Living-donor liver transplantation for giant hepatic hemangioma with diffuse hemangiomatosis in an adult: a case report

Hepatic hemangioma represents the most common benign primary hepatic neoplasm. Although most such tumors are small and asymptomatic, giant hepatic hemangioma is frequently symptomatic, and requires intervention. Moreover, diffuse multiple hepatic hemangiomatosis occupying almost the entire liver is extremely rare in adults, and the optimal management for this condition is unclear. We report a case of a rapidly growing, symptomatic giant hepatic hemangioma with diffuse hepatic hemangiomatosis in a 50-year-old female patient who was treated by living-donor liver transplantation. This case shows malignant behavior of a benign hemangioma that required liver transplantation. Although this case could not meet the criteria for transplantation according to the MELD (model for end-stage liver disease) score system, it should be considered as an exceptional indication for deceased-donor liver allocation. Further studies of the mechanism underlying hemangioma growth are warranted.

The safety and efficacy of raltitrexed combined with oxaliplatin in TACE treatment for BCLC B/C hepatocellular carcinomas / 介入放射学杂志

Objective To evaluate the efficacy and safety of trascatheter arterial chemoembolization (TACE) with raltitrexed and oxaliplatin (RO) regimen as well as lipiodol emulsion in treating BCLC B/C hepatocellular carcinomas.Methods A total of 183 patients with BCLC B/C hepatocellular carcinoma were treated with TACE by using RO regimen and lipiodol emulsion.The therapeutic regimen included raltitrexed 3 mg/m2 for hepatic artery perfusion,oxaliplatin 130 mg/m2 mixed with lipiodol 5-30 ml emulsion for embolization.The toxicities were assessed according to WHO anti-cancer drug toxicity grading standards.Liver damage was determined by Child-Pugh classification.All the patients were followed up and the survival time was calculated.Results In 183 patients,the hematologic toxicity was characterized by bone marrow suppression.The incidences of neutropenia,anemia and thrombocytopenia were 21.9％,8.3％ and 2.7％,respectively.The degree Ⅰ,Ⅱ,Ⅲ and Ⅳ of neutrophil count decrease were seen in 15.85％,5.46％,0.55％ and 0％ of patients,respectively.Nausea and vomiting of degree Ⅰ-Ⅱ was observed in 71.58％ of patients.Liver function damage was presented as elevated transaminase and elevated bilirubin level.Preoperative Child-Pugh grade A was seen in 96 patients and grade B in 87 patients.Child-Pugh grade was elevated from preoperative grade A to postoperative grade B in 48 patients,from preoperative grade A to postoperative grade C in 6 patients,and from preoperative grade B to postoperative grade C in 12 patients.In this series,no symptoms or signs of cardiac,urinary or nervous system toxicity were observed.The survival time of 183 patients was 5-35 months,with the median survival time being 20 months.Conclusion For the treatment of BCLC B/C hepatocellular carcinomas,TACE using RO regimen and lipiodol emulsion is safe and effective,and it can reliably improve the quality of life of patients.

Clinicopathological analyses of combined hepatocellular carcinoma and cholangio carcinoma / 临床与实验病理学杂志

Purpose To investigate the clinicopathological characteristics and treatment of combined hepatocellular carcinoma-cholangio carcinoma (cHCC-CC).Methods 24 cases of cHCC-CC were collected.The clinical pathological characteristics,imaging,immunophenotyping and clinical features were retrospectively analyzed and reviewed the literature.Results There were 18 males and 6 females in 24 cases of cHCC-CC.The age ranged from 36 to 68 years (mean age was 54.38).Tumour location:right hepatic lobe in 15 cases,left hepatic lobe in 6 cases,both left lobe and right hepatic lobe in 1 case,hepatic caudate and left lateral lobe in 1 case,diffuse nodular liver tumors in 1 case.Grossly,the texture and color of tumor was related to the composition of tumor.Microscopically,classic cHCC-CC had two areas composed of hepatocellular carcinoma area and cholangiocar cinoma area of mixed distribution or migration distribution.3 cases were cHCC-CC with stem cell properties (cholangiolocellular carcinoma type,CLC type).Immunohistochemical staining revealed that HCC like area mainly expressed CD10,CK8,Hepatocyte and CD10,cHCC-CC area expressed CK7 and EMA.CLC type expressed the immunophenotypic features of intermediate type of HCC.Conclusion The clinical manifestations of cHCC-CC are not specific,the preoperative diagnosis is difficult,and it should be combined with pathological characteristics,imaging features and immunophenotype diagnosis.

