Progression Of Liver Lesions Research Articles

Radiographic response of desmoplastic mesenteric lesions to peptide receptor radionuclide therapy (PRRT).

362 Background: 177Lu-dotatate PRRT is indicated in well-differentiated, SSTR+ small bowel NETs. These tumors often metastasize to mesenteric lymph nodes and produce a desmoplastic reaction, consisting of tumor cells mixed with fibrotic tissue. We hypothesized that in patients treated with 177Lu-dotatate, mesenteric tumors would remain stable even as liver tumor size changes were observed. Methods: We retrospectively reviewed the records of all patients treated with 177Lu-dotatate between 4/2018 and 12/2019. Among patients with desmoplastic mesenteric tumors and liver metastases, we evaluated changes in tumor size of mesenteric and liver lesions based on pre and post-treatment radiology reports. Due to the infrequency of objective radiographic response (ORR), any reported changes in tumor size were considered significant. Scans were subsequently reviewed by a radiologist to confirm findings. Results: 21 patients met the inclusion criteria: 9 had evidence of shrinkage of liver lesion(s), 1 report described mild progression of liver lesions, 7 described stable hepatic disease and 4 described mixed hepatic progression/response. 2 of the patients with hepatic tumor shrinkage met criteria for PR by RECIST 1.1. Desmoplastic mesenteric lesions remained unchanged in size, regardless of the changes detected on liver lesions. Conclusions: 177Lu-dotatate does not impact desmoplastic mesenteric tumors typically associated with midgut NETs. Patients whose disease is confined to desmoplastic mesenteric lesions are unlikely to respond radiographically to PRRT. Moreover, the inclusion of desmoplastic mesenteric lesions as target lesions in RECIST measurements increases rates of disease stability versus response or progression.

Five Year Survival in Hepatocellular Carcinoma with Herbal Agents

A 53 years old man with hepatitis C presented 5 years ago, with right upper quadrant pain and a liver lesions (Right lobe:10×10 cm and a smaller left lobe lesion). Alpha-fetoprotein (AFP) level was 900 ng/ml (normal 0 -9 ng/ml), biopsy revealed hepatocellular carcinoma (HCC). He did not receive any therapy and 8 months later his AFP levels went down to 230 ng/ml and CT scan showed complete clearing of left lobe lesion and right lobe lesion had 50% shrinkage. He reports taking a variety of herbal agents since the diagnosis of HCC and the list included, Black Walnut, Barley Green, Ellagic Acid, Cell Forte, Coral Calcium, Chlorophyll water, Milk Thistle, Activin OPC 50 and Gene flora. Liver lesion remained stable and AFP levels dropped to two digits and remained between 25 and 75 ng/ml for around three years. Patient quit taking herbal medications on his physician's advice and due to the cost of herbal medications ($1000/month). His AFP levels started rising and tumor size increased. He was started on chemotherapy, AFP rose to 42000 ng/ml with progression of liver lesions. He refused further chemotherapy and was referred to hospice. He is alive at the time of writing this report, 5 years after the diagnosis of HCC. Discussion: HCC has a median survival of 6 to 20 months. Given the variety of agents he was taking it is difficult to identify any single agent. Several of the herbal medicines he was taking are suspected to have anticancer activity. Studies have shown that Ellagic acid inhibits the growth of cancer cells and promotes apoptosis. Cell forte (IP6inositol + regular inositol) inhibit cell adhesion, migration and invasion in human breast cancer cells. Conclusion: We report a case of advanced HCC that showed significant response to herbal supplements. Further research on the anti-tumor effects of these herbal agents can result in better understanding of HCC and may lead to the development of newer therapeutic agents.

Lysosomal injury and MFO activity in the liver of flounder ( Platichthys flesus L.) in relation to histopathology of hepatic degeneration and carcinogenesis

Flounder ( Platichthys flesus L.), 18–48 cm total length were sampled in the mouth of the Elbe River during a 3-year interdisciplinary project ‘Fish Diseases in the Wadden Sea’. Lysosomal changes (lysosomal membrane stability) and the activity of biotransforming enzymes (MFOs/EROD) were measured parallel to investigations of ultrastructural changes in liver cells, tissue pathologies and macroscopically visible changes. The aim of the study was to investigate if these cyto- and biochemical parameters were able to reflect contaminant induced biological effects. Interlinking of the results of the MFO activity to the pathological alterations observed at the electron- and light-microscopic levels as well as during macroscopic inspection of identical individuals evidenced that the activity of the biotransformation enzymes (EROD) was not induced in healthy livers, increased considerably with the onset of liver changes and dropped again in those livers with degenerative, preneoplastic and neoplastic lesions. In contrast, concurrent studies of lysosomal membrane stability measured in parallel showed a decrease with the onset and progression of liver lesions from reversible to irreversible, neoplastic change.