Revisión del hepatocarcinoma fibrolamelar / Fibrolamellar Hepatocelullar Carcinoma

El carcinoma hepatocelular fibrolamelar (CHC-FL) es una variante poco frecuente de CHC convencional, representa el 0,85 al 16% de todos los carcinomas hepatocelulares. Se presenta en personas jóvenes, sin antecedente de enfermedad hepática crónica subyacente, alrededor del 65-85% de estos tumores ocurren en pacientes menores de 40 años. Para su diagnóstico, las modalidades de imagen cumplen un papel importante tanto el ultrasonido, tomografía y resonancia magnética principalmente ésta última podría aportar sustancialmente al diagnóstico. Se presenta el caso de un joven de 16 años con diagnóstico histopatológico de hepatocarcinoma fibrolamelar y su correlación con las diferentes modalidades de imagen, el cual fue sometido a trasplante hepático, se realiza la revisión del mismo dada la importancia del diagnóstico por imagen y las alternativas terapéuticas en estos casos.

Fibrolamellar hepatocellular carcinoma (CHC-FL) is a rare variant of conventional HCC, representing 0.85 to 16% of all hepatocellular carcinomas. It occurs in young people, without a history of underlying chronic liver disease, about 65-85% of these tumors occur in patients under 40 years. For its diagnosis, imaging modalities play an important role, both ultrasound, tomography and magnetic resonance, mainly the latter could contribute substantially to the diagnosis. We present the case of a 16-year-old boy with a histopathological diagnosis of fibrolamellar hepatocellular carcinoma and its correlation with the different imaging modalities, which underwent hepatic transplantation. He was reviewed, given the importance of imaging diagnosis and alternatives. therapeutic in these cases.

Laparoscopy of hepatocellular carcinoma is helpful in minimizing intra-abdominal adhesion during salvage transplantation

PURPOSE: This study analyzes the impact of laparoscopic liver resection on intra-abdominal adhesion. METHODS: Patients who underwent salvage liver transplantation after liver resection for hepatocellular carcinoma from January 2012 to October 2017 at our institution were included. Information about the severity of intra-abdominal adhesions was collected from a prospectively maintained database. Intra-abdominal adhesions were graded after the agreement of 2 surgeons who participated in the salvage liver transplantation based on predetermined criteria. Adhesion severity and demographic, operative, and postoperative data were compared between the laparoscopic group and the open group. Multivariate logistic regression was performed to consider potential factors related to severe adhesion during salvage transplantation. RESULTS: Sixty-two patients who underwent salvage liver transplantation after liver resection were included in this study. Among them, 52 patients underwent open surgery, and 10 patients underwent laparoscopy. Adhesion was significantly more severe in the open group than in the laparoscopy group (P = 0.029). A multivariate logistic regression model including potential factors related to severe adhesion showed that laparoscopy (odds ratio, 0.168; 95% confidence interval, 0.029–0.970; P = 0.048) was the only significant factor. CONCLUSION: Laparoscopic liver resection for hepatocellular carcinoma can minimize intra-abdominal adhesion during salvage liver transplantation.