Hepatocarcinoma en hígado no cirrótico: serie bicéntrica de 19 casos / Hepatocellular carcinoma in the non-cirrhotic liver: a two-center experience with 19 cases

Antecedentes: El carcinoma hepatocelular es la neoplasia hepática más frecuente; el 90% se desarrolla sobre hígado cirrótico o con hepatopatía crónica, constituyendo así el principal factor de riesgo; la inflamación crónica, la necrosis y regeneración que estas producen condiciona la aparición de mutaciones genéticas y el desarrollo de células tumorales. Sin embargo, el 10% se desarrolla sobre hígado sano, no cirrótico y sin factores desencadenantes. Material y métodos: Se realizó un análisis descriptivo y de la supervivencia de una serie de 19 pacientes con anatomía patológica de carcinoma hepatocelular y ausencia de antecedentes de cirrosis hepática o hepatopatía crónica intervenidos en dos Unidades HPB en el período enero 2007- enero 2016. Resultados: La serie incluyó 13 varones y 6 mujeres con una edad media de 65 años. La presentación clínica más frecuente fue dolor abdominal. El 60% registraba analítica normal y solo en el 16% se elevó la AFP. El 61% presentó prueba de imagen diagnóstica. El tamaño medio fue de 110,6 mm. A todos se los trató con cirugía. Ocurrieron complicaciones en el 36,8% de los pacientes y una supervivencia a los 5 años del 62,3%. Conclusión: el carcinoma hepatocelular suele diagnosticarse cuando es de gran tamaño por hallazgos en pruebas de imagen realizadas generalmente en el estudio del dolor abdominal. La cirugía ofrece tratamiento curativo, pudiendo realizarse grandes resecciones con un alto índice de seguridad, con morbimortalidad perioperatoria baja y con bajo índice de insuficiencia hepática, ya que el remanente hepático es sano y la función hepática se mantiene.

Background: Hepatocellular carcinoma is the most common type of primary liver cancer and is the third cause of cancer related deaths; 80% of the HCC are associated with cirrhotic livers or chronic liver diseases, which constitute the main risk factor. Chronic inflammation, necrosis and regeneration due to these conditions produce genetic mutation and development of tumor cells. Yet, 10% develop in non-cirrhotic healthy livers without precipitating factors. Material and methods: We conducted a retrospective analysis of the characteristics and survival of patients with diagnosis of hepatocellular carcinoma in non-cirrhotic liver and absence of a history of liver cirrhosis or chronic liver disease undergoing surgery in two hepato-pancreato-biliary units between January 2007 and January 2016. Results: Mean age was 65 years and 13 patients were men. Abdominal pain was the most common clinical presentation. Liver panel was normal in 60% of the cases and alpha-fetoprotein was elevated in only 16%. The diagnosis was made by imaging tests in 61% of the cases. Mean tumor size was 110.6 cm. All the patients underwent surgery. Complications were observed in 36.8% of the patients and survival at 5 years was 62.3%. Conclusion: hepatocellular carcinoma is usually diagnosed as a large lesion in imaging tests ordered due to abdominal pain. Surgery provides curative treatment, and large resections can be safely performed, with low perioperative morbidity and mortality and low incidence of postoperative liver failure, since the liver remnant is healthy and liver function is maintained.

HEPATOCELLULAR CARCINOMA IN A NON-CIRRHOTIC PATIENT WITH SUSTAINED VIROLOGICAL RESPONSE AFTER HEPATITIS C TREATMENT / Carcinoma hepatocelular em paciente não cirrótico com resposta virológica sustentada após tratamento para hepatite C

Chronic infection by hepatitis C virus (HCV) is one of the main risk factors for the development of liver cirrhosis and hepatocellular carcinoma. However, the emergence of hepatocellular carcinoma (HCC) in non-cirrhotic HCV patients, especially after sustained virological response (SVR) is an unusual event. Recently, it has been suggested that HCV genotype 3 may have a particular oncogenic mechanism, but the factors involved in these cases as well as the profile of these patients are still not fully understood. Thus, we present the case of a non-cirrhotic fifty-year-old male with HCV infection, genotype 3a, who developed HCC two years after treatment with pegylated-interferon and ribavirin, with SVR, in Brazil.

A infecção crônica pelo vírus da hepatite C é um dos principais fatores de risco para o desenvolvimento de cirrose hepática e carcinoma hepatocelular. Entretanto, o surgimento do carcinoma hepatocelular em pacientes portadores de hepatite C na ausência de cirrose, especialmente após o tratamento e a obtenção de resposta virológica sustentada, é um evento incomum. Recentemente tem sido sugerido que o genótipo 3 do vírus da hepatite C possa ter um mecanismo oncogênico particular, mas todos os fatores envolvidos nestes casos, assim como o perfil destes pacientes, ainda não estão totalmente esclarecidos. Deste modo, apresentamos o caso de um paciente masculino de 50 anos de idade, com infecção pelo vírus da hepatite C genótipo 3a, não cirrótico, que desenvolveu carcinoma hepatocelular dois anos após ter atingido resposta virológica sustentada com o tratamento com interferon peguilado e ribavirina.

