Objective:To explore the diagnosis and treatment of lymphoepithelioma-like intrahepatic cholangiocarcinoma(LEL-ICC).Methods:The retrospective and descriptive study was conducted. The data of 7 patients with pathological diagnosis of LEL-ICC after hepatectomy who were treated in Lishui Central Hospital in Zhejiang Province from December 1, 2009 to January 30, 2024 were collected. There were 2 males and 5 females. The age range was from 40 to 64 years old, with a median age of 52 years old. All 7 patients showed no obvious clinical symptoms.We analysed the imaging manifestations, pathological features, treatmentsand prognoses of patients.Postoperative follow-upswere conducted via telephone, with a focus on whether the patient had relapsed. The deadline was February 20, 2024.Results:Five cases underwent ultrasound examination, of which 4 cases showed hypoechogenicity and 1 case showed hyperechogenicity. 7 cases underwent MRI examination, showing low signal on T1WI, high signal on T2WI, and high signal on diffusion-weighted imaging. 2 cases had type A enhancement, 2 cases had type B enhancement, and 3 cases had type C enhancement. All 7 cases received surgical treatment, 2 cases were received prophylactic transarterial chemoembolization (TACE) after surgery, and 3 cases were received systemic chemotherapy after surgery; All 7 cases underwent postoperative follow-up, with a follow-up time of 1-166 months and a median follow-up time of 56 months. One case developed hilar and retroperitoneal lymph node metastasis after surgery for 6 months, and underwent surgical treatment. After surgery, chemotherapy was performed. 25 months later, right adrenal gland metastasis reappeared, and after combined treatment, the metastatic lesion was reduced and the patient received surgical treatment and chemotherapy, and there is currently no recurrence. The remaining 6 cases showed no recurrence.Conclusions:LEL-ICC lacks specific clinical symptoms and imaging manifestations, diagnosis relies on histopathological and immunohistochemical examinations. Comprehensive treatment with surgical intervention as the main approach can lead to better prognosis for patients.

Hepatocellular carcinoma (HCC) is a malignant tumor with high incidence rate and mortality worldwide. However, most patients are not suitable for radical treatment at the time of first diagnosis. As one of the important schemes for the treatment of HCC, one of the most representative drug is Sorafenib, which has certain survival benefits for HCC patients at different stages. However, the drug resistance of HCC to Sorafenib greatly limits its efficacy. So far, people have found that some natural substances, experimental agents and biological macromolecules can reverse the drug resistance of HCC to Sorafenib through tumor cell microenvironment, metabolism and other mechanisms. This article will summarize the above substances and their mechanism in order to provide research ideas for the improvement of Sorafenib′s treatment program.

Objective:To explore the clinical manifestations, diagnosis and treatment methods, and prognosis of acute portal vein thrombosis after hepatectomy.Methods:Retrospective case analysis was used in the case data of 11 patients with acute portal vein thrombosis after hepatectomy, who were treated in Lishui Central Hospital of Zhejiang Province from January 2018 to August 2023, including their demographic characteristics, clinical manifestations, test results, imaging examinations, treatment plans, and prognosis.Results:The diagnostic time of PVT was 4-15 days after surgery. 5 cases were main portal vein thrombosis, including 2 cases who were accumulated splenic vein and superior mesenteric vein, and 6 cases were portal vein branch thrombosis. 2 cases had fever, 3 cases had abdominal distension, 3 cases had ascites, and 5 cases had no obvious clinical symptoms. Patients may experience elevated bilirubin, elevated transaminase, prolonged prothrombin time, and elevated D-2 dimer levels during PVT. 10 cases were diagnosed through CT enhancement, and 1 case was first diagnosed through ultrasound examination. 11 patients who diagnosed with PVT were received anticoagulant therapy, with 6 patients receiving a combination of circulatory improvement drugs. One patient progressed to liver failure, and 10 patients had thrombus disappearance, who were receivedsatisfactory clinical efficacy.Conclusions:Early detections and treatments are the key to treating the acute PVT after hepatectomy. If possible, anticoagulant therapy should be used as soon as possible after surgery. For main grade 3 portal vein thrombosis, early surgical thrombectomy should be considered. At present, there is a lack of effective prevention and prediction methods for acute PVTafter hepatectomy, and thefurther research and exploration are needed.

Hepatocellular carcinoma (HCC) is the sixth most common malignant disease in the world and one of the main causes of cancer-related death. At present, the treatment of patients with advanced HCC is very limited, and as an important research direction of advanced cancer treatment in recent years, immunotherapy has achieved good results. Up to now, scholars have tested a variety of immunotherapy methods, and the use of immune checkpoint inhibitor (ICIs) in the treatment of advanced cancer has made considerable progress. However, immunotherapy is still incurable for HCC, and the benefit of treatment is limited to a small number of patients. In the current context of liver cancer, one of the key research directions of oncology is to understand the biomarkers that predict the clinical response of immunotherapy, so as to improve patient selection, maximize clinical benefits and avoid unnecessary toxicity. Compared with tumor and surrounding tissue biomarkers, peripheral blood biomarkers play a unique role in clinical research and use because of their advantages of non-invasive detection. In this review, we summarize the peripheral blood biomarkers that play a key role in predicting the clinical response and prognosis of HCC patients.

