Combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC) is sometimes found in resected livers, however, cases with double cancer of HCC and CC are very rare. As well, the rarity of CC arising in von Meyenburg complexes (VMCs) is appreciated. We report the case of a 74-year-old man found to have intrahepatic double cancer composed of well-differentiated HCC and CC which exhibited a histologic progression from VMCs to adenomatous lesions and CC. To our knowledge, this is the first case report published in the literature of a double HCC and CC associated with multiple VMCs. The pathogenesis and previous associated reports of these lesions are discussed.
Aged ; Bile Ducts, Intrahepatic/abnormalities* ; Carcinoma, Hepatocellular/pathology* ; Carcinoma, Hepatocellular/etiology ; Case Report ; Cholangiocarcinoma/pathology* ; Cholangiocarcinoma/etiology ; HumanLiver Neoplasms/pathology* ; Liver Neoplasms/etiology ; Male ; Neoplasms, Multiple Primary/pathology* ; Neoplasms, Multiple Primary/etiology

Hepatitis C virus (HCV) is a leading etiology of hepatocellular carcinoma (HCC). The interaction of HCV with its human host is complex and multilayered; stemming in part from the fact that HCV is a RNA virus with no ability to integrate in the host's genome. Direct and indirect mechanisms of HCV-induced HCC include activation of multiple host pathways such as liver fibrogenic pathways, cellular and survival pathways, interaction with the immune and metabolic systems. Host factors also play a major role in HCV-induced HCC as evidenced by genomic studies identifying polymorphisms in immune, metabolic, and growth signaling systems associated with increased risk of HCC. Despite highly effective direct-acting antiviral agents, the morbidity and incidence of liver-related complications of HCV, including HCC, is likely to persist in the near future. Clinical markers to selectively identify HCV subjects at higher risk of developing HCC have been reported however they require further validation, especially in subjects who have experienced sustained virological response. Molecular biomarkers allowing further refinement of HCC risk are starting to be implemented in clinical platforms, allowing objective stratification of risk and leading to individualized therapy and surveillance for HCV individuals. Another role for molecular biomarker-based stratification could be enrichment of HCC chemoprevention clinical trials leading to smaller sample size, shorter trial duration, and reduced costs.
Biomarkers, Tumor/genetics/metabolism ; Carcinoma, Hepatocellular/*etiology ; Hepacivirus/genetics/*pathogenicity ; Hepatitis C/complications/pathology/virology ; Humans ; Liver Neoplasms/*etiology ; Risk

Adult ; Aged ; Carcinoma, Hepatocellular ; etiology ; pathology ; prevention & control ; therapy ; Female ; Hepatitis B ; pathology ; therapy ; Humans ; Male ; Middle Aged ; Phyllanthus ; Phytotherapy ; Precancerous Conditions ; etiology ; pathology ; prevention & control ; therapy

Bile Duct Neoplasms ; pathology ; surgery ; Carcinoma, Hepatocellular ; complications ; pathology ; surgery ; Cholestasis, Intrahepatic ; etiology ; pathology ; surgery ; Humans ; Liver Neoplasms ; complications ; pathology ; surgery ; Neoplasm Invasiveness

A 66-year-old female patient was diagnosed with hepatocellular carcinoma accompanied by neuropathic pain induced by a metastatic tumor that compromised root and spinal canal. Although her pain was relieved following medical treatment, breakthrough pain occurring 1-2 times a day was still distressing. Neuropathic pain in her right lower limb caused discomfort and irritability and decreased her quality of life. We had limited options to adjust her prescription drug regime, due to the side effect of these drugs. Although acupuncture therapy was only performed at her home once a week, the efficacy was outstanding. The patient did not report any further instances of breakthrough pain, and she did not require additional bolus morphine. She could comfortably live in her familiar surroundings with her family and did not require any emergency room visits or admission into the hospital during the last month of her life. She had excellent quality of life in the terminal period of her life, and could even participate in a family function during this time. The present case report suggests that acupuncture may have a role in treating neuropathic pain induced by bone metastasis in patients with advanced cancer across clinical and in-home settings.
Acupuncture Therapy ; Aged ; Bone Neoplasms ; complications ; secondary ; Carcinoma, Hepatocellular ; pathology ; Female ; Home Care Services ; Humans ; Liver Neoplasms ; pathology ; Neoplasms ; pathology ; Neuralgia ; etiology ; therapy ; Quality of Life

