Hepatocellular Carcinoma of the Liver with Sarcomatous Feature / 한국간담췌외과학회지

One case of hepatocellular carcinoma with sarcomatous changes is presented. Histologically, the tumor was composed of hepatocellular-carcinomatous and sarcomatous components, including trabecular, pseudoglandular, and spindle-shaped varieties. There was a transitional cell form between the carcinoma and sarcomatous cells. Immunohistochemical examination for alpha-feto protein reveals positive staining in hepatocellular carcinoma component, and vimentin had positive result in most spindle-shaped sarcomatous cells and some epithelial tumor cells, whereas cytokeratin and EMA(epithelial membrane antigen) revealed negative staining in tumor cells, On the basis of this findings, the possibility of sarcomatous transformation of hepatocellular carcinoma was discussed.

Relationship of Serum Interleukin-6 and Liver Regeneration after Hepatectomy in N-nitrosodi ethylamine-induced Cirrhotic Rats

PURPOSE: The evolution of cirrhosis from chronic inflammatory liver disease represents a dysmorphogenic "response to injury". It is important to understand how inflammatory cytokines, known to be associated with such responses, influence the growth of different cell populations within the liver. The purpose of this work is to establish a role of serum interleukin-6 (IL-6) in liver regeneration following partial hepatectomy in N-nitrosodieth ylamine (DEN)-induced cirrhotic rats. METHODS: Male Sprague-Dawley rats were used for this study. Liver cirrhosis was induced using DEN (100 mg/kg) given once a week for 6 weeks. In Group I (n=18), 70% partial hepatectomy was accomplished and then the resected liver weight, regenerated liver weight, serum IL-6, and serum GOT/GPT was determined on postoperative days 1, 2, and 4 and at intervals. In Group II (n=19), partial hepatectomy was carried out and Laennec, a hepatocyte growth promoter, was injected on preoperative 1 day and postoperative days 1 and 2. RESULTS: The value of serum GOT in Group I was 415 IU/ml on the first postoperative day and peaked at 1870 IU/ml on the third day. In Group II, the level of serum GOT was 404 IU/ml on the first postoperative day and peaked at 593 IU/ml on the third day, then decreased gradually thereafter. The value of serum IL-6 was 106.54 pg/ml on the first postoperative day, 130.59 pg/ml on the 14th postoperative day in Group I, however in Group II, it was 40 pg/ml on thefirst postoperative day and then decreased to 29.18 pg/ml on the 14th postoperative day. The percentages of regenerated weights of liver at intervals following the 70% partial hepatectomy was 55.1% on the first postoperative day, and 102.3% on the 4th week in Group I and 60.4% on the first postoperative day, 95.8% on the first week postoperatively, and 116.1% on the 2nd week in Group II. CONCLUSION: As the value of serum IL-6 was sustained below 40 pg/ml, which was the value on the first postopeative day following partial hepatectomy with Laennec treatment, the resected liver was rapidly regenerated and restored to normal liver function. In cirrhotic liver, regenerative activity was related to serum IL-6 level, so downregulation of serum IL-6 might be helpful to the regeneration of resected liver.

Changes of Serum Interleukin-6 after Liver Warm Ischemia/Reperfusion Injury and Postoperative Liver Function Improvement

