With the advances in hepatocellular carcinoma (HCC) treatment, the lung metastasis of HCC is becoming increasingly important. In treating the lung metastasis of HCC, a multidisciplinary approach can lead to better results than systemic chemotherapy alone. Here, we report on a patient who presented with pulmonary masses, while the HCC was being controlled in the abdominal cavity. The presence of nontuberculous mycobacteria was identified during the diagnosis of the pulmonary masses. The pulmonary metastases of HCC were treated with a combination of angiotherapy, radiation therapy, and radiofrequency ablation. The patient showed a satisfactory progress with this multidisciplinary localized treatment. We report the clinical progress and review the recent literature regarding the treatment of pulmonary metastasis without intrahepatic HCC herein.
Abdominal Cavity ; Carcinoma, Hepatocellular ; Catheter Ablation ; Diagnosis ; Drug Therapy ; Humans ; Lung ; Neoplasm Metastasis ; Nontuberculous Mycobacteria

Carcinoma, Hepatocellular ; drug therapy ; therapy ; Chemoembolization, Therapeutic ; Female ; Humans ; Intracranial Embolism ; chemically induced ; diagnosis ; Iodized Oil ; administration & dosage ; adverse effects ; Liver Neoplasms ; drug therapy ; therapy ; Middle Aged

Hepatocellular carcinoma (HCC) is well known malignancy with poor prognosis, even after resection of the primary tumor. Sorafenib is the first-line treatment in advanced HCC, but the disease control rate of sorafenib is only 43%. Pulmonary metastasectomy in patients with pulmonary metastasis from HCC has been reported to increase long-term survival compared with systemic chemotherapy. Video-assisted thoracic surgery is considered a reliable approach to the diagnosis and treatment of pulmonary diseases with low complication rate. Pulmonary metastasectomy is not universally accepted because of frequent local recurrence, an uncontrollable primary tumor, and frequent multiple pulmonary metastases in HCC, but outcome of pulmonary metastasectomy and adjuvant sorafenib therapy has not been studied. We experienced a patient who had advanced HCC with pulmonary oligometastasis and received surgical resection of the metastatic pulmonary nodule and sorafenib chemotherapy. In advanced HCC with pulmonary oligometastasis, surgical resection of pulmonary metastasis and sorafenib chemotherapy should be considered.
Carcinoma, Hepatocellular* ; Diagnosis ; Drug Therapy ; Humans ; Lung Diseases ; Metastasectomy ; Neoplasm Metastasis* ; Prognosis ; Recurrence ; Thoracic Surgery, Video-Assisted

PURPOSE: Surgical excision has been the primary treatment for hepatoblastoma and hepat-ocellular carcinoma. However, at presentation, only one third of such tumors are surgically resectable. Without operation, the disease is fatal. Therefore, neoadjuvant chemotherapy has been introduced for conversion of the unresectable tumors into the resectable ones. We studied th e effects of chemotherapy for hepatic malignancy in children. METHODS: Between November 1986 and August 1993, 30 children presented with hepatoblastomas or heptocellular carcinoma, which were diagnosed by histology. We analysed the laboratory findings of hepatic tumors and the outcome of chemotherapy. RESULTS: Laboratory findings revealed mild anemia, elevated SGOT/SGPT, and extremely increased AFP level. Twenty-six among 30 patients entered into surgery or neoadjuvant chemotherapy. Initial complete resection of tumor was attempted in 11 case, and was successful in 9 cases. Fifteen cases with initially unresectable tumors were treated with chemotherapy including cisplatin and/or doxorubicin. Nine of 15 showed significant reduction in tumor size, and delayed resection of the primary lesion was possible. But one case did not respond to chemotherapy, and 5 cases was droped out due to death(n=2) and refusal of chemotherapy(n=3). Twenty p atients were enrolled in survival analysis. Over-all 3 year survival rate was 61%, and 2 year survival rates of hepatoblastoma and hepatocellular carcinoma were 85% and 33% respectively(P=0.06). According to the stage, 2 year survival rate of stage I and III were 87% and 75% respectively. None of patient with metastasis survived at 16 months. Chemotherapy was tolerable in most patients and its principal toxicities were myelosuppression and fever. Three patients developed decreased left ventricular shortening fraction and their cumulative dose of doxorubicin were 771mg/m2, 557mg/ m2, and 390mg/ m2. CONCLUSIONS: Chemotherapy including cisplatin and/or doxorubicin is an effective treatment in inducing surgical resectability in hepatoblastomas which are unresectable at diagnosis.
Anemia ; Carcinoma, Hepatocellular* ; Child* ; Cisplatin ; Diagnosis ; Disulfiram ; Doxorubicin ; Drug Therapy* ; Fever ; Hepatoblastoma* ; Humans ; Neoplasm Metastasis ; Survival Rate

