ABSTRACT
Objective: To analyze the clinical features and diagnosis of hepatic angiomyolipoma patients, and to investigate its treatment strategy. Methods: The clinical data of 79 patients with pathologically-confirmed hepatic angiomyolipoma, who were treated in the Eastern Hepatobiliary Surgery Hospital during 1992-2006, were retrospectively reviewed. Results: The patients included 58 women and 21 men with a median age of (43±8.14) years old (ranging 17 to 69 years). None of the patients was found complicated with renal angiomyolipoma or tuberous sclerosis complex. Twenty-five patients were symptomatic on presentation. All the patients had a single hepatic lesion, with the tumor size ranging 1.0-25 cm and a median of (6.1±4.08) cm. Fifty-three tumors were located in the right lobe, 22 in the left lobe, and 4 in the caudate lobe. Preoperative diagnoses were correctly made in 41 (52%) patients. Spontaneous rupture of tumor occurred in 1 patient. All the patients underwent surgical treatment without operative mortality and serious morbidity. The patients were regularly followed-up for 3-13 years. Tumor recurrence occurred in one patient 6 years after the surgery, and the patient died 1 year later. Conclusion: Hepatic angiomyolipoma has no specific clinical signs and symptoms. Comprehensive imaging studies can help to make correct diagnosis, but the differential diagnosis is difficult, especially for small tumors with diameter less than 5 cm. The final diagnosis depends on pathologic examination and HMB-45 special staining. Surgical resection is safe and effective for the disease. Attention should be paid to the potential of malignant transformation and risk of rupture as a life-threatening complication. Early operation is needed once a diagnosis is made, and the patients should be followed up after operation.
ABSTRACT
<p><b>OBJECTIVE</b>To investigate the effects of different treatments for hepatocellular carcinoma (HCC) with tumor thrombus in the portal vein (PVTT).</p><p><b>METHODS</b>From Jan. 2000 to Jan. 2003, a total of 84 HCC patients with PVTT were divided into five groups based on methed of treatment: Group A (n = 9), HCC resection + PVTT removal + postoperative TACE + thymosin alpha(1); Group B (n = 20), HCC resection + PVTT removal + postoperative TACE; Group C (n = 7), HCC resection + PVTT removal; Group D (n = 38), TACE only; Group E (n = 10), conservative treatment only.</p><p><b>RESULTS</b>The rate of PVTT shrinkage or disappearance of groups A, B, C, D and E was 66.7%, 70.0%, 57.1%, 7.9% and 0, respectively with respective median survival time of 10.0, 7.0, 8.0, 5.0 and 2.0 months. The one year survival rate was 44.4%, 15.0%, 14.3%, 10.5% and 0.</p><p><b>CONCLUSION</b>Resection of HCC and removal of tumor thrombus in the portal vein may have the tumor thrombus cleared in most of the patients and postoperative TACE and thymisin alpha(1) treatment may improve their survival.</p>