Hepatitis B virus (HBV) infection is the major etiology of chronic liver disease worldwide and thus a global health problem, especially in Asia-Pacific region. The long-term outcomes of Asian HBV carriers vary widely; however, a significant proportion of them will finally develop end-stage liver disease. Over the past decade, several host and HBV factors predictive of clinical outcomes in Asian HBV carriers have been identified. The community-based REVEAL-HBV study illustrated the strong association between HBV-DNA level at study entry and risk of HCC over time, and male gender, older age, high serum alanine aminotransferase (ALT) level, positive HBeAg, higher HBV-DNA level, HBV genotype C infection and core promoter mutation are independently associated with a higher hepatocellular carcinoma (HCC) risk. Another hospital-based ERADICATE-B cohort further validated the HCC risk started to increase when HBV-DNA level was higher than 2,000 IU/mL. Of particular note, in patients with low viral load (HBV-DNA level <2,000 IU/mL), HBsAg level > or =1,000 IU/mL was a new independent risk factor for HCC. With the results from REVEAL-HBV study, a risk calculator for predicting HCC in adult non-cirrhotic patients has been developed and validated by independent international cohorts (REACH-B). With the combination of HBV-DNA, HBsAg, and ALT levels, ERADICATE-B study proposed an algorithm to predict disease progression and categorize risk levels of HCC as well as corresponding management in Asian HBV carriers. The introduction of transient elastography may further enhance the predictive power. In conclusion, HBsAg level can complement HBV-DNA level for the risk stratification of disease progression in Asian adult patients with chronic HBV infection.
Carcinoma, Hepatocellular/etiology ; DNA, Viral/blood ; Genotype ; Hepatitis B/*pathology ; Hepatitis B Surface Antigens/blood ; Hepatitis B virus/*genetics ; Humans ; Liver Neoplasms/etiology ; Risk Factors

OBJECTIVE: To assess the safety and therapeutic efficacy of a percutaneous radiofrequency (RF) ablation for the hepatocellular carcinoma (HCC) abutting the diaphragm. MATERIALS AND METHODS: We retrospectively assessed 80 patients who underwent a percutaneous RF ablation for a single nodular (< 4 cm) HCC over the last four years. Each patient underwent an ultrasound-guided RF ablation using internally cooled electrodes for the first-line treatment. We divided patients into two subgroups based on whether the index tumor was abutting (less than 5 mm) the diaphragm or not: group A (abutting; n = 31) versus group B (non-abutting; n = 49). We compared the two subgroups for complications and therapeutic efficacy using image and the review of medical records. The statistical assessment included an independent t-test, Fisher's exact test, and chi-square test. RESULTS: The assessment of the diaphragmatic swelling at CT immediately following the procedure was more severe in group A than group B (mean thickness change:1.44 vs. 0.46 mm, p = 0.00). Further, right shoulder pain was more common in group A than B (p = 0.01). Although minor complications (hemothorax 1 case, pleural effusion 1 case) were noted only in group A, no major thoracic complication occurred in either group. The technical success rate was lower in group A than group B (84% vs. 98%, p = 0.03). As well, the primary and secondary technique effectiveness rates in group A and group B were 90% versus 98% (p = 0.29) and 79% versus 91% (p = 0.25), respectively. The local tumor progression rate was higher in group A than in group B (29% vs. 6%, p = 0.02). CONCLUSION: We found that the percutaneous RF ablation for the HCC abutting the diaphragm is a safe procedure without major complications. However, it is less effective with regard to technical success and local tumor control.
Adult ; Aged ; Aged, 80 and over ; Burns/etiology ; Carcinoma, Hepatocellular/pathology/*surgery ; Catheter Ablation/*adverse effects ; Diaphragm/injuries/pathology ; Female ; Humans ; Liver Neoplasms/pathology/*surgery ; Lung Injury/etiology ; Male ; Middle Aged ; Shoulder Pain/etiology ; Treatment Outcome ; Young Adult

