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Hepatic Immunoglobulin G4-related Inflammatory Pseudotumor Mimicking Hepatocellular Carcinoma.

Seung Heon KANG ; Sang Hoon PARK ; Ho Hyun PARK ; Jeong Rok LEE ; Won Hyeok CHOE ; So Dug LIM ; Soon Young KO

Journal of Liver Cancer.2016;16(2):151-154. doi:10.17998/jlc.2016.16.2.151

Immunoglobulin G4-related disease is a recently recognized entity characterized by a mass-forming or regional lesion that contains an extensive infiltration of IgG4-producing plasma cells with dense fibrosis. Immunoglobulin G4-related disease can affect any organ system, but solitary hepatic lesion of Immunoglobulin G4-related disease is very rare. This entity mimics primary malignant hepatic tumor, such as hepatocellular carcinoma or intrahepatic cholangiocarcinoma. We experienced a case of hepatic IgG4-related inflammatory pseudotumor in a 50-year-old woman, mimicking hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Cholangiocarcinoma ; Female ; Fibrosis ; Granuloma, Plasma Cell* ; Humans ; Immunoglobulins* ; Middle Aged ; Plasma Cells

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A Case of Surgical Resection in Hepatocellular Carcinoma with Pulmonary Metastasis.

Woo Jin JUNG ; Jae Young JANG ; Jun Seok PARK ; Hee Jeong LEE ; Young Kyu CHO ; Soung Won JEONG ; Sae Hwan LEE ; Sang Gyune KIM ; Sang Woo CHA ; Young Seok KIM ; Young Deok CHO ; Hong Soo KIM ; Boo Sung KIM

Journal of Liver Cancer.2016;16(2):145-150. doi:10.17998/jlc.2016.16.2.145

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

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Sarcomatoid Intrahepatic Cholangiocarcinoma: A Rare Case of Primary Liver Cancer.

Doo Hyuck LEE ; Kyu Hyung HAN ; Sun Young AHN ; Sang Sun KIM ; Hyun Sung SHIN ; Ki Bae BANG ; Jun Ho CHOI ; Suk Bae KIM ; Won Ae LEE ; Il Han SONG

Journal of Liver Cancer.2016;16(2):139-144. doi:10.17998/jlc.2016.16.2.139

Sarcomatoid carcinoma arising from intrahepatic cholangiocyte, an extremely rare primary liver cancer, has highly invasive and metastatic potential. The pathogenesis of this tumor is unclear, although histogenetic mechanisms, such as transdifferentiation/dedifferentiation (epithelial-mesenchymal transition or metaplastic transformation), biphasic differentiation (combination and collision), and redifferentiation, might be suggested to explain the simultaneous co-existence of carcinoma and sarcoma components in the same tumor. Immunohistochemical staining might be necessary to differentiate whether sarcomatous component is originated from hepatocyte or cholangiocyte. We report a case of sarcomatoid intrahepatic cholangiocarcinoma in a 58 year-old man presenting as an incidentally detected liver mass on regular health examination, which was diagnosed by an application of immunohistochemical methods after surgical resection, with a review of the literature based on 9 cases reported in Korea.
Cholangiocarcinoma* ; Hepatocytes ; Korea ; Liver Neoplasms* ; Liver* ; Sarcoma

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A Case of Advanced Hepatocellular Carcinoma with Portal Vein Tumor Invasion that Showed Favorable Prognosis after Combined External Radiation Therapy and Sorafenib Therapy.

Namyoung PAIK ; Dong Hyun SINN ; Hee Chul PARK ; Woo Kyung JEONG ; Min Sun KIM ; Ji Hye KIM ; Bumhee YANG

Journal of Liver Cancer.2016;16(2):134-138. doi:10.17998/jlc.2016.16.2.134

A prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal that the median survival is 2 to 4 months without treatment. Sorafenib, the standard regimen of advanced HCC, can prolong median survival only 1.5 months. A 50-year-old man with a history of chronic hepatitis B was diagnosed advanced HCC with PVTT. By a multidisciplinary medical team approach, the combination of 3-demensional conformal radiation therapy with sequential sorafenib was challenged. 4 months after initiation of treatment, he achieved partial response as modified response evaluation criteria in solid tumors criteria. Sorafenib was continued so far, and stable disease has been maintained up to now, without significant adverse effect.
Carcinoma, Hepatocellular* ; Hepatitis B, Chronic ; Humans ; Middle Aged ; Portal Vein* ; Prognosis* ; Response Evaluation Criteria in Solid Tumors ; Thrombosis

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A Case of Management for Hepatocellular Carcinoma with Lung Metastasis.