Chronic inflammation and tumor occurrence and development, recurrence and metastasis and immune escape and other key links have a far-reaching impact. The level of inflammation and immunity can be reflected by the markers of inflammatory response, including C-reactive protein, neutrophils, platelets, lymphocytes and their combinations in the blood, such as neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, lymphocyte to monocyte ratio, systemic immune inflammation index and so on. At present, inflammatory index has been proved to be predictors of recurrence and survival in a variety of malignant tumors. Hepatocellular carcinoma (HCC), as a common invasive tumor, is often diagnosed in the late course of the disease, so patients often can not achieve a satisfactory prognosis. This article mainly reviews the clinical application of the above inflammatory response indexes in HCC.

Hepatocellular carcinoma is one of the pathological types of primary liver cancer, and its prognosis is often not ideal. The prognosis of patients with hepatocellular carcinoma is not only closely related to tumor load and general physical status, but also closely related to liver reserve function. Albumin-bilirubin grading (ALBI) is a new model reflecting liver reserve function. In many therapeutic measures, such as surgical resection, liver transplantation, transcatheter arterial chemoembolization, radiofrequency ablation and targeted therapy, its ability to predict the prognosis of patients with hepatocellular carcinoma has been proved to be no less than that of Child-Pugh grade, which is widely used in clinic, and its predictive performance will be further improved when combined with other indexes.Therefore, it has great application value in clinical practice. This article mainly reviews the clinical application of ALBI grade in patients with hepatocellular carcinoma and the progress of research results in recent years.

Objective To explore the effect of supplemental parenteral nutrition (SPN) combined with early enteral nutrition (EN) for enhanced recovery in postoperative liver cancer patients.Methods From June 2015 to June 2018,liver cancer patients admitted to our hospital were randomly divided into two groups with 47 patients receiving SPN combined with early EN in the study group and 45 patients receiving early EN in the control group.Results There were no significant difference in bilirubin recovery,liver enzyme recovery,postoperative exhaust and defecation time and complication rate between the two groups (P ＞ 0.05).In study group prealbumin (PAB) synthesis recovered faster (F =7.89,P =0.006),albumin use was significantly lower (t =-2.29,P =0.0024),and postoperative hospital stay was shorter (t =2.46,P =0.016).Conclusion In ERAS patients with liver cancer,the combination of SPN and early EN provide reasonable energy support to improve nutritional status and accelerate patient recovery.

Objective To investigate the impact of blood glucose level on the recurrence of liver cancer after laparoscopic surgery. Methods The clinical data of 98 patients with primary hepatocellular carcinoma from January 2012 to January 2015 were retrospectively analyzed. All patients were treated by laparoscopic radical resection of hepatocellular carcinoma. Patients were divided into elevated blood glucose group (n = 23) and control group (n = 75) according to whether the fasting blood glucose was ≥6.1 mmol/L. The recurrence of liver cancer in 1 year and 2 years after operation was compared. The factors influencing the recurrence of liver cancer were analyzed by univariate and multivariate analysis. Results The recurrence rates were 47.82% and 21.33% respectively in the patients with elevated blood glucose and the control group. The recurrence rates were 73.91% and 36.00%respectively in the 2-year postoperative patients with blood glucose and 1 year and 2 years. The recurrence rate was higher than that of the control group, the difference was statistically significant (P < 0.05). Logistic multivariate analysis showed that fasting blood glucose was high, Child-Pugh grade B, intraoperative blood transfusion, lymphatic invasion, high clinical pathology stage, postoperative alpha-fetoprotein (AFP) high, no postoperative adjuvant therapy (P < 0.05). Conclusion The recurrence rate of patients with elevated liver cancer after laparoscopic surgery is high, and fasting blood glucose is high, Child-Pugh grade is B grade, blood transfusion is high, there is lymphatic invasion, high clinical pathology stage after AFP high, no postoperative adjuvant therapy for its postoperative recurrence of risk factors, should strengthen the monitoring of high-risk patients, reduce postoperative recurrence rate.

Eukaryotic initiation factor 5A (eIF5A),which is ubiquitous in the eukaryote,is the unique protein containing the special lysine hypusine.There are evidences show that eIFSA is involved in the progress of translation,peptide elongation and peptide bond formation,and takes part in the occurrence and development of various human diseases.The activation of eIF5A is essential to its biological function.The active eIFSA is involved in the growth of plasmodium and contributes to tumor proliferation.And it can act as nuclear output protein to integrate special mRNA,and in this way the special mRNA can shuttle between the nucleus and cytoplasm.Basing on these findings,the scientists pay more attention to eIF5A,and deem it as a direction to cure some related human diseases.

Neurofibroma is an autosomal dominant genetic disease which is originated from the abnormal differentiation of neural crest cells and would cause system damage.NF can occur at most organs in the body,while it is rarely seen in the common bile duct.In February 2007,1 old patients with NF was admitted to the Lishui Central Hospital of Zhejiang Province.The results of preoperative magnetic resonance cholangiopancreatography (MRCP) revealed that the common bile duct was slightly dilated,and the diameter of the common bile duct was 1.2 cm.A nodular short T2 signal lesion was detected at the middle part of the common bile duct with the size of 1.4 cm × 1.6 cm.The results of intraoperative rapid frozen section pathological examination showed that the lesion was cholangiocarcinoma,then cholangiocarcinoma resection + biliojejunal Roux-en-Y anastomosis was applied to the patient.Postoperative pathological examination confirmed that the lesion was neurofibroma.The patient was followed up for 7 years and died of pulmonary infection in June 2014.The clinical presentation of neurofibroma of the common bile duct is untypical.Space-occupying lesions detected in the patients with history of bile duct injury or operation should be considered to be diagnosed as neurofibroma.Special attention should be paid to the accuracy of the results of rapid frozen section pathological examination in order to avoid missdiagnosis.