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Query: UMLS:C0019204 (hepatocellular carcinoma)
 71,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirteen patients with hepatic tumors, from the Boston Center for Liver Transplantation, have been transplanted among a total of 169 recipients. Ten were transplanted primarily for tumor, while three other patients harbored incidental tumors. Two perioperative deaths occurred (15%). Eight patients had hepatocellular carcinoma, one hepatoblastoma and four bile duct (Klatskin) tumors. Two of the bile duct cancers recurred with patient deaths at 9 and 10 months. The remaining nine patients are alive from between 1 month and 36 months postoperatively. A selected review of the literature allowed analysis of follow-up on 185 patients transplanted for tumor. Overall, the proportion of patients transplanted for tumor was 16%. Fifty-two percent of patients had hepatocellular carcinomas (HCC), 24% cholangiocarcinomas, 10% other primary liver tumors, and 14% metastatic hepatic tumors. Median survival for HCC was 1 year; 90-day mortality was 30%. Actuarial survival for 1, 2 and 3 years was 49%, 37% and 30% respectively. Fibrolamellar HCC and incidental HCC had significantly better results than other HCC. Tumor recurrence was present in 72% of autopsies after 90 days. Transplantation for HCC has satisfactory results in selected patients and may be improved by adjuvant chemotherapy. The median survival with cholangiocarcinomas was 8 months; 90-day mortality was 40%. Actuarial survival for 1 year was 36%. Recurrence was present in 100% of autopsies after 90 days. Survival after transplantation for this tumor was similar to that observed in patients not undergoing surgical treatment. Median survival for 18 other primary hepatic tumors was 16 months. Transplantation in carefully selected patients with these other primary tumors appears warranted. Although experience overall with transplantation for metastatic disease has been relatively unfavorable, each histological type must be considered independently.
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PMID:Experience with transplantation in the treatment of liver cancer. 253 55

According to the European Liver Transplant Registry the percentage of patients selected to receive liver grafts for malignant liver disease decreased from 40% in 1983 to 23% currently. This development is due to disappointing results: 2-year survival rates of about 25-30% have been reported for malignant diseases compared to about 70% for benign diseases. Correlating the stage of the primary tumor and the survival time according to TNM-grading recent publications now show that the T1-3 and N-0 stage are clearly prognostic for long-term survival in contrast to a T-4 or N-1 stage which indicate a limited prognosis for about 90% of patients with HCC and Klatskin carcinoma during the first postoperative year.
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PMID:[Liver transplantation in tumors]. 257 57

The regenerative process was evaluated in terms of liver size, function, and histology in 28 adults who had major hepatic resection: hepatocellular carcinoma (HCC) in 21, secondary liver cancer from colorectum in four, carcinoma of the gallbladder in one, Klatskin tumor in one, and Caroli's disease in one. There were 22 men and six women. Ages ranged from 17 to 74 years with a mean age of 56.7. All patients with HCC had underlying liver disease: liver cirrhosis in 14 and chronic hepatitis in seven. Extended right lobectomy was done on 10 patients, right lobectomy on 16 patients, and left lobectomy on two patients. The residual liver size was serially estimated with computed tomography (CT) in 15 patients: six with normal liver, five with chronic hepatitis, and four with cirrhosis. A complete restoration of the residual liver size was found within 3 months in 3 and 6 months, respectively, in two patients with normal livers. The liver was enlarged in all patients with the parenchymal diseases but obviously more slowly compared with normal liver. Liver functions were restored normally within 2-3 weeks in patients with normal livers, but hyperbilirubinemia persisted longer in those with chronic hepatitis and cirrhosis. A continuous rise of bilirubin was an ominous sign of liver failure and subsequent death, which occurred in five patients with cirrhosis. Serum alpha-fetoprotein did not rise in accordance with the regeneration. Histologically, evidence of active regeneration with increased mitotic activity was found at 10 and 35 days in those patients with normal livers. Mitosis was not seen in a specimen taken at 7 days. Enlarged cuboidal hepatocytes and cells with basophilic cytoplasm or two nuclei were observed more or less in all specimens. The livers with cirrhosis or hepatitis also showed histologic evidence of regeneration during the first 2 months but substantially less compared with normal liver, which was well supported by the volumetric study of the liver remnants with CT.
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PMID:Human liver regeneration after major hepatic resection. A study of normal liver and livers with chronic hepatitis and cirrhosis. 303 39

