk of complications. The tissue was fixed directly in 7.5% buffered formalin and processed through shortened xylene cycle for better morphology. In thyroid lesions, CB allowed recognition of hyperplastic papillae and fragments of dilated follicles which were characteristic of colloid nodules and enabled distinction from follicular neoplasms to be made. On the other hand, follicles lined by columnar cells and prominent sinusoid stroma are in favour of follicular neoplasms. In the liver, CB revealed the trabecular and sinusoidal pattern of hepatocellular carcinoma well. Immnocytochemistry was also much more conveniently performed on CB which provided more sections to work on. The short and yet better fixation also enabled superior preservation of antigens. A histologial approach, in addition to cytological, would enhance diagnostic yield of FNA.