Hepatocellular carcinoma (HCC) frequently occurs in association with liver cirrhosis, as chronic liver disease is one of the most important factors in carcinogenesis. In addition to HCCs, recent reports of pathologic studies of resected specimens from cirrhotic liver describe associated small nodular lesions such as regenerative nodule, dysplastic nodule (adenomatous hyperplasia), and dysplastic nodule with subfocus of HCC (early HCC). In hepatocarcinogenesis of the cirrhotic liver, a regenerative nodule might be the first step in the development of HCC, going through phases of dysplastic nodule, early HCC and early advanced HCC in a multistep fashion. Fortunately, recent advances in various imaging techniques have facilitated the verification of these nodules. In this review, new nomenclature of small hepatocellular nodules, and detection and characterization of hepatic nodules in carcinogenesis with various imaging techniques are described with focus on the premalignant lesions and early stage of HCC. In addition, the efficacy of various imaging techniques for diagnosing them is discussed. Although the terms and definitions of these nodules are still variable and controversial, familiarity with the concept of these borderline lesions is important.
Carcinoma, Hepatocellular/pathology ; Carcinoma, Hepatocellular/diagnosis* ; Carcinoma, Hepatocellular/complications ; Diagnostic Imaging*/methods ; Human ; Liver Cirrhosis/pathology ; Liver Cirrhosis/diagnosis* ; Liver Cirrhosis/complications ; Patient Care Management ; Terminology

Metabolic (dysfunction) associated fatty liver disease (MAFLD), previously known as non-alcoholic fatty liver disease, is the most common cause of chronic liver disease worldwide. Many risk factors contribute to the pathogenesis of MAFLD with metabolic dysregulation being the final arbiter of its development and progression. MAFLD poses a substantial economic burden to societies, which based on current trends is expected to increase over time. Numerous studies have addressed various aspects of MAFLD from its risk associations to its economic and social burden and clinical diagnosis and management, as well as the molecular mechanisms linking MAFLD to end-stage liver disease and hepatocellular carcinoma. This review summarizes current understanding of the pathogenesis of MAFLD and related diseases, particularly liver cancer. Potential therapeutic agents for MAFLD and diagnostic biomarkers are discussed.
Carcinoma, Hepatocellular/complications* ; Humans ; Liver Neoplasms/complications* ; Non-alcoholic Fatty Liver Disease/complications* ; Risk Factors

A 67-year-old man, diagnosed as hepatocellular carcinoma by percutaneous needle aspiration biopsy of liver mass, presented microangiopathic hemolytic anemia, thrombocytopenia and renal failure from the early phase of the illness. We could establish the diagnosis of cancer-associated hemolytic uremic syndrome which was unrelated to chemotherapy clinically. This is a rare case reported in adult hepatoma patients.
Aged ; Carcinoma, Hepatocellular/*complications ; Case Report ; Hemolytic-Uremic Syndrome/*etiology ; Human ; Liver Neoplasms/*complications ; Male

Carcinoma, Hepatocellular ; complications ; surgery ; Humans ; Liver Cirrhosis ; etiology ; surgery ; Liver Neoplasms ; complications ; surgery

Carcinoma, Hepatocellular ; complications ; genetics ; pathology ; Humans ; Liver Neoplasms ; complications ; genetics ; pathology

Hepatocellular carcinoma (HCC) is one of the most common malignancies. Many factors are considered to be etiology associated with HCC; the important factors are hepatitis B and C viruses and alcohol. Cirrhosis is present in the majority of patients with HCC. It is assumed that all diseases, which lead to liver cirrhosis, may be complicated by the development of HCC. We report a 36-year-old man with HCC which developed from cardiac cirrhosis caused by constrictive pericarditis in whom both hepatitis B virus and hepatitis C viral marker tests were all negative. CT scan of his heart showed pericardial calcification with diastolic dysfunction of right ventricle. Abdominal CT scan revealed mottled mosaic pattern of contrast enhancement of liver parenchyme and two hepatic lesions that were considered to be HCCs. Left lateral segmentectomy of liver was performed. There were two well-circumscribed masses which were confirmed to be HCC and the remaining hepatic parenchyma showed bridging fibrosis between central zonal regions. To our knowledge, this is the first case of HCC complicating cardiac cirrhosis in Korea.
Adult ; Bromhexine ; Carcinoma, Hepatocellular/*complications/radiography ; Humans ; Liver Cirrhosis/*complications/radiography ; Liver Neoplasms/*complications/radiography ; Male ; Pericarditis, Constrictive/*complications/radiography