The purpose of our study was to evaluate children who underwent hepatic resection for primary malignant hepatic tumor in the period from January 1994 to December 2001. A total of 8 patients, seven with hepatoblastoma (HB) and one with hepatocellular carcinoma (HCC). were studied. One HCC was respectable at the initial diagnosis, but five cases of unresectable HB received two cycles of transarterial chemoembolization (TACE) before operation. One patient with an unresectable HB with bone marrow metastasis was operated after one cycle of TACE and one cycle of systemic chemotherapy based on CCG-823F protocol. All 6 patients who underwent TACE and neoadjuvant chemotherapy showed marked redcuction in tumor volume and a clear outline of the lesion. Major complication was not noticed. Mean alpha-fetoprotei (alpha-FP) level at diagnosis, after neoadjuvant chemotherapy and after postoperative chemotherapy was 9,818 (42-35,350), 664, and 10.1 ng/mL, respectively. Half life of the alpha-FP after complete resection was 5.1 days (3.0-8.7 days). Median follow up period was 57.1 months (10-97 months) and all the patients are alive with NED. In conclusion, preoperative chemotherapy, especially TACE, is effective, safe, and useful to treat initially unresectable hepatoblastoma, and serial level of the serum alpha-FP is a useful tumor marker for diagnosis and monitoring therapeutic responses.
Bone Marrow ; Carcinoma, Hepatocellular ; Child ; Diagnosis ; Drug Therapy ; Follow-Up Studies ; Half-Life ; Hepatoblastoma ; Humans ; Neoplasm Metastasis ; Tumor Burden

BACKGROUND: Metastases to the pancreas are uncommon, and are usually a part of widespread disease. However, isolated metastatic lesions can be resected, which can lead to prolonged survival of the patient. The aim of this study was to evaluate the characteristics of metastatic tumors of the pancreas in a Korean poulation. METHODS: We evaluated clinical features and treatment results in patients with a pathological confirmation of metastasis to the pancreas from January 1997 to June 2005. RESULTS: Twenty-five patients were included in the study. Nineteen patients were male. The mean age at the diagnosis of the metastasis was 58.2 years. Renal cell carcinoma was the most frequent primary malignancy (n=8), followed by gastric carcinoma (n=5), colorectal carcinoma (n=2), hepatocellular carcinoma (n=1), lymphoma (n=1), thymic carcinoid (n=1), gastrointestinal stromal tumor (n=1), liposarcoma (n=1), cholangiocarcinoma (n=1), osteosarcoma (n=1), small cell lung cancer (n=1), and non-small cell lung cancer (n=1). Eleven patients were asymptomatic upon diagnosis. The mean interval between the primary diagnosis and diagnosis of the metastases was 4.9 years. Fourteen patients underwent surgery with or without chemotherapy, five patients received chemotherapy, one patient received radiation therapy, and five received palliative care. The mean survival after the diagnosis of metastasis was 44.3 months. Renal cell carcinoma as the primary tumor, asymptomatic upon diagnosis of the metastasis, the interval between primary diagnosis and diagnosis of the metastases of more than 43 months, and surgery with or without chemotherapy were associated with a prolonged survival. CONCLUSIONS: Metastasis to the pancreas can occur after a prolonged period from an initial diagnosis. In selected patients (e.g., renal cell carcinoma), aggressive treatment can prolong survival.
Carcinoid Tumor ; Carcinoma, Hepatocellular ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Renal Cell ; Cholangiocarcinoma ; Colorectal Neoplasms ; Diagnosis ; Drug Therapy ; Gastrointestinal Stromal Tumors ; Humans ; Liposarcoma ; Lymphoma ; Male ; Neoplasm Metastasis ; Osteosarcoma ; Palliative Care ; Pancreas* ; Small Cell Lung Carcinoma

Aged ; Antineoplastic Agents ; adverse effects ; Carcinoma, Hepatocellular ; drug therapy ; Hand-Foot Syndrome ; diagnosis ; etiology ; Humans ; Liver Neoplasms ; drug therapy ; Male ; Neoplasms, Multiple Primary ; drug therapy ; Niacinamide ; adverse effects ; analogs & derivatives ; Phenylurea Compounds ; adverse effects