Argon-helium cryoablation combined with transcatheter arterial chemoembolization for the treatment of advanced hepatocellular carcinoma:analysis of therapeutic effectiveness / 介入放射学杂志

Objective To evaluate argon-helium cryoablation combined with transcatheter arterial chemoembolization (TACE) in treating advanced hepatocellular carcinoma (HCC). Methods The clinical data of 66 patients with pathologically-proved HCC were retrospectively analyzed. Based on the therapeutic scheme the patients were divided into TACE group (n=31) and combination group (TACE+argon-helium cryoablation, n=35). All the patients were followed up for 5-35 months. The complete remission rate, total effective rate and survival time were evaluated. The short-term and the long-term effectiveness were compared between the two groups. Results Both the complete remission rate and total effective rate of the combination group were significantly higher than those of TACE group (P0.05). Conclusion For the treatment of advanced hepatocellular carcinoma, argon-helium cryoablation combined with TACE can improve the short-term effect and prolong the progression-free survival time, although its exact effectiveness still needs to be confirmed by large sample, multi-central and randomized controlled studies.

Expression levels of Ech1 in hepatocarcinoma and subcellular location / 临床与实验病理学杂志

Purpose To study the expression of Ech1 in hepatocarcinoma and its clinical significance, and to explore the relationship between subcellular location of Ech1 and malignant biologic behaviour of hepatocarcinoma. Methods Immunohistochemical analysis was used to detect Ech1 expression in the 20 cases of normal liver tissue and the 30 cases of hepatocarcinoma. Subcellular location of Ech1 in Hca-F and FEch1-down cell was observed with subcellular protein extraction. Results The expression of Ech1 in primary hepa-tocarcinoma was increased compared to that of normal liver tissues ( P0. 05). Ech1 was found expressed almost at the same location although the expression level one is normal and the other is downregulation. Ech1 expres-sion was found in cytosol, membrane fraction, and its expression was higher in cytosol than other fractions both in Hca-F cell and Ech1 downregulated Hca-F cell. Conclusions The expression of Ech1 in primary hepatocarcinoma was increased, which may indicate that Ech1 is a critical factor in the development of primary hepatocarcinoma, but the subcellular location of Ech1 has not much contribution to that.

The clinical application of contrast enhanced ultrasonography in radiofrequency ablation therapy for residual and recurrent hepatic neoplasms / 介入放射学杂志

Objective To discuss the clinical application of contrast enhanced ultrasonography (CEUS) in radiofrequency ablation (RFA) treatment for residual and recurrent hepatic neoplasms. Methods A total of 517 cases of primary hepatocellular carcinoma (HCC) or hepatic metastases with residual or recurrent hepatic neoplasms after different kinds of treatment were treated with RFA. A total of 619 lesions were used as study subjects. The average size of the 290 lesions detected in 281 patients with recurrent HCC was (3.4 ± 1.5) cm. CEUS-guided RFA group included 150 cases (154 lesions in total), while conventional US-guided RFA group included 131 cases (136 lesions in total). A total of 329 lesions were detected in 236 cases with recurrent hepatic metastases, and the mean size of the lesions was (3.1 ± 1.3) cm, of which CEUS-guided RFA group included 152 cases (198 lesions in total) and conventional US-guided RFA group included 84 cases (131 lesions in total). Results In recurrent HCC, the one-month tumor necrosis rate of CEUS group and conventional US group was 96.1% and 89.7% respectively (P = 0.032), and the local recurrence rate was 9.7% and 17.6% respectively (P = 0.049). The differences between the two groups were statistically significant. In recurrent hepatic metastases , the one-month tumor necrosis rate of CEUS group and conventional US group was 88.4% and 87.0% respectively (P = 0.712), and the local recurrence rate was 16.7% and 23.7%respectively (P = 0.117). No significant differences existed between the two groups. Conclusion For the treatment of recurrent HCC, CEUS-guided radiofrequency ablation can effectively improve the early necrosis rate and decrease local recurrence rate.

Peribiliary cysts developed in normal underlying liver: report of a case

Peribiliary cysts, known as cystic dilatation, of the extramural peribiliary glands of the bile duct are rare, and are usually detectable under conditions of pre-existing hepatobiliary diseases such as liver cirrhosis. Preoperative diagnosis is often difficult, because they are usually asymptomatic. Distinction of peribiliary cysts from premalignant or malignant cystic lesions is mandatory. Herein, we report a case of peribiliary cyst, which was preoperatively assumed as unilobar Caroli's diseases in healthy young patients and briefly discuss the management of the condition.

