Hepatocellular carcinoma peritoneal metastasis: role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy [HIPEC]

Introduction: Peritoneal dissemination of hepatocellular carcinoma [HCC] is a rare presentation with an incidence of 2-6%. The most common cause of peritoneal deposits is a ruptured HCC that results in tumor spillage into the peritoneal cavity. The overall incidence of spontaneous ruptures of HCC ranges from 5 to 15% and carries a high mortality rate of up to 50%. Other factors influencing peritoneal dissemination are the lymph node metastasis and the direct diaphragmatic invasion and there is no significant association with past history of FNAB, or percutaneous RFA or ethanol injection and lung or adrenal metastasis

Clinical Study: We present our experience with 4 patients with localized peritoneal metastases from HCC controlled and managed with cytoreductive surgery [CRS] and hyperthermic intraperitoneal chemotherapy [HIPEC]. The mean peritoneal cancer index [PCI] was 10.2. In two cases there is a history of rupture at the onset of diagnosis and in one case dissemination of peritoneal cavity after FNB procedure. All patients after CRS and HIPEC received Sorafenib

Results: In our study the mean time of onset of peritoneal metastasis was 13.5 months from initial operation and the mean survival was 30 months. Our results are comparable with other studies

Conclusion: Peritoneal metastasis of hepatocellular carcinoma is rare and the benefit of systemic chemotherapy is poor and from Sorafenib is not well described. Surgical resection of extrahepatic HCC metastasis remains challenging. However several case reports and a few case series have provided that surgical resection of HCC peritoneal implants may benefit. Vfe believe from our experience in well-selected patients with peritoneal metastasis from HCC, cytoreductive surgery with HIPEC and Sorafenib may prolong survival compared to systemic chemotherapy alone

Detection of O-Linked-N-Acetylglucosamine Modification and Its Associated Enzymes in Human Degenerated Intervertebral Discs

STUDY DESIGN: Human herniated discs were obtained from discectomy specimens for the immunohistochemical detection of O-GlcNAc and O-GlcNAcase (OGA)/O-GlcNAc transferase (OGT). PURPOSE: This study aimed to quantify the extent of O-GlcNAcylation and its associated enzymes (OGT/OGA) in human degenerated intervertebral discs. OVERVIEW OF LITERATURE: The O-GlcNAcylation of nuclear, cytoplasmic, and mitochondrial proteins as well as the effects of such post-translational modifications are currently the focus of extensive research. O-GlcNAcylation is believed to contribute to the etiology of chronic illnesses by acting as a nutrient and stress sensor in the cellular environment. Mature intervertebral disc cells are chondrocyte-like cells, and O-GlcNAc has been shown to promote chondrocyte apoptosis in vitro. We believe that O-GlcNAcylation is a key regulator of disc degeneration. METHODS: Fifty-six specimens were fixed for 24 hours in a 10% solution of neutral-buffered formaldehyde, dehydrated, and embedded in paraffin. Tissue slices (4-µm-thick) were used for hematoxylin-eosin staining and immunohistochemistry. RESULTS: We found that O-GlcNAcylation of cytoplasmic proteins was less than that of nuclear proteins in both single cells and cell clusters. Cytoplasmic O-GlcNAcylation occurs subsequent to nuclear O-GlcNAcylation and is directly proportional to disc degeneration. OGT and O-GlcNAc expression levels were identical in all specimens examined. CONCLUSIONS: O-GlcNAc and OGA/OGT expression is shown to correlate for the first time with intervertebral disc cell degeneration. Increasing disc degeneration is associated with increasing O-GlcNAcylation in both nuclear and cytoplasmic proteins in human disc cells.