PURPOSE: Although the liver is an important source of IL-6 and the primary site for its clearance, the role of IL-6 in liver disease remains unclear. Warm ischemia/reperfusion (WI/Rp) injury to the liver occurs in numerous clinical situations including liver transplantation and surgery, trauma, hemorrhagic and endotoxic shocks, and thermal injury. A better understanding of the pathogenesis of WI/Rp injury of the liver and the availability of an agent that could alleviate Rp injury would have important clinical implications. The aim of this study was to evaluate the role of IL-6 in WI/Rp injury of the liver. METHODS: Thirteen patients who had undergone hepatectomy were evaluated with regard to postoperative changes in serum IL-6. The measurements were performed before surgery, within 30 minutes after WI/Rp injury, and at postoperative 24 hr, 48 hr, 1 wk, 2 wk, and 4 wk. Seven of 13 patients had the complication of cirrhosis. RESULTS: The mean value of IL-6 was 8.13 pg/ml preoperatively, and peaked at 20.51 pg/ml on the first postoperative day. Serum IL-6 levels within 30 minutes following WI/Rp injury and at postoeprative 1 day were higher in patients with cirrhosis than non-cirrhotic patients, although statistically insignificant. In the case of the cirrhotic patients, IL-6 values on the first postoperative day peaked at 40.81 pg/ml, compared to 35.27 pg/ml in non-cirrhotic patients. SGOT and SGPT were consistently increased with IL-6 on the first postoperative day, and gradually decreased thereafter. CONCLUSION: This study shows that IL-6 may be an indicatorin WI/Rp injury of the liver. Procedures undertaken to reduce the excessive production of this cytokine may be useful of improving postoperative liver function with or without cirrhosis.

Management Of Intrahepatic Recurrence after Surgical Resection of Primary Hepatic Malignancy / 한국간담췌외과학회지

BACKGROUND: Surgical resection is generally accepted as the first choice of treatment for primary hepatic malignancy. But liver resection of primary hepatic malignancy is associated with a high incidence of recurrence, that has a poor prognosis. The goal of this research was to assess the rationale and result of treatment of recurrence following resection of primary hepatic malignancy. PATIENTS & METHODS: This was a retrospective study of 258 patients who had done hepatic resection with primary hepatic malignancy from 1990. Jan to 1999. Dec. And retrospective analysis of 72 patients with recurrent intrahepatic malignancy after hepatic resection. We exclude extrahepatic recurrence. The treatment methods of intrahepatic recurrence are variable. They include repeated hepatic resection, transcatheter arterial chemoembolization, percutaneous injection therapy of alcohol or hot saline, holmium-166 injection therapy, systemic chemotherapy and combined therapy. RESULTS: The cases of hepatic re-resection are 8, the cases of transcatheter arterial chemoembolization are 19, the cases of percutaneous injection therapy of alcohol or hot saline are 7, the cases of holmium- 166 injection therapy are 6, the cases of systemic chemotherapy are 13 and the cases of combined therapy are 13. In the poor general condition, 6 patients, only conservative therapy was applied. The survival rate of 72 patients with recurrent intrahepatic malignancy after hepatic resection is 61.6%, 46.6%, 33.5%, 26.9%, 15.5%, 2.7% at 3 month, 6 month, 9month, 1year, 2year, 3year. The survival rate of the cases of hepatic re-resection is 100%, 85.7%, 71.4%, 71.4%, 47.6%. The survival rate of transcatheter arterial chemoembolization is 89.5%, 73.0%, 61.8%, 61.8%, 44.1%. 11.0%. The survival rate of percutaneous injection therapy of alcohol or hot saline is 100%, 71.4%, 42.9%, 42.9%, 14.3%, 0%. The survival rate of holmium-166 injection therapy is 66.7%, 66.7%, 66.7%, 33.3%, 33.3%. The survival rate of systemic chemotherapy is 53.9%, 38.5%, 30.8%, 15.4%, 15.4%, 0%. The survival rate of combined therapy is 100%, 84.6%, 69.2%, 69.2%, 41.5%, 0%. And the survival rate of conservative therapy is 54.1%, 39.8%, 19.9%, 14.2%, 7.6%, 3.8%. CONCLUSION: We got results that the hepatic resection, holmium-166 injection therapy, and transcatheter arterial chemoembolization combined therapy were better than systemic chemotherapy and percutaneous injection therapy of alcohol or hot saline in longterm survival rate.