BACKGROUND/AIMS: Patients with hepatocellular carcinoma (HCC) may manifest paraneoplastic syndromes such as hypercholesterolemia, hypoglycemia, hypercalcemia and erythrocytosis. This study was aimed at evaluating the incidence and clinical significance of paraneoplastic syndromes in Korean HCC patients. METHODS: The medical records of 165 HCC patients who were diagnosed and died in the Kyung Hee University Hospital, were reviewed retrospectively. The following variables were analyzed: age, gender, hepatitis markers, platelet, liver function test, alpha-fetoprotein (AFP), Child-Pugh score, tumor features, and the duration of their survival. RESULTS: In total, paraneoplastic syndromes were presented in 43.6% of the HCC patients during the course of their disease. Hypercholesterolemia was solely presented in 14.5%, hypoglycemia in 12.7% and hypercalcemia in 7.8%. The patients who presented with more than 2 syndromes were 8.5%. While 80% of erythrocytosis (4/5) and 51.6% of hypercholesterolemia (16/31) was presented at the time of HCC diagnosis, hypoglycemia and hypercalcemia mainly occurred as terminal events. The patients with paraneoplastic syndromes were younger and had higher rates of portal vein thrombosis, bi-lobar tumor involvement and tumor more of more than 10 cm in diameter, compared to those patients without them. The proportion of patients with a serum AFP more than 400 ng/mL tended to be higher in the patients with paraneoplastic syndromes. The HCC patients with paraneoplastic syndromes, except for erythrocytosis, had a shorter survival than those patients without them. CONCLUSIONS: Paraneoplastic syndromes are not infrequently presented in HCC patients, especially at an advanced stage, and the survival of these patients is relatively shorter.
Aged ; Carcinoma, Hepatocellular/*complications/mortality ; English Abstract ; Female ; Humans ; Liver Neoplasms/*complications/mortality ; Male ; Middle Aged ; Paraneoplastic Syndromes/complications/diagnosis

Portal venous tumor emboli is one of the important factors that affect the prognosis of patients with hepatocellular carcinoma (HCC). There are different characters of surgery, interventional therapy, radiation therapy, treatment of local damage, targeted therapy in the treatment of portal venous tumor emboli, but the effects are not ideal. Scholars at home and abroad are exploring a variety of treatment patterns in the treatment of portal venous tumor emboli, to achieve better effect.Predominantly surgical comprehensive treatment can excision of tumor and tumor emboli, improve liver function, improve the quality of survival, prolong survival time. But the operation risk is big. Mainly non-surgical treatment has advantages of little trauma, less risk, and better local control of tumor emboli. But the efficiency, effect, alleviate period is ineffective. Therefore, the best treatment mode should be explored according to the different tumor emboli parting.
Carcinoma, Hepatocellular ; complications ; surgery ; Humans ; Liver Neoplasms ; complications ; surgery ; Neoplastic Cells, Circulating ; Portal Vein ; Prognosis ; Thrombosis ; complications ; surgery

OBJECTIVETo perform a meta-analysis of contrast-enhanced ultrasound (CEUS) as a diagnostic tool for small hepatocellular carcinoma (HCC) in patients with cirrhosis.

