Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hepatic angiomyolipoma is a rare benign mesenchymal tumor of the liver. Most multiple hepatic angiomyolipomas have appeared in patients with renal angiomyolipoma and tuberous sclerosis. A 38-year-old female patient without chronic hepatitis B or C was hospitalized because of epigastric fullness for 2 months. Radiologic studies showed a large solid tumor with a small daughter nodule in the right hepatic lobe. Upon intravenous bolus injection of contrast medium, both tumors showed weak heterogeneous enhancement in the delayed phase. Although hepatocellular carcinoma was suspected by the findings of computed tomography, percutaneous transhepatic ultrasound-guided biopsy was performed for the large tumor. The histopathology showed many mature fat cells intermingled with thick-walled blood vessels, and epithelioid cells with eosinophilic cytoplasm; the epithelioid cells stained positively for HMB-45 and smooth muscle actin. Angiomyolipoma of the liver was confirmed. The main tumor enlarged considerably during a follow-up period of 3 years. Surgical resection was performed due to persistent symptoms. She had an uneventful postoperative recovery and was well when followed up 10 months after surgery. We should be aware that a hepatic angiomyolipoma can change in size during its natural course, and this finding does not necessarily indicate malignancy.
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PMID:Angiomyolipoma of the liver: case report. 1148 Mar 29

To determine the safest and most efficient way of performing hepatectomy, the differences in methods employed by Japanese surgeons were examined. In November 1998, a questionnaire on bleeding control during hepatectomy was sent to 270 hospitals located throughout Japan. The answers from 231 hospitals (85.6%) were analyzed. Surgical apparatus such as an ultrasonic dissector (USD) was used in 203 hospitals. Pringle's maneuver was performed routinely in 25%, for segmentectomy and subsegmentectomy in 25%, for lobectomy in 9%, depending on the situation in 34%, and never in 7%. In 135 hospitals (60%), hemostatic materials such as fibrin glue were always applied to the cut surface after hepatectomy. The USD was chosen and widely accepted by the hospitals studied. As Japanese patients with hepatoma often have liver cirrhosis, intermittent occlusion and the selective clamping of hepatic inflow were considered preferable to persistent inflow occlusion. The gentle exposure of hepatic venous branches, careful hemostasis during hepatectomy, and accurate location of the hepatic vein by intraoperative ultrasonography were all considered to be extremely important.
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PMID:Control of intraoperative bleeding during liver resection: analysis of a questionnaire sent to 231 Japanese hospitals. 1187 17

Pulmonary lymphangioleiomyomatosis (LAM) is an uncommon disease that to this point has been known to occur exclusively in reproductive women. To our knowledge, only one case of pulmonary LAM that was proven pathologically has been reported in a genotypical and phenotypical man. Multiple occurrence of hepatic angiomyolipomas is also rare, and only six cases have been found in the literature. Here, we report a biological and phenotypical man who had pulmonary LAM and multiple hepatic angiomyolipomas, leading to a presumptive diagnosis of tuberous sclerosis. This unusual presentation further broadens the wide spectrum of various clinicopathological aspects of pulmonary lymphangioleiomyomatosis and hepatic angiomyolipoma. Here, we emphasize that multiple hepatic angiomyolipomas should be distinguished from hepatic tumors, particularly in an endemic area for hepatocellular carcinoma. Further, pulmonary lymphangioleiomyomatosis can be a cause of cystic pulmonary disease even in a man.
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PMID:Pulmonary lymphangioleiomyomatosis and multiple hepatic angiomyolipomas in a man. 1267 67

Cardiac tumors in infants and children are extremely rare. Their clinical manifestations vary widely from asymptomatic presentations to life-threatening cardiac events. Improvements in diagnostic techniques, such as those offered by echocardiography, have made early detection of cardiac masses possible, with or without the presence of clinical symptoms. Fifteen pediatric cases of cardiac tumor were diagnosed at our institution between July 1989 and July 2002 (male-female ratio, 10:5; age range, one day to nine years). Eleven of the cases involved primary cardiac tumors [rhabdomyoma (n = 10) and fibroma (n = 1)]. Ninety percent of the rhabdomyomas (9/10) were associated with tuberous sclerosis. Four of the fifteen cases were secondary metastatic tumors [hepatoblastoma (n = 2), hepatoma (n = 1) and rhabdomyosarcoma (n = 1)]. Clinical manifestations of the cardiac tumors included shortness of breath (n = 5), seizure (n = 4), cardiac murmur (n = 6), and cyanosis (n = 3). Surgery was performed for three of 11 patients with primary cardiac tumor (27%) due to severe obstruction of flow (n = 2) and other cardiac defects (n = 1). The primary cardiac tumor spontaneously regressed in five of the tuberous sclerosis patients. All four of the patients with secondary cardiac tumors continued to receive chemotherapy, and only one of them subsequently experienced regression. Based on our experiences, we conclude that: 1) rhabdomyoma is the most common primary cardiac tumor in children; 2) most pediatric tumors are associated with tuberous sclerosis; 3) clinical presentation is determined by the tumor size and number of tumors, and whether expansion of the malignancy has resulted in cardiac blood-flow obstruction; 4) there is a strong possibility of regression of the primary cardiac tumor, with surgery recommended only when cardiac symptoms are severe; and, 5) unless there is a significant obstruction of blood flow, chemotherapy is still the treatment of choice for secondary cardiac tumors.
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PMID:Cardiac tumors in infants and children. 1467 25