Serum Interleukin-6 Changes according to Rejection after Heterotopic Partial Liver Transplantation in Rat / 대한이식학회지

PURPOSE: Liver transplantation has been accepted as the treatment for end-stage-liver diseases. However, despite the development of more powerful and selective immunosuppressive agents to improve survival following transplantation, graft rejection remains a major cause of morbidity and mortality. It is not always easy to diagnose rejection precisely at an early stage even by liver biosy, which can involve risk, especially when the recipient shows coagulation disorder. Therefore, it is important to develop noninvasive diagnostic approach that can supplement or substitute for histological examination in order to diagnose the rejection response earlier and more precisely. METHODS: In this study, as the experimental group (rejection combination strains), 30% partial liver of Dark-Agauti (DA) rat was transplanted heterotopically to Sprague-Dawly (SD) rat by microsurgical technique. As the control group, partial liver of SD rat was transplanted heterotopically to SD rat. After liver transplantation, serum inteleukin-6 (IL-6), GOT/GPT and histological findings of grafts were evaluated. RESULTS: In the experimental group, serum IL-6 was 84.6 pg/ml on postoperative 2 days, and not decreased so much, remained 28.9 pg/ml on postoperative 8 days. In the control group, serum IL-6 was 58.8 pg/ml on postoperative 2 days, after then decreased to 6.72 pg/ml. In the experimental group, serum IL-6 was already increased, in which rejection was histologically confirmed. CONCLUSION: Therefore, IL-6 may be used as the noninvasive diagnostic parameter to predict rejection of graft after liver transplantation.

Donor Cell Repopulation after Bone Marrow Transplantation and Heterotopic Partial Liver Transplantation in Rats Prework for Chimerism

PURPOSE: Improvements in the prevention or control of rejection of kidneys and livers have been largely interchangeable and then applicable. However, the mechanism by which antirejection treatment permits any of these grafts to be accepted has been an immunological enigma. Recently, the exchange of migratory leukocytes between the transplant and the recipient, with consequent long-term cellular chimerism in both has been the basis for acceptance of all whole-organ allografts and xenografts. METHODS: The donors of liver transplants were male Lewis rats weighing 100-150 g in all experiments groups. Male Brown Norway rats were the experimental group and female Lewis were the control group. Heterotopic partial liver transplantation was performed by Lee's method without arterial reconstruction. All procedures were performed under ether anesthesia. Bone marrow was taken from the tibias and femurs and was processed in RPMI 1640. The cell counts of suspensions were 2.5x10(8) per experiment. Genomic DNA prepared from peripheral blood and various tissues. Male Lewis Sry-specific oligonulceotide primers were used. RESULTS: In allogenic liver transplantation with bone marrow transplants (LEW-BN), donor cells were detected in the liver, and the spleen by day 7. However, in rejection cases, donor cell were not detected in any tissues. In isografted transplants (LEW-LEW), after bone marrow transplantation, donor cells were found in lymph nodes, the liver, and peripheral blood. In isografted transplants (LEW-LEW), after liver transplantation donor, cells were only found in the grafts. CONCLUSION: In allogenic liver transplantation with bone marrow transplantation, chimerism induction was augmentedwith bone marrow-derived stem cells. Therefore, it is necessary to have many samples to investigate more precisely chimerism and rejection after liver transplantation with bone marrow transplantation.