Hemi-hepatectomia direita laparoscópica para cistoadenoma biliar intra-hepático: relato de caso / Laparoscopic right hemi-hepatectomy for intra-hepatic biliary cystadenoma:a case report

O cistoadenoma biliar intra-hepático é neoplasia benigna rara, que se apresenta como lesão cística multisseptada. Essa afecção é considerada lesão pré-maligna. O tratamento tem sido ressecção completa. Atualmente, a hepatectomia maior laparoscópica é aceita como preferencial em afecções hepáticas benignas devido à baixa morbidade e ao melhor resultado estético. Relata-se o caso de um doente com cistoadenoma biliar intra-hepático, tratado com hemi-hepatectomia direita laparoscópica. Houve bom curso pós-operatório sem recidiva do tumor nos doze mesesde seguimento. O tratamento do cistoadenoma biliar intra-hepático por hemi-hepatectomia direita laparoscópica apresenta baixa morbidade e bom resultado estético.

Intra-hepatic biliary cystadenoma is a rare benign neoplasm presented as multisepted cystic lesion. This affection has been considered a premalignant lesion. Treatment has been complete resection. Nowadays, laparoscopic major hepatectomy has been accepted as preferential treatment for benign hepatic diseases due to both low morbidity andbest aesthetic result. The authors present a case of intra-hepatic biliary cystadenoma treated with laparoscopic right hemi-hepatectomy. The patient presented good postoperative course without tumor recurrence after a twelve month follow-up period. Intra-hepatic biliary cystadenoma treatment with laparoscopic right hemi-hepatectomy presentsboth low morbidity and good aesthetic result

Management of main hepatic vein injury in hepatectomy for hepatic neoplasm of segment Ⅷ / 中华肝胆外科杂志

Objective To summarize the experience in management of main hepatic vein injury due to hepatectomy for hepatic neoplasm of segment Ⅷ. Methods Clinical data of 64 patients suffering from main hepatic vein injury due to hepatectomy of hepatic neoplasm of segment Ⅷ in our hospital from October 1996 to October 2008 were retrospectively analyzed. Results Both the main trunks of the middle and right hepatic vein were injured in 34 patients, single right hepatic vein in 13 and middle hepatic vein in 17. In these patients with hepatic vein injury, the main trunk of the hepatic vein was repaired in 39, vessels ligated in 12 and direct liver wound surfaces sutured in 12. The hepatectomy and hemostasis were successfully performed during operation in all patients. After operation, 3 patients had active bleeding and 2 patients were reoperated on to sew up the bleeding points by wadding with the gelatin sponge and discharged after rehabilitation. One patient gave up treatment and was discharged automatically. Conclusion Main hepatic vein injury in hepatectomy of hepatic neoplasm of segment Ⅷ can be managed effectively by hepatic vein repair, hepatic vein ligation and suture of the liver section that can be chosen to control the bleeding of hepatic vein injury according to the actual conditions.

Correlation of CT findings of secondary hepatic lymphoma with pathology / 中华放射学杂志

Objective To correlate CT findings of secondary hepatic lymphoma with pathology and to evaluate it's clinical value.Methods Nine patients with secondary hepatic lymphoma confirmed by pathology underwent spiral CT scanning and dual-phase dynamic contrast-enhancement scanning before operation, the CT data were reviewed and analysed retrospectively in comparison with surgical and pathological results.Results Twenty-three lesions of secondary hepatic lymphoma in 9 patients were located in the left lobe (9 lesions), the fight lobe (6 lesions),the porta of the liver (5 lesions) and the caudate lobe (3 lesions), respectively.Sixteen of these 23 lesions were distributed over an area near the portal vein, 7 were seattered in the exterior of liver.17 lesions had an ellipsoid contour and 6 showed irregular contour.The diameter of the lesions ranged from 2.7 to 16.5 cm, with a mean diameter of 5.9cm.The tumor demonstrated mild homogeneous dynamic delayed contrasted-enhancement and the CT value of the non-contrast scans, AP phases and PVP phases were 20.7 to 31.5 HU(with a mean value of 25.3 HU), 23.8 to 48.5 HU(with a mean value of 31.9 HU) and 35.3 to 60.2 HU(with a mean value of 47.8 HU) respectively.Intrinsic hepatic vessels could be discerned in 6 lesions.The lesions situated in the perta of the liver encased the portal vessels, but there was no vessel compression or occlusion.Conclusion Recognition of the dynamic CT features of hepatic lymphoma could enhance its diagnostic accuracy.