Superparamagnetic iron oxide particles (AMI-25) were evaluated as a liver contrast agent in high-field MR imaging (1.5 T). 16 patients with up to 5 presumed focal liver lesions (liver metastases n = 8, HCC n = 5, Klatskin tumours n = 2, FNH n = 1) received 15 mumol Fe/kg BW intravenously and were examined via standard T1- and T2-weighted spin-echo sequences. Quantitative image analysis showed a post-contrast increase of the contrast-to-noise ratio (C/N) from 1.6 to 7.4 on SE 2,500/15 images (p < .05). However, C/N was in the same range on plain SE 2,500/90 scans. Blind evaluation by two independent readers revealed that AMI-25-enhanced images did not provide a significantly increased number of lesions. Two patients reported minor, self-limited side-effects (flush, back pain). We conclude that in contrast to reports at mid-field MR imagers, the use of AMI-25 at 1.5 T does not significantly improve the detection of focal liver lesions on conventional SE images.
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PMID:[The MR tomography of focal liver lesions with the superparamagnetic contrast agent AMI-25 at 1.5 tesla]. 830 92

Hilar tumors are extremely difficult to manage with a considerably lower resection rate. We performed endoscopic biliary drainage for 288 patients with hilar tumors (Klatskin tumor 184, gallbladder carcinoma 23, HCC 47 and other metastases 34) in the past 3 years. 162 patients underwent endoscopic nasobiliary drainage, 80 plastic biliary stenting, and 46 expandable metal stent implantation. 4 patients were given double stents insertion simultaneously, 43.1% of patients received good drainage with the total effective rate of 67.0%, but postprocedure cholangitis took place in 13.8% of patients within one month and 3 died of cholangitis and sepsis. In the long-term follow-up patients without surgical treatment, the median sruvival was 5.3 months. The outcome was closely related to Bismuth types, and jaundice could be relieved if more than about 40% of the liver was drained. The double stents for the left and right intrahepatic duct in the meantime could enlarge drainage area and improve the theraputic effectiveness. To get highest benefit, the 3 endoscopic biliary drainage methods should be choosen properly and exchanged flexibly. We conclude that endoscopic biliary drainage is a safe and useful management for the hilar tumor and should be the treatment of choice for palliating jaundice in the inoperable patients.
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PMID:[The evaluation of endoscopic biliary drainage for 288 patients with malignant hilar obstruction]. 1037 80

Cholangiocellular carcinomas (CCCs) of the peripheral type (not Klatskin tumors) appear sonographically as solid space-occupying lesions. No typical sonomorphological signs are known. Important hint for the clinician is the knowledge of earlier or accompanying diseases in which CCCs occur more often (primary sclerosing cholangitis, ulcerative colitis, intrahepatic gallstones, parasitic diseases of the bile ducts, choledochal cysts, Caroli's syndrome). Typical Color-Doppler signs are also missing. Definitive diagnostic is left to biopsy. Hepatocellular carcinomas (HCCs) mostly occur in cirrhotic livers. Every newly detected space-occupying lesion in a cirrhotic liver is suspected of HCC until otherwise proven, even when AFP-levels are normal. AFP levels constantly higher than 400 ng/ml make HCC probable, AFP levels of 2000 ng/ml ore more proof HCC. Gray-scale imaging is not uniform and not guiding. Using Color-Doppler nearly all HCCs show markedly hyperperfusion compared to the surrounding liver tissue, vessels are arranged in a chaotic shape. Echo-enhanced Color-Doppler always shows a distinct early arterial hyperperfusion.
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PMID:[Enhanced imaging diagnosis of liver carcinomas. Technical progress is not a substitute for clinical knowledge]. 1085 80