To study the manifestations of endoscopic retrograde cholangiopancreatography (ERCP) in patients of obstructive jaundice associated with HCC, 32 cases of histopathologically diagnosed HCC with obstructive jaundice were successfully examined with routine ERCP. 31 patients were demonstrated by ERCP as having malignant obstructive jaundice. Among them, 19 were hepatic perihilar bile duct stricture, 7 bile ductile tumorous thrombus, 3 perihilar bile duct stricture complicated with thrombus, 2 metastasis to hilar lymph node, and 1 common bile duct stone as proven by sphincterotomy. The malignant perihilar stricture was all of type III and IV by Bismuth standard of Klastin tumor. In patients identified as having bile duct tumor thrombus, by the Ueda classification, none was of type I and II; 1 type III a; 4 III b; 2 type IV. HCC with obstructive jaundice was mainly caused by the malignant infiltration of tumor, and most stricture was of serious nature. When major extra-hepatic bile duct was involved by tumor thrombus, obstructive jaundice might develop. Malignant perihilar stricture and tumor thrombus might coexist in some patients. Jaundice was rarely caused by hepatic hilar lymph node metastasis. Jaundice was not necessarily caused by tumors and sometimes, it might be caused by common bile stones. Care should be exercised in differentiation diagnosis in such patients.
Adult ; Aged ; Carcinoma, Hepatocellular ; complications ; diagnosis ; pathology ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Humans ; Jaundice, Obstructive ; diagnosis ; etiology ; Liver Neoplasms ; complications ; diagnosis ; pathology ; Male ; Middle Aged

Carcinoma, Hepatocellular ; pathology ; surgery ; Humans ; Liver Neoplasms ; pathology ; surgery ; Liver Transplantation ; Neoplasm Recurrence, Local ; etiology ; prevention & control ; therapy ; Prognosis ; Treatment Outcome

BACKGROUND/AIMS: Spontaneous rupture of hepatocellular carcinoma (HCC) is known as a rare but life- threatening condition because of massive blood loss into the peritoneal cavity. In the countries with high prevalence, the reported incidence of spontaneous rupture and hemorrhage ranged from 10.2% to 14.5% of patients with HCC. This study was aimed to analyze the risk factors for spontaneous rupture and prognosis in the patients with ruptured HCC. METHODS: Among 642 consecutive patients with HCC who had admitted to Gyeongsang National University Hospital from January 1998 to September 2003, spontaneous rupture of HCC occurred in 83 patients (12.9%). The medical records of the 83 patients were reviewed retrospectively, and the clinico-laboratory parameters and radiologic findings were analyzed. RESULTS: Sixty-nine out of the 83 patients were male, the mean age was 57.7 +/- 13.2 years (male, 56.8 +/- 12.9 years; female, 62.3 +/- 13.5 years). Location of tumor, Child-Pugh class and Okuda stage were the risk factors influencing spontaneous rupture of HCC, whereas the TNM stage, presence of portal vein thrombosis, and size of the tumor were not. Among the 83 patients with ruptured HCC, 51 were treated by transarterial embolization (TAE), 31 by supportive measures, and 1 by operation. The median survival time was 3.4 +/- 4.5 months in all patients with ruptured HCC, 4.9 +/- 5.1 in successful TAE, and 2.1 +/- 3.4 in supportive measure groups. CONCLUSIONS: Advanced Child-Pugh class, advanced Okuda stage, and peripheral location were the risk factors for spontaneous rupture of HCC. The prolonged survival could be achieved in patients eligible for successful transarterial embolization rather than supportive measures.
Aged ; Carcinoma, Hepatocellular/*complications/pathology ; English Abstract ; Female ; Hemoperitoneum/etiology ; Humans ; Liver Neoplasms/*complications/pathology ; Male ; Middle Aged ; Prognosis ; Risk Factors ; Rupture, Spontaneous