Changes of Cellular Immunity after Interventional Treatment of Hepatocellular Carcinoma / 中国医师杂志

0.05). In both A and B groups the number of CD_3~+, CD_4~+, CD_8~+ T cells and NK was signficantly higher after treatment than before treatment(P0.05). The amount of CD_3~+,CD_4~+ T cells and NK was obivously lower after treatment than before treatment in C group, and CD_8~+ T cells amount significantly increased after treatment compared with before treatment(P

The Value Of MR Dualecho Imaging in Differential Diagnosing Liver Benign,Malignant Lesions / 中国医师杂志

Objective To evaluate MR Dual echo imaging in the differential diagnosing liver lesions.Methods:MR Dual echo features in 80 patients with different liver lesions,including 40 cases of benign lesions and 40 cases of malignant lesions,were analyzed,and comparison with MR Dual echo imaging was made.Results MR Dual echo sensitivity and specificity were 85% and 95% in the benign lesions,80% and 94% in the malignant lesions respectively.Conclusion MR Dualecho imaging is a useful MR technique,which is helpful in differentiating benign from malignant lesions.

Outcome of hepatic resection for metastatic gastric cancer / 한국간담췌외과학회지

BACKGROUND/AIMS: The role of hepatic resection for metastatic gastric cancer is less well defined due to its tendency of multiple intra- and extra-hepatic metastatic patterns. We have reviewed our experiences in the gastric cancer patients with liver metastases to define good candidates for the prolonged survival by hepatic resection. METHODS: Records of eleven patients who underwent hepaatic resection for metastatic gastric cancer from January 1988 to December 1996 at Seooul National University Hospital were reviewed. The clinicopathologic features and their long-term results were analysed. RESULTS: All resected hepatic metastases were solitary mass. Among eight patients with synchronous liver metastases, only one patient who had early gastric cancer with lymph node metastases (T1N2M1) was alive for 9 years 6 months after hepatic resection without recurrence. Among three patients with metachronous liver metastases, two patients who had advanced gastric cancer with lymph node metastases (T3N2M0, T2N1M0 at initial operation, respectively) survived 8 years 6 months and 3 years after hepatic resection, respectively. Median survival time of synchronous and metachronous liver metastases were 13.0 and 74.3 months, respectively. CONCLUSION: Good prognosis may be expected in some selected patients who underwent hepatic resection for metastatic gastric cancer.

Utilização das hepatectomias centrais nas cirurgias hepatobiliares / Use of central hepatectomies in the hepatobiliary surgeries

O tratamento das doenças hepatobiliares através de hepatectomias centrais tem sido um dos desafios técnicos mais importantes para a cirurgia neste final de século. Embora diversas técnicas tenham sido utilizadas nas últimas décadas, só recentemente estas têm sido executadas com segurança, diminuindo drasticamente as taxas de morbi-mortalidade, e com isso propiciando resultados favoráveis no tratamento das diferentes afecções hepáticas. Quer o figado apresente-se ou não com hepatopatia crônica, a integração de equipes multidisciplinares afeitas a este tipo de cirurgia e de patologia, permitiu que ressecções complexas fossem realizadas. Com o princípio de manter massa e função hepatocitária remanescente viáveis, o estudo morfológico e funcional do fígado no pré-operatório impõe que técnicas de transplante de segmentos hepáticos sejam freqüentemente utilizadas, seja na reconstrução vascular, seja na redução e conservação de massa hepática. Desta maneira, a ressecção de qualquer parte do fígado com o mínimo de utilização de derivados sangüíneos tem se mostrado factível através do conhecimento apurado da anatomia hepática e da utilização de ecografia transoperatória. Deste trabalho de revisão de diferentes técnicas de hepatectomias centrais são apresentadas, discutidas as indicações e detalhes cirúrgicos de cada uma delas.

The treatment of hepatobiliary diseases by central hepatectomies has been one of the most important challenges in surgical technique at the end of this century. Although different techniques were used in the last decades, only recently they have been carried out safely, drastically reducing the morbidity and mortality rates, and thus providing favorable results in treating different hepatic diseases. Whether the liver does or not present chronic liver disease, the integration of related multiple-disciplinary teams in this type of surgery and disease has allowed complex ablations, sometimes bordering on the limit of the possibility of life. Based on the principle of maintaining a viable remaining hepatocyte mass and function, the morphological and functional study of the liver during the preoperative period requires the frequent use of techniques to transplant liver segments, both for vascular reconstruction and for the reduction and conservation of the liver mass. Thus, the resection of any part of the liver with a minimum use of blood products has proved feasible with thorough knowledge of the anatomy of the liver, and the use of echography during surgery. Different central hepatectomy techniques are, thus, presented, discussing indications and surgical details of each of them.