Han Jo JEON ; Tae Hyung KIM ; Soon Ho UM ; Yeon Seok SEO ; Hyun Seo KIM ; Ki Joon LIM ; Seung Woon PARK ; Han Ah LEE ; Dong Sik KIM

Journal of Liver Cancer.2016;16(2):129-133. doi:10.17998/jlc.2016.16.2.129

Liver cancer is the 2nd most common cause of cancer related death in Korea. Especially, patients who present extrahepatic spread of hepatocellular carcinoma (HCC) have a shorter life expectancy (50% survival at 1 year and less than 4 months of median overall survival). Molecular target agent like sorafenib was usually mentioned as a treatment for them, but that was still not firmly established. We present a 75 year-old who had expanding nodular type of HCC. The mass was removed by resection and radiofrequency ablation. However, lung metastasis were revealed shortly after surgery. That lesions were treated with lenvatinib and systemic chemotherapy.
Carcinoma, Hepatocellular* ; Catheter Ablation ; Drug Therapy ; Humans ; Korea ; Life Expectancy ; Liver Neoplasms ; Lung* ; Molecular Targeted Therapy ; Neoplasm Metastasis*

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A Case of Achieving Complete Remission with Stereotactic Body Radiation Therapy in Patients with Hepatocellular Carcinoma with Macrovascular Invasion after Repeated Transarerial Chemoembolization.

Sang Youn HWANG ; Seon Mi LEE ; Jong Woo IM ; Ki Jeong JEON ; Sang Bu AHN ; Eun Kyeong JI ; Jin Young PARK ; Cheol Won CHOI ; Gwang Mo YANG

Journal of Liver Cancer.2016;16(2):123-128. doi:10.17998/jlc.2016.16.2.123

Transarterial chemoembolization (TACE) is the worldwide procedure performed for patients with various stage hepatoceullar carcinoma (HCC), but is not yet considered as curative treatment because of relatively high local recurrence rate. Moreover, many clinicians frequently experience treatment failure (incomplete necrosis or stage progression etc.) after repeated TACE, but no clear guidelines have been recommended about salvage treatment modalities for this situation. Recently, studies for combination of radiation therapy and TACE for HCC with TACE refractoriness have been tried and reported better therapeutic efficacy. Based on above suggestions, we herein offer our experience of a patient with macrovascular invasion developed after repeated TACE that achieve complete remission by stereotactic body radiation therapy. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage HCC patients with TACE refractoriness.
Carcinoma, Hepatocellular* ; Humans ; Necrosis ; Recurrence ; Salvage Therapy ; Treatment Failure

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A Case of Successful Hepatic Resection after Insufficient Response to Transarterial Chemoembolization and Radiation Therapy in Hepatocellular Carcinoma with Portal Vein Invasion.

Seong Kyun NA ; Hyung Joon YIM ; Sang Jun SUH ; Young Kul JUNG

Journal of Liver Cancer.2016;16(2):118-122. doi:10.17998/jlc.2016.16.2.118

Hepatocellular carcinoma (HCC) with portal vein invasion has a poor prognosis. Treatments such as transarterial chemoembolization (TACE), radiation therapy (RT), sorafenib are done as a first line treatment. But in case of incomplete response to first line treatment, there's no established guideline about salvage treatment. We present a 47 year-old male who was diagnosed as HCC with portal vein invasion. He was treated with RT and repeated TACE, but remnant viable tumor was observed. Surgical resection was performed as a salvage treatment, and HCC was completely removed. He has been followed up over 3 years, but there was no recurrence.
Carcinoma, Hepatocellular* ; Humans ; Male ; Portal Vein* ; Prognosis ; Recurrence ; Salvage Therapy ; Thrombosis

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High-level Expression of Interleukin-17 and C-reactive Protein Predicts Tumor Progression in Unresectable Hepatocellular Carcinoma Treated by Transarterial Chemoembolization.

Myeong Jun SONG ; Sung Won LEE ; Eun Jee OH ; Bohyun JANG ; Jeong Won JANG ; Si Hyun BAE ; Jong Young CHOI ; Seung Kew YOON

Journal of Liver Cancer.2016;16(2):108-117. doi:10.17998/jlc.2016.16.2.108

BACKGROUND/AIMS: Transarterial chemoembolization (TACE) is the standard locoregional treatment in patients with unresectable hepatocellular carcinoma (HCC). Angiogenesis and inflammation play important roles in tumor growth in HCC. In this study, we evaluated the associations between the levels of growth factors and inflammatory markers and clinical prognosis in patients with unresectable HCC treated with TACE. METHODS: The clinical outcomes of 58 HCC patients treated with TACE at the Catholic Medical Centers from January, 2012 to February 2015 were evaluated. Baseline levels of the growth factors vascular endothelial growth factor, fibroblast growth factor, platelet-derived growth factor, and hepatocyte growth factor and the inflammatory cytokines interleukin (IL)-17 and high sensitivity C-reactive protein (hs-CRP) were compared with the treatment outcomes. The primary endpoint was time to progression (TTP); the secondary endpoint was overall survival (OS). RESULTS: During the 20.8 months of follow-up, TTP was significantly delayed in patients with low levels of hs-CRP (≤0.15) and IL-17 (≤0.94) and a maximal tumor diameter ≤5 cm (P=0.010, P=0.015, and 0.048, respectively). Patients with HCC with low hs-CRP and IL-17 levels had a longer survival than that of those with high hs-CRP levels and IL-17 (35.1 vs. 22.5 months, P=0.000; 41 vs. 21.8 months, P=0.000, respectively). However, any baseline growth factors were not significantly correlated with TTP and OS. CONCLUSIONS: Elevated IL-17 and hs-CRP may be predictive of a poor outcome in patients with HCC treated with TACE. A better understanding of this relationship will require further investigation of the immune mechanisms underlying tumor progression.
C-Reactive Protein* ; Carcinoma, Hepatocellular* ; Cytokines ; Fibroblast Growth Factors ; Follow-Up Studies ; Hepatocyte Growth Factor ; Humans ; Inflammation ; Intercellular Signaling Peptides and Proteins ; Interleukin-17* ; Interleukins ; Platelet-Derived Growth Factor ; Prognosis ; Vascular Endothelial Growth Factor A