Consensus Report of the 4th International Forum for Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid Magnetic Resonance Imaging

This paper reports on issues relating to the optimal use of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging (Gd-EOB-DTPA MR imaging) together with the generation of consensus statements from a working group meeting, which was held in Seoul, Korea (2010). Gd-EOB-DTPA has been shown to improve the detection and characterization of liver lesions, and the information provided by the hepatobiliary phase is proving particularly useful in differential diagnoses and in the characterization of small lesions (around 1-1.5 cm). Discussion also focused on advances in the role of organic anion-transporting polypeptide 8 (OATP8) transporters. Gd-EOB-DTPA is also emerging as a promising tool for functional analysis, enabling the calculation of post-surgical liver function in the remaining segments. Updates to current algorithms were also discussed.

Cirrhotic liver explants: regenerative nodule, dysplasia and hepatocellular carcinoma occurrence

The detection of hepatic nodules by imaging techniques in cirrhotic patients has increased and the growing consensus that these lesions may be premalignant increases their clinical importance and demands precise diagnostic criteria. The prevalence of macroscopic suspect hepatic nodule (MSHN) in cirrhotic livers was analyzed to identify macroregenerative nodule (MRN), dysplastic nodule and hepatocellular carcinoma (HCC) and to evaluate an association between MSHN and HCC. Hepatic nodules larger than 1cm and different from the surrounding nodules of the cirrhosis in color and texture were considered MSHN. Sixty-one cirrhotic liver explants were serially sectioned into 0.5 to 0.7cm slices and MSHN and protocol samples were examined histologically. Ninety-four MSHN were identified in 26 livers (histologically 11 were cirrhotic nodules, 61 MRN, 12 dysplastic nodules, and ten HCC). HCC was identified macroscopically in one liver and by light microscopy within MSHN in six other livers. The relation between HCC and MSHN, specifically MRN, was statistically significant. These findings suggest an association between MRN and MSHN with HCC in cirrhotic livers and reinforce the practical importance of histological classification of hepatic nodules in cirrhosis in order to guide the management of patients who are waiting for liver transplant or surgical treatment.

A detecção de nódulos hepáticos por técnicas de imagem em pacientes com cirrose tem aumentado, e o consenso de que essas lesões podem ser pré-malignas aumenta sua importância clínica e demanda critério diagnóstico preciso. A prevalência de nódulos hepáticos macroscopicamente suspeitos (NHMS) em fígados com cirrose foi analisada para identificar macronódulo regenerativo (MNR), nódulo displásico e carcinoma hepatocelular (CHC) e para avaliar a associação de NHMS e CHC. Nódulos hepáticos maiores que 1cm com cor e textura diferentes dos demais nódulos da cirrose em cada peça foram definidos como NHMS. Sessenta e um fígados explantados por cirrose foram seccionados em fatias de 0,5 a 0,7cm e NHMS e amostras de áreas aleatórias do fígado foram examinadas histologicamente. Noventa e quatro NHMS foram identificados em 26 fígados (à histologia 11 foram nódulos típicos da cirrose; 61, MNR; 12, nódulos displásicos; e dez, CHC). O CHC foi identificado macroscopicamente em um fígado e pela microscopia óptica em NHMS em seis outros. A relação entre CHC e NHMS, especificamente MNR, foi estatisticamente significante. Esses achados sugerem associação entre MNR e NHMS com o CHC em fígados com cirrose e reforçam a importância prática da classificação histológica dos nódulos na cirrose, com o propósito de orientar a conduta médica no manuseio de pacientes que estão à espera de transplante hepático ou de tratamento cirúrgico.

Retrospective review of cholecystis pathologic changes in patients with portal hypertension / 临床外科杂志

Objective To analyze the patients with the portal hypertension.Methods We analyzed 121 cases with gallbladder pathologic changes from 391 cases with portal hypertension.Results Among 391 cases,52.1% were posthepatitic type, 24.8% were composites type,4.1% were ethanol type,4.1% were bile type,11.5% were bilharziasis type,1.7% were latent type,1.7% were peculiar type;81 cases were proved with gallbladder wall thicker and rougher, double shadow or cholecysitis,14 cases were proved cholestatis sludge,51 cases with gallbladder stones or single stone,5 cases with gallbladder polyps,5 cases with gallbladder wither, 7 cases with choledocholiths.Conclusion Portal hypertention,insufficient hepatic function, ascites and hypersplenism are the main causes of cholecystis pathologic changes in patients with portal hypertension.