Current systemic treatment of hepatocellular carcinoma: A review of the literature.

Hepatocellular carcinoma (HCC) is the fifth most common form of human cancer worldwide and the third most common cause of cancer-related deaths. The strategies of various treatments for HCC depend on the stage of tumor, the status of patient's performance and the reserved hepatic function. The Barcelona Clinic Liver Cancer (BCLC) staging system is currently used most for patients with HCC. For example, for patients with BCLC stage 0 (very early stage) and stage A (early stage) HCC, the curable treatment modalities, including resection, transplantation and radiofrequency ablation, are taken into consideration. If the patients are in BCLC stage B (intermediate stage) and stage C (advanced stage) HCC, they may need the palliative transarterial chemoembolization and even the target medication of sorafenib. In addition, symptomatic treatment is always recommended for patients with BCLC stage D (end stage) HCC. In this review, we will attempt to summarize the historical perspective and the current developments of systemic therapies in BCLC stage B and C in HCC.

Non-septicemic Burkholderia pseudomallei liver abscess in a young man.

Melioidosis, caused by Burkholderia pseudomallei, has been increasingly recognized in Taiwan recently. Its isolation in liver abscess is rare compared to pulmonary melioidosis. We report a case of liver abscess due to B. pseudomallei in an immunocompetent 27-year-old male soldier admitted due to fever, sore throat and mild non-productive cough for 1 week. Physical examination was unremarkable except for congestion of the pharyngeal wall, moderate enlargement of the tonsils without pus coating, and palpable tender lymphadenopathy over bilateral submental regions. Antibiotic treatment with cefazolin 1 g every 8 hours intravenously was given without response. Left flank pain, followed by right flank pain associated with epigastric tenderness developed. Sonography and computed tomography scan of the abdomen demonstrated liver abscess. Aspiration of the liver abscess was performed and abscess culture yielded B. pseudomallei. Treatment with ceftazidime 2 g every 8 hours intravenously (4 weeks' duration) followed by oral regimens of amoxicillin-clavulanate was given. The patient was free of symptoms at 8 months' follow-up. Early awareness and definite diagnosis as well as institution of proper antimicrobial agents are imperative for successful treatment of melioidosis.

Combined cytologic and histologic diagnosis of liver tumors via one-shot aspiration.

BACKGROUND/AIMS: Ultrasound-guided fine needle aspiration is considered to be a safe alternative in diagnosing liver tumors. Combined cytologic and histologic preparation via one-shot fine needle aspiration was evaluated, especially in outpatients. METHODOLOGY: During a 1-year period, 95 patients (including 57 outpatients and 38 inpatients) who had received 97 sessions of fine needle aspiration and had final diagnosis were enrolled. Using a 22-gauge needle, the aspirate from liver tumor was processed for cytology and cell block histology simultaneously in patients without ascites and/or bleeding tendency. RESULTS: From 94 malignant and 3 benign tumors, the accuracy of cytology was 88.7%; while, the difference between outpatients and inpatients was not significant (91.2% vs. 85%). No complication after fine needle aspiration was elicited in both groups. The rates of inadequate specimen preparation for cytology and histology were 0% and 13.4%, the false-negative rates of malignancy were 11.7% for cytology and 16% for histology. The inadequate and false-negative rates of histology were not associated with gender, underlying liver cirrhosis, or tumor size, type, and location. CONCLUSIONS: Ultrasound-guided 22-gauge one-shot fine needle aspiration is safe, convenient and reliable in diagnosing liver tumor, and can be performed in outpatients meticulously.