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Cause of Mortality for Hepatocellular Carcinoma Patients who were Diagnosed within the Milan Criteria.

Hyun Woo LEE ; Dong Hyun SINN ; Wonseok KANG ; Geum Youn GWAK ; Yong Han PAIK ; Moon Seok CHOI ; Joon Hyeok LEE ; Kwang Cheol KOH ; Seung Woon PAIK

Journal of Liver Cancer.2016;16(2):101-107. doi:10.17998/jlc.2016.16.2.101

BACKGROUND/AIMS: Hepatocellular carcinoma (HCC) is a unique condition where the cause of death might not only be due to progressive cancer, but also from liver failure. We evaluated specific causes of death for HCC patients who were initially diagnosed within the Milan criteria. METHODS: A retrospective cohort of 147 patients with mortality who were initially diagnosed with HCC within the Milan criteria between January 2008 and December 2012 at a single institution was reviewed. RESULTS: During follow-up, 104 patients (70.7%) experienced one or more cirrhotic complications, such as ascites, variceal bleeding, or hepatic encephalopathy. Near mortality, cancer progression (exceeding the Milan criteria) was recorded for 102 patients (69.3%), while cirrhosis progression (greater than two-point increase in Child-Pugh score) was noted in 110 (74.8%) patients. Alpha-fetoprotein, protein-induced by vitamin K antagonist-II levels and treatment modality were associated with cancer progression, while age and Child-Pugh class were associated with cirrhosis progression. There were 61 patients with in-hospital mortality; cancer progression plus liver failure was noted in 34 patients (55.7%), liver failure without cancer progression was seen in 20 patients (32.8%), and only four patients (6.6%) showed mortality from extrahepatic metastasis without liver failure. CONCLUSIONS: Among HCC patients who were diagnosed within the Milan criteria, most of them had cirrhosis progression near mortality, and significant proportion died without uncontrolled cancer growth, mainly due to liver failure. These findings show the importance of liver function that should be considered in managing HCC patients.
alpha-Fetoproteins ; Ascites ; Carcinoma, Hepatocellular* ; Cause of Death ; Cohort Studies ; Esophageal and Gastric Varices ; Fibrosis ; Follow-Up Studies ; Hepatic Encephalopathy ; Hospital Mortality ; Humans ; Liver ; Liver Failure ; Mortality* ; Neoplasm Metastasis ; Retrospective Studies ; Vitamin K

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Diagnostic Performance of Diffusion-weighted Imaging for Hepatic Neuroendocrine Tumor: Comparison with Combined Diffusion-weighted Imaging and Contrast-enhanced Magnetic Resonance Imaging.

Suk Ki JANG ; Jung Hoon KIM ; Mi Hye YU ; Joon Koo HAN

Journal of Liver Cancer.2016;16(2):92-100. doi:10.17998/jlc.2016.16.2.92

BACKGROUND/AIMS: To investigate the diagnostic performance of diffusion-weighted imaging (DWI) for hepatic neuroendocrine tumors (NET) compared with combined DWI and contrast-enhanced magnetic resonance imaging (MRI). METHODS: Fifteen patients with hepatic NET (n=128) underwent enhanced MRI and DWI with multiple-b values. We analyzed three different sets: Precontrast set; DWI set (added DWI); combined set (added enhanced image). Two reviewers rated possibility of NET using a 5-point scale for each image set. Their diagnostic performance was compared using Jackknife alternative free-response ROC (JAFROC). RESULTS: Diagnostic performance was better on the combined set (figure of merit [FOM]=0.852, 0.761) than the precontrast set (FOM=0.427, 0.572, P〈0.05) and the DWI set (FOM=0.682, 0.620, P〈0.05). However, DWI improved performance compared with precontrast set without statistical difference. In small NETs (〈1 cm), all sets showed low sensitivity (10.7-65.9%) with high specificity (95.4-100%). Interobserver agreement was moderate in all image sets (k=0.521 to 0.589). CONCLUSIONS: Combined DWI and enhanced MRI were more useful for detecting NET. Although statistically insignficant, there was a trend in improved diagnostic performance with DWI.
Humans ; Magnetic Resonance Imaging* ; Neuroendocrine Tumors* ; Sensitivity and Specificity

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