Evaluation of Feridex-enhanced MRI in the Diagnosis of Hepatic Lesions / 实用放射学杂志

Objective To evaluate Feridex(superparamagnetic iron oxide,SPIO)enhanced MRI in the diagnosis of hepatic lesions.Methods Feridex-enhanced MRI was performed in 31 patients with CT,or MRI proved or suspected hepatic lesions.T 2WI signal intensity of hepatic parenchyma,lesion and background noise was measured before and after enhancement separately.SNR and CNR of parenchyma and lesion before and after enhancement were calculated.The number of lesions on plain and enhanced scans were observed and alalyzed.Results Post-enhancement SNR of liver significantly decreased (?0.05).Post-enhancement lesion-liver CNR increased significantly (?

Preventive Interventional Management Following the Focus Radical Resection in Patients with Small Hepatocellular Carcinoma / 介入放射学杂志

20?g/L) after surgery in one month.The survival rate for 1,3,5yr were 100%(n=17),91.5%(n=16) and 84.7% (n=14) respectively in the therapy group,and in the control group 95.45% (n=21),72.7% (n=16),40.91%(n=9) respectively.Sur- vival rate between two groups showed significant difference (P

The Diagnostic Efficacy of SPIO in Patients with Known Liver Lesions / 实用放射学杂志

Objective:To evaluate the diagnostic efficacy of SPIO in known liver lesions.Methods:30 patients with known liver lesion were underwent MRI.The contrast noise rate(CNR)of lesion to liver and the relative enhancement rate(RE)of liver were measured at 10、30、45、70 min and 16 hour after SPIO was injected.The dynamic curve of signal-noise were made and analysed.Results:The study shown that the hepatic parenchyma had a significantly negative enhancement in T 2 weight of SE and GRE sequence.However,the signal intensity showed few changes in hepatic metastases and only a little positive or negative enhancement in angioma、HCC and FNH.Conclusion:SPIO,as a negative contrast media for liver,has a significantly efficacy to show liver lesions,and as liver lesion-specific contrast MR agent,is worth being explored. [

Clinical Study of Using Cinobufotalin and Chemotherapeutic Agents by Transcatheter Arterial with Oily Chemoembolization in the Treatment of Primary Liver Cancer / 实用放射学杂志

Objective To evaluate the effect of cinobufotalin and chemotherapeutic agents by transcatheter arterial with oilychemoembolization(TACE) in the treatment of primary liver cancer.Methods 144 patients with HCC proved histopathologically were divided into 2 groups.76 of them(group A) were treated by transcatheter arterial infusion(TAI) with cinobufotalin 100 ml,DDP and 5-FU,then embolism with iodized oil mixed ADM;while the other 68 patients(group B) were treated by TAI with DDP and 5-FU,then embolism with iodized oil mixed ADM.The serum T lymphocytes,HBV DNA,AFP and CT scan were acquired before and after treatment.Results The effective rate(PR+MR) of group A was 86.64%,the lymphocyte transformation rate(LTT),T lymphocytes CD_3~+,CD_4~+proportion and CD_4~+/CD_8~+ratio markedly increased;HBV DNA descended in 21 cases,unchanged in 46 cases,and elevated in 9 cases;1 and 2 year survival rate was 86.84%(66/76)and71.05%(54/76) respectively.The effective rate(PR+MR) of group B was 72.73%,LTT,T lymphocytesCD_3~+,CD_4~+proportion and CD_4~+/CD_8~+ratio markedly descended;HBV DNA descended in 2 cases,unchanged in 20 cases and elevated in 46 cases;1 and 2 year survival rate was 72.73%(48/68) and 54.41%(37/68) respectively.There were significant statistical differences between the two groups(P

Evaluation of Feridex-enhanced MRI in the Diagnosis of Focal Hepatic Lesions / 实用放射学杂志

Objective To evluate Feridex-enhanced MRI in the diagnosis of focal hepatic lesions. Methods Conventional plain and Feridex-enhanced MR scanning was performed in 20 cases with suspected hepatic neoplasm.The number of lesions on T 2WI ,and the signal intensity of liver and lesions demonstrated on plain and enhanced scans were observed and analyzed.Results After the injection of Feridex,the signal intensity of normal liver tissue reduced significantly,while the signal intensity of lesions showed no marked changes,Feridex-enhanced MRI clearly displayed more lesions on T 2WI than plain scanning did.Conclusion Feridex-enhanced MRI is very sensitive in detecting focal hepatic lesions.