In the belief that the advantages stemming from a minimally invasive approach are significant, particularly in cirrhosis patients, we decided to apply this technique in the treatment of a group of patients suffering from HCC associated with cirrhosis. Sixteen patients (10 men, 6 women; mean age 60.1 years) underwent laparoscopic surgery for HCC associated with well compensated HCV-related liver cirrhosis (Child-Pugh class A; mean tumour size 2.9 cm). Seven of these lesions were located in the left liver and 9 in the right lobe. Laparoscopy was performed with a CO2 pneumoperitoneum (12-14 mmHg). The Pringle manoeuvre was not used. There was one conversion to laparotomy due to inadequate exposure. We performed 13 non-anatomical resections, 1 VI segmentectomy and 1 anatomical left lobectomy. None of the patients required blood transfusions. One patient died of severe respiratory distress syndrome on postoperative day 3. Major morbidity included 2 moderate postoperative ascites successfully resolved with conservative treatment. To date (mean follow-up: 18 months) no recurrences at the resection site or port-site metastases have been observed. Limited laparoscopic liver resections for HCC in cirrhotic patients are technically feasible and safe when careful selection criteria are adopted (hepatic involvement limited and located in the left or anterior right segments, tumour size smaller than 5 cm, Child-Pugh class A).
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PMID:[Laparoscopic liver resection without a Pringle maneuver for HCC in cirrhotic patients]. 1583 34

Reducing blood loss during resection of hepatocellular carcinoma (HCC) in patients with impaired liver function is important. This study evaluated the effect and safety of inflow occlusion (hemihepatic vascular occlusion and the Pringle maneuver) in reducing blood loss during hepatectomy. A total of 120 HCC patients with impaired liver function (with a preoperative indocyanine green retention rate at 15 minutes > 10%) who underwent hepatectomy were included in this retrospective study. Patients were divided into three groups, no-occlusion (n = 30), hemihepatic vascular occlusion (n = 49), and Pringle maneuver (n = 41). There was one hospital death in each group. Of all three groups, 50 patients (41.7%) had blood loss less than 1000 ml. The three groups were similar in terms of clinocopathological features. All patients underwent minor resection. Blood loss was significantly greater in the no-occlusion group; there was no difference between the hemihepatic group and the Pringle group. Multivariate analysis revealed that risk factors related to blood loss included no inflow occlusion [odds ratios (ORs), 2.93; 95% confidence intervals (CIs) 1.13-7.59], tumor centrally located (ORs, 3.85; 95% CIs, 1.50-9.90), serum albumin level < 3.5 gm/dl (ORs, 5.15; 95% CIs, 1.20-22.07), and serum alanine aminotransferase >120 U/l (ORs, 3.58; 95% CIs, 1.19-10.80). For patients with occlusion time > or = 45 minutes, postoperative serum total bilirubin and aspartate aminotransferase levels in the Pringle group were significantly higher than those in the hemihepatic and no-occlusion groups (P < 0.05). In HCC patients with impaired liver function undergoing hepatectomy, both hemihepatic vascular occlusion and the Pringle maneuver are safe and effective in reducing blood loss. Patients subjected to hemihepatic vascular occlusion responded better than those subjected to the Pringle maneuver in terms of earlier recovery of postoperative liver function, especially when occlusion time was > or = 45 minutes.
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PMID:Evaluation of effect of hemihepatic vascular occlusion and the Pringle maneuver during hepatic resection for patients with hepatocellular carcinoma and impaired liver function. 1624 64