Results and Risk Factors in Hepatic Resection 506 cases

BACKGROUND: With advances in the techniques of liver resection as well as with better improvement of preoperative and postoperative care, hepatic resections for liver disease have become more common. This study presents a review of our experience for hepatic resection and an analysis of potential risk factors affecting the morbidity and the mortality in a hepatectomy. METHOD: From 1970 to 1996, 506 patients underwent hepatic resections; 139 patients with benign hepatic diseases, 329 patients with primary hepatic malignancy, and 38 patients with secondary hepatic malignancy. RESULTS: We divided the patients into two groups. Group 1 had 272 patients (from 1970 to 1990), and group 2 had 234 patients (from 1991 to 1996). As compared with group 1, group 2 had more malignant diseases than non-malignant diseases as operative indications. In the patients resected for primary hepatic malignancy, the 1-, 2-, 3-, and 5-year survival rates were 56.6%, 36.7%, 30.1%, and 15.2%, respectively, and 1-, 2-, 3-, 4-, and 5-year survival rates for a hepatocellular carcinoma were 58.5%, 41%%, 30.1%, 25.3%, and 17.2% and for a cholangiocarcinoma 39.5%, 22.5%, 19%, 8.3%, and 5.2%, respectively. The overall operative mortality rate was 5.9% (30/506), 7.4% in group 1 and 4.3% in group 2. The significant risk factors for perioperative mortality were liver cirrhosis, jaundice, increase of postoperative alkaline phosphatase, extended time needed for operation (above 4 hours), massive transfusion during operation (above 5,000 cc), malnutrition and/or weight loss (above 10%), low hemoglobin (below 10 gm%) and low serum albumin level (below 3.0 gm). Also, the major complicationsinfluencing perioperative mortality were liver failure, perioperative hemorrhage, cholangitis, intraabdominal abscess, sepsis, pulmonary lesions, and renal failure. CONCLUSION: After 1990, minor resections having enough margin from the hepatic malignant lesion have increased. However there has been no difference in the survival rate compared with that for a major resection for hepatic malignant diseases. Rather, operative morbidity, perioperative mortality, and postoperative complications have decreased in favor of a minor resection for hepatic malignant diseases.

Survival rate of hepatectomy according to liver cirrhosis in hepatoculluar carcinoma / 한국간담췌외과학회지

The authors analyzes the outcomes of patients with hepatocellular carcinoma and liver cirrhosis who underwent liver resection. Hepatic resection were carried out in 145 patients with hepatocellular carcinoma during 8-year period from 1990 to 1997. Of 145 hepatocellular carcinoma, one group of hepatocellular carcinoma with cirrhosis is 112(77.2%) cases, the other group of hepatocellular carcinoma without cirrhosis is 33(22.8%)cases. The serum HbsAg positivity is 80%(88/110) in hepatocellular carcinoma with cirrhosis, 63.6%(21/33) in hepatocellular carcinoma without cirrhosis. The serum Anti HCV positivity is 21.3%(20/94)in hepatocellular carcinoma with cirrhosis, 34.4%(10/29) in hepatocellular carcinoma without cirrhosis. According to liver resection, major resection is the right lobectomy, left lobectomy, extended right lobectomy, and extended left lobectomy, and minor resection is left lateral segmentectomy, segmentectomy, subsegmentectomy The survival rate and postoperative complications were compared hepatocellular carcinoma with cirrhosis with hepatocellular carcinoma without cirrhosis. The survival rate of 1 year, 2 year , 3 year and 5 year was 63%, 47%, 36% and 25% in hepatocellular carcinoma with cirrhosis and 63%, 56%, 48% and 39% in hepatocellular carcinoma without cirrhosis. The group without liver cirrhosis is somewhat higher in survival rate, but the outcome was not statistically significant.(p>0.05). Overall operative mortality was 4.1%(6/145), With liver cirrhosis 5,4%(6/112) in group. Of this 6 cases , four cases were hepatic failure, two cases postoperative bleeding. Group without liver cirrhosis had not mortality cases. Of the group combined with liver cirrhosis, the operative mortality for operation method was 13%(3/23) in major resection group, 3.4%(3/89) in minor resection group.

A case of hepatoblastoma in adult / 한국간담췌외과학회지

Hepatoblastoma is a primary embryonic liver tumor usually found in children. It extremely rarely occurs in adults. We report a case of hepatoblastoma in a 56 year old man with chronic hepatitis B of 10years duration. Laboratory investigation of the patient on admission showed a marked elevation of alpha-fetoprotein in serum. Ultrasonography and Computerized tomography scan revealed a primary tumor, 6x7cm in size, in the right lobe. The tumor removed by a right lobectomy. Complete removal of the tumor is the treatment which is potentially curative provided that lesion is confined within the liver capsule. The literature revealed and a case of this tumor reviewed.