METHODSA computer-based retrieval system was first used to identify reports on the diagnostic efficacy of CEUS for small HCC in patients with cirrhosis that were published between 1995 and April 2012 in the following literature databases: Medline, PubMed, Foreign Medical Journal Service (FMJS), China National Knowledge Infrastructure (CNKI), VIP Journal Integration Platform (VJIP), Wanfang Chinese Periodical Database, and Chinese Biomedicine Database (CBM). Two investigators, working independently, then selected cases from the relevant based upon specific inclusion and exclusion criteria. The extracted data was subjected to quality assessment of diagnostic accuracy studies (QUADAS). The MetaDisc version 1.4 software was used to conduct meta-analyses.

RESULTSSix studies, involving 380 lesions detected by various contrast mediums, were selected for analysis. Diagnosis of small HCC in patients with cirrhosis by CEUS based on Sonovue and Levovist had pooled sensitivities of 0.73 (95% confidence interval (CI): 0.67-0.79) and 0.76 (95% CI: 0.60-0.89), pooled specificities of 0.89 (95% CI: 0.81-0.94) and 0.79 (95% CI: 0.61-0.91), pooled positive likelihood ratios of 6.53 (95% CI: 2.74-15.52) and 3.60 (95% CI: 1.89-6.85), pooled negative likelihood ratios of 0.26 (95% CI: 0.13-0.54) and 0.21 (95% CI: 0.02-2.63), and pooled diagnostic odds ratios of 27.50 (95% CI: 7.99-94.72) and 25.74 (95% CI: 5.30-125.04), respectively. The area under the curve of the summary receiving operating characteristic (SROC) of CEUS based on Sonovue was 0.9252 and the Q* index was 0.8595.

CONCLUSIONCEUS is a valuable diagnostic tool for small HCC in cirrhotic patients.

Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; Contrast Media ; Humans ; Liver Cirrhosis ; complications ; diagnostic imaging ; Liver Neoplasms ; complications ; diagnostic imaging ; Ultrasonography

BACKGROUND/AIMS: To determine the treatment modalities and the prognosis of a patient with liver cirrhosis, quantitative estimation of liver function is important. We assessed the Child-Pugh score (CPS), the common method as a severity index for the cirrhosis, the Promthombin, gamma GT, and Apolipoprotein A1 (PGA) index and model for end-stage liver disease (MELD) score. The purpose of this study was to evaluate the correlation between these indices in the patients with cirrhosis only and hepatocellular carcinoma (PHC), according to underlying causes (HBV and alcohol). METHODS: We reviewed medical records of 339 cirrhotic patients with/without hepatocellular carcinoma and divided patient groups by disease and underlying cause: cirrhosis caused by alcohol; LC-Al, cirrhosis caused by HBV; LC-B, hepatocellular carcinoma with cirrhosis caused by alcohol; HCC-Al, hepatocellular carcinoma with cirrhosis caused by HBV; HCC-B. We assessed the CPS, PGA index and MELD score and calculated the correlation coefficient between these scores. RESULTS: Among the total of 339 patients, 201 patients were diagnosed on the liver cirrhosis only, and 138 patients on the hepatocellular carcinoma with cirrhosis. In each groups, mean score values were not significantly different in CPS, PGA index and MELD score. The correlation of CPS, PGA index and MELD score in all groups, except for the correlation of PGA index and MELD score in HCC-Al group, was significantly positive (p<0.05). Compared to correlation coefficients between three indices, the patients with cirrhosis only had higher tendencies than the patients with hepatocellular carcinoma. The patients by HBV had higher tendencies than by alcohol. CONCLUSIONS: The correlations between CPS, PGA index and MELD score showed significantly positive correlations in the patients with liver cirrhosis only and hepatocellular carcinoma with cirrhosis (except in HCC-Al group). The patients with cirrhosis only had higher correlation coefficients than the patients with PHC and the patients by HBV had higher than by alcohol.
Adult ; Aged ; Carcinoma, Hepatocellular/*complications ; Female ; Hepatitis B/*complications ; Humans ; Liver Cirrhosis/*complications ; Liver Cirrhosis, Alcoholic/complications ; Liver Neoplasms/*complications ; Male ; Middle Aged ; Prognosis ; *Severity of Illness Index