Laparoscopic surgery is a relatively new option for the treatment of hepatocellular carcinoma (HCC) on cirrhosis. To date, there have been only a few reports of this option for this pathology in the literature, probably because of the intra operative difficulties related to the treatment of this pathology (even at laparotomy) and because of the problems related to the minimally invasive approach (technical difficulties, complicated management of the bleeding, lack of dedicate tools, and fear of gas embolism). In this article we report four patients from our whole series (23 laparoscopic liver resections for HCC) who underwent a laparoscopic resection for completely exophytic HCC on cirrhosis, located in segment IV in two patients, and in segment III and segment V respectively, in the other two. The mean operative time was 116 min (range, 90-150 min). The Pringle maneuver was never performed. No blood transfusions were needed. No postoperative complications occurred, neither ascites, nor jaundice, nor encephalopathy. Postoperative liver function returned to the preoperative level within 3 days. Food intake started on postoperative day 2. The patients were discharged on postoperative days 5 (one patient), 6 (two patients), and 7 (one patient) after uncomplicated courses. In our opinion, limited laparoscopic liver resections could be considered, at present, to be the best option for the treatment of extremely rare protruding HCC on cirrhosis. We believe that a minimally invasive approach can minimize the postoperative morbidity rate, which is still too high in this group of patients. Our experience confirmed that nonanatomical limited resections or anatomical left lateral segmentectomies for HCC on cirrhosis are feasible and safe in the hands of surgeons trained in both open liver surgery and advanced laparoscopic surgery.
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PMID:Laparoscopic hepatic resection for completely exophytic hepatocellular carcinoma on cirrhosis. 1636 25

The incidence of hepatocellular carcinoma (HCC) in cirrhotic patients is increasing. Despite advances in imaging and laboratory screening which allow earlier diagnosis, the surgeon is all too often confronted with an HCC of advanced stage or arising in the setting of severe cirrhosis. Hepatic resection is still considered the treatment of choice for hepatocellular carcinoma in patients with liver cirrhosis. From 1998 to 2005, 6 patients (5 males, 1 female, age 52-70 years, mean age 64.1 years) with HCC associated severe, but well compensated liver cirrhosis (Child A-- 4 patients, Child B--2 patients) underwent 9 hepatic resection in our department. Mean tumor size was 56 mm (range 23-86 mm). Two of these lesions were in the left liver and four in the right lobe. Doppler ultrasonography was performed in all cases and CT in 3 cases to confirm the extension of the lesions. Laparoscopy was performed in 3 patients under CO2 pneumoperitoneum. The Pringle maneuver was not used. The transection of the liver parenchyma was obtained by the use of Ligasure and harmonic scalpel. Nine hepatic resections were performed: 7 segmentectomy and 2 non-anatomical resections. The resection margin was 1 cm. The mean operative time was 90 minutes (range 60-120). Mean blood loss was 250 ml and 2 patients required blood transfusion. One patient died on the tenth postoperative day from a severe respiratory distress syndrome and hepatic failure. Major morbidities occurred in three patients who developed moderate postoperative ascites, which resolved successfully with conservative treatment in two patients. Limited liver resection in cirrhotic patients with HCC is feasible with a low complication rate when careful selection criteria are followed (tumor size smaller than 8 cm, Child-Pugh A class and the good general conditions of the patients). Other medical and interventional treatments (chemoembolization, chemotherapy) can only slow the progress of HCC.
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PMID:[Liver resection for hepatocellular carcinoma in cirrhotic patients]. 1661 Jan 75

Consensus is lacking concerning how to manage afferent vessels during hepatectomy, particularly as to the Pringle maneuver vs. selective hemihepatic clamping. Data for 81 hepatocellular carcinoma patients with chronic hepatitis or liver cirrhosis whose liver resection was limited to one section or less, including intraoperative data and postoperative liver function data, were analyzed retrospectively to compare two strategies. No significant differences of intraoperative data or postoperative clinical course were seen between the two groups, even in patients with chronic hepatitis or liver cirrhosis whose postoperative deterioration of liver function could be expected to be more than patients with a normal liver. The difference was evident only in serum alanine aminotransferase level on postoperative day 10 (mean +/- SEM, 64.5 +/- 5.1 IU in the Pringle group vs. 51.6 +/- 4.4 IU in the selective clamping group; P < 0.05). During liver resection limited to one section or less, even with underlying chronic hepatitis or cirrhosis, intermittent use of the Pringle maneuver preserved liver function to the same extent as selective clamping.
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PMID:Outcome using hemihepatic vascular occlusion versus the pringle maneuver in resections limited to one hepatic section or less. 1684 68

The growing clinical impact of radiofrequency ablation of liver lesions is reflected by a rapidly increasing number of published papers. Experimental work focuses on factors that reduce the variability of the ablation zone. The Pringle-maneuver plays a key role in this question from a surgeon's perspective. Large single center studies and a meta-analysis show a sharp rise in the rate of local recurrences for tumors larger 3 cm. An open surgical approach is significantly correlated to a low local recurrence rate. Bile duct lesions and intrahepatic abscesses are the most frequent complications. Intraductal bile duct cooling can prevent these complications. Three prospective randomized trials support the use of RFA for small hepatocellular carcinoma. The use of RFA in patients with multiple colorectal metastases is supported by single center studies showing a 3 year survival of > 35%. The favourable cost / benefit ratio will make RFA a part of future multimodal cancer therapy concepts.
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PMID:[Percutaneous, laparoscopic and open surgical radiofrequency ablation of malignant liver lesions]. 1772 30


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