This pictorial essay aims to show the clinical mimicry of hepatocellular carcinoma (HCC) and its diagnostic difficulty, and to create awareness among clinicians and radiologists of potential diagnostic pitfalls. A selected consecutive series of hepatectomies with proven HCC over a three-year period, identifying clinical presentation, blood results and imaging of patients with difficult preoperative diagnosis, was reviewed. The imaging of the focal liver lesions is presented pictorially with pathological correlation. Six patients out of 34 cases of resected HCC were diagnosed to have benign (three liver abscesses) and neoplastic (one Klatskin tumour, one colorectal liver metastasis, one gallbladder cancer) conditions. Compared to the rest in the series, all six patients had normal serum alpha fetoprotein levels. On computed tomography, the mosaic appearance of HCC mimicked locules of liver abscess while HCC with pseudocapsule (rim enhancement) was misdiagnosed as unilocular abscess or metastatic lesion. Arterial enhancement on contrast-enhanced triphasic computed tomography was useful in diagnosis of HCC. In summary, HCC can mimic benign and neoplastic clinical syndromes. The diagnosis of liver abscess can delay subsequent diagnosis of HCC and potentially complicate the treatment plan. Contrast-enhanced triphasic computed tomography or magnetic resonance imaging is useful to resolve difficult diagnosis, especially when the serum alpha fetoprotein level is not raised.
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PMID:Clinical mimicry of hepatocellular carcinoma: imaging-pathological correlation. 1563 7

The advantages of living donor liver transplantation are an individually available graft and a tremendously reduced waiting time until transplantation. One consequence is that many centers have extended the pretransplant selection criteria, especially for potential recipients suffering from hepatocellular carcinoma. In contrast, reports on living donor liver transplantation for cholangiocarcinoma are restricted to few case reports. We have analyzed our experience with seven patients suffering from cholangiocarcinoma (Klatskin tumors, n=5; intrahepatic cholangiocarcinoma, n=2). During a median follow-up of 20 months (range 2-46 months), all patients are alive except for one posttransplant death. Four patients suffering from Klatskin tumors are alive without recurrence; both patients suffering from intrahepatic cholangiocarcinoma are alive with bone and peritoneal metastases. Living donor liver transplantation may be beneficial in selected patients suffering from Klatskin tumors, whereas caution should prevail when considering intrahepatic cholangiocarcinoma.
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PMID:Extended indications in living-donor liver transplantation: bile duct cancer. 1628 84

Cholangiocarcinoma is a malignant lesion of the bile duct epithelium. Its incidence and prevalence are low. It appears from the sixth decade of life and there is slight male predominance. It is most frequently found in the confluence of the hepatic ducts, where it is called hilar cholangiocarcinoma or Klatskin tumor. Its etiology is unknown but there are predisposing conditions and environmental risk factors such as primary sclerosing cholangitis, Caroli's disease, bile duct malformations, industrial toxins and parasitic infections. The classic presentation of cholangiocarcinoma includes jaundice, weight loss and right upper quadrant pain. These, in addition to laboratory exams, endoscopical and imaging procedures, lead to the diagnosis. Hilar cholangiocarcinoma must be distinguished from other malignant or benign causes of biliary obstruction. Cholangiocarcinoma of the distal common bile duct must be differentiated from other periampullary tumors and intrahepatic cholangiocarcinoma can be confused with a hepatocellular carcinoma. Two classifications are used for clinical staging: TNM and Bismuth-Corlette. The best treatment is the complete surgical excision with negative histological margins, although the resectability index is low. The type and size of surgery depends on the location and extent of the tumor. Patients with unresectable tumors can be subjected to palliative procedures such as biliary-enteric bypass, endoscopic or pecutaneous stent placement. Chemotherapy is not effective. Recently, endoscopic phototherapy has emerged as a better alternative for palliative care.
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PMID:[Cholangiocarcinoma]. 1848 80

Hepato-pancreatico-biliary (HPB) surgery encompasses major hepatic resection and pancreatic surgery, both procedures of high complexity with a potentially high complication rate. The establishment of centres of excellence with a high patient volume has lowered the complication and increased the resection rate. Besides this, increased life expectancy and improved general health status have increased the number of elderly patients eligible for major surgery. Because elderly patients have more co-morbidities and decreased life expectancy, the benefit of these procedures must be critically evaluated in such patients. Analysis of the literature on this subject demonstrated that pancreatico-duodenectomy can be performed safely in selected elderly patients (80 years of age or older), with morbidity and mortality rates approaching those observed in younger patients. This aspect was also confirmed by cost analysis studies that reported similar data in both groups. Similar findings are also reported for major hepatic resection in elderly patients with either hepatocellular carcinoma (HCC), Klatskin tumour or gallbladder carcinoma. Nevertheless, those elderly patients who will benefit from surgery must be critically selected.
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PMID:Surgical aspects in management of hepato-pancreatico-biliary tumours in the elderly. 1994 68


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