Hepatocellular carcinoma is a fatal disease with median survival less than 6 months. About 50% of hepatocellular carcinoma patients showed distant metastasis at earlier stage. Common metastatic sites are lung, intraabdominal lymph nodes, adrenal gland or bone, in order of frequency. Renal metastasis from hepatocellular carcinoma is rare with the incidence of 1.2-4.3% at autopsy. Lack of clinical symptoms and signs make it difficult to diagnose metastatic renal cancer before dying of. Common primary sites of metastatic renal cancer are malignant lymphoma, lung, stomach or breast. We report a case of hepatocellular carcinoma with renal metastasis. A 54 female patient was found to have coincidental right hepatic and right renal tumors on abdominal ultrasonographic and computed tomographic examinations. After the percutaneous needle biopsy on the right hepatic tumor and right renal tumor, histopathologic and immunohistochemical studies ultimately confirmed the diagnosis of hepatocellular cracinoma with renal metastasis. Intraarterial chemotherapy with cisplatin for primary hepatocellular carcinoma and intraarterial embolization for renal metastatic lesion were performed.
Adrenal Glands ; Autopsy ; Biopsy, Needle ; Breast ; Carcinoma, Hepatocellular* ; Cisplatin ; Diagnosis ; Drug Therapy ; Female ; Humans ; Incidence ; Kidney Neoplasms ; Lung ; Lymph Nodes ; Lymphoma ; Neoplasm Metastasis* ; Stomach

BACKGROUND/AIMS: Little is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion. METHODS: A total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included. RESULTS: The majority of patients had Barcelona Clinic Liver Cancer (BCLC) stage C HCC (66.8%). Portal vein tumor thrombosis was present in 166 (67.2%) patients. Median survival was 4.1 months. Various modalities of treatment were initially employed including surgical resection (10.9%), repeated transarterial chemoembolization (TACE) (42.5%), and conservative management (42.9%). Among the patients with obstructive jaundice (n=88), successful biliary drainage was associated with better overall survival rate. Among the patients with BCLC stage C, overall survival differed depending on the initial treatment for HCC; surgical resection, TACE, systemic chemotherapy, and conservative management showed overall survival rates of 11.5, 6.0 ,2.4, and 1.6 months, respectively. After adjusting for confounders, surgical resection and repeated TACE were significant prognostic factors for HCC patients with bile duct invasion (hazard ratios 0.47 and 0.39, Ps <0.001, respectively). CONCLUSIONS: The survival of HCC patients with bile duct invasion at initial diagnosis is generally poor. However, aggressive treatments for HCC such as resection or biliary drainage may be beneficial therapeutic options for patients with preserved liver function.
Bile Ducts* ; Bile* ; Carcinoma, Hepatocellular* ; Diagnosis ; Drainage ; Drug Therapy ; Humans ; Jaundice, Obstructive ; Liver ; Liver Neoplasms ; Portal Vein ; Prognosis ; Retrospective Studies ; Survival Rate ; Thrombosis

BACKGROUND/AIMS: Gastric hepatoid adenocarcinoma (GHA), a rare type of primary gastric cancer, is characterized by a histology resembling hepatocellular carcinoma. Previous case studies reported that patients with GHA have a poor prognosis due to early lymph node or liver metastasis, but information concerning GHA is still limited. Therefore, we aimed to evaluate the clinicopathological features of GHA. MATERIALS AND METHODS: We reviewed the medical records of 9 patients who were diagnosed as having GHA between January 2011 and December 2016. The clinicopathological characteristics of these patients were retrospectively analyzed. RESULTS: The median age of the patients at diagnosis was 68.9 years. Seven of the 9 patients were male. Serum AFP levels were elevated in 3 of 4 patients. All the tumors were >4 cm (range, 4~12 cm), and 7 tumors were located at the lower third of the stomach. Five tumors were classified as Borrmann's type 3, with a purple, berry-like surface. Of the 6 patients without distant metastasis, 5 received curative-intent surgery and 3 received adjuvant chemotherapy. Three patients with distant metastasis received either palliative operation and/or chemotherapy. Their median survival time was 11.8 months (range, 1~36 months). Two patients with elevated serum CEA levels had poor outcomes. CONCLUSIONS: GHA is a rare subtype of gastric cancer that is prone to liver metastasis. All GHAs are advanced gastric cancer with a purple, berry-like surface at diagnosis. Although the prognosis of advanced-stage GHA is poor, active multimodality treatment might provide some benefit.
Adenocarcinoma* ; Carcinoma, Hepatocellular ; Chemotherapy, Adjuvant ; Diagnosis ; Drug Therapy ; Endoscopy ; Humans ; Liver ; Lymph Nodes ; Male ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies ; Stomach ; Stomach Neoplasms