Coexistence of primary clear cell subtype of hepatocellular carcinoma, cholangiocarcinoma, and ordinary type hepatocellular carcinoma: A case report.

INTRODUCTION AND IMPORTANCE: Primary Clear Cell subtype of Hepatocellular Carcinoma (PCHCC) is a rare kind of Hepatocellular Carcinoma (HCC). The coexistence of PCHCC, Intrahepatic Cholangiocarcinoma (ICC), and ordinary-type HCC(OHCC) in different parts of the liver is seldom reported in the literature. CASE PRESENTATION: A 66 years old man with three masses in his liver was admitted. Positron emission tomography-computed tomography suggested that 2 of the lesions were low-density and likely malignant, while the 3rd lesion was considered benign. Magnetic Resonance Imaging indicated all were malignant tumors. Minor hepatectomies were underwent respectively, and the pathology indicated the 3 tumors were PCHCC, ICC, and OHCC. Twelve months post operation, the patient was readmitted because of the recurrence of a 10.2 × 9.2 × 8.9 cm hepatic tumor. Transarterial chemoembolization and three courses of systemic chemotherapy were carried out, but the effectiveness was limited. The patient passed away 20 months after surgery. CLINICAL DISCUSSION: Surgical resection is the primary treatment of CHCC and minor hepatectomy should be considered especially when complicated with cirrhosis. Considering the poor prognosis and the high recurrence rate, sequential treatments like hepatectomy, targeted therapy, and TACE are recommended. CONCLUSION: PCHCC, ICC, and OHCC coexisted in a different part of one liver is particularly rare, comprehensive treatment with minor hepatectomy should be recommended, but the prognosis is poor.

Gene variation profile and it's potential correlation with clinical characteristics in HBV-associated HCC patients of Sichuan Han nationality in China.

OBJECTIVE: To explore the correlation between hepatocellular carcinoma (HCC) gene variation profile and clinical characteristics in Han nationality with HBV infection in Sichuan province. METHODS: The clinical data and HCC tissues were obtained from the enrolled patients. Whole exome sequencing and bioinformatics analysis were performed on formalin-fixed and paraffin-embedded samples from HCC. Tumor mutational burden (TMB) was measured by an algorithm developed in-house. RESULTS: Sixteen high-frequency mutated genes with differential expressions were identified by WES. SMG1 gene variation could be positively correlated with satellite lesions. AMY2B and RGPD4 gene mutation seemed to have a greater chance of vascular invasion. The patients with TATDN1 variation have bigger diameters and greater chances of vascular and microvascular invasion (all P < 0.05). Univariate analysis indicated patients with gene TATDN1 variation had worse prognoses both in disease free survival (DFS) and overall survival (OS). In addition, the enrichment analysis showed many pathways, including the cell cycle pathway, viral oncogene pathway, MAPK pathway, PI3K-AKT pathway, etc., may be associated with HCC. CONCLUSION: This study explores the gene variation profile of HCC patients with HBV infection in Han nationality of Sichuan Province for the first time, which confirmed the existence of some high-frequency mutated genes and the possibility that the gene variations are involved in the tumorigenesis of HCC through multiple signal pathways. Also, patients with TATDN1 wild type showed a trend of better prognosis both in DFS and OS.

Pancreatic follicular dendritic cell sarcoma: one case report and literature review.

Pancreatic follicular dendritic cell sarcoma (FDCS) is a rare neoplasm with unclear pathological characteristics. In this study, we report one case of pancreatic FDCS and review published cases to summarize the characteristics and treatment of pancreatic FDCS. A man in his early 30 s was admitted for jaundice, abdominal fullness, and weight loss for 15 days. Computed tomography revealed a large capsule solid mass in the pancreatic head together with a dilated bile duct and enlarged retroperitoneal lymph nodes. Serum biochemistry revealed high total bilirubin levels (313.9 µmol/L) and normal tumor marker levels. Pancreatoduodenectomy was performed, but no chemotherapy was administrated at the patient's behest. The pathologic diagnosis was pancreatic FDCS infiltrating the duodenal seromuscular layer and common bile duct. The patient presented with liver metastasis 3 months after surgery and died 8 months after surgery from multiorgan failure. Pancreatic FDCS is a rare disease with high invasiveness. Our previous case exhibited paraneoplastic syndrome together with this disease, and further investigation is needed to confirm whether paraneoplastic syndrome is a typical syndrome of pancreatic FDCS.

CXCL12 secreted by pancreatic stellate cells accelerates gemcitabine resistance of pancreatic cancer by enhancing glycolytic reprogramming.

Pancreatic stellate cells (PSCs) are the primary cell components of pancreatic cancer (PC) and are involved in tumor growth, metastasis and resistance. However, the role and the mechanism of PSCs in gemcitabine (GEM) resistance to PC still need more investigation. We found that CXCL12 mRNA and secreted CXCL12 protein were higher in PSCs after GEM treatment. The conditioned medium (CM) from GEM-treated PSCs reduced the GEM sensitivity of PC cells. Blocking of CXCL12 in CM by anti-CXCL12 antibody partly restored the GEM sensitivity of PC cells. Blocking of CXCL12 decreased glucose consumption, lactate production, ECAR, and glycolysis-related gene expression in PC cells. The PI3K/AKT/mTOR pathway was activated by the binding of CXCL12 and CXCR4. Moreover, CXCR4 mRNA and protein expressions in PC cells were increased after GEM treatment. Our results indicated the cross-talk between PSCs and PC cells during GEM chemotherapy. CXCL12 secreted by PSCs reduces GEM sensitivity of PC cells by binding to CXCR4 and activating PI3K/AKT/mTOR-glycolysis pathway in PC. Our findings would lay the foundation for solving GEM resistance in PC.

Primary pancreatic hydatid cyst: a case report and literature review.

BACKGROUND: Hydatid cysts are parasitic zoonoses that often occur in the liver. Pancreatic hydatid cysts are very rare and are usually misdiagnosed as pancreatic cystadenomas. At present, surgical resection combined with albendazole administration is the standard treatment for pancreatic hydatid cysts. However, making accurate preoperative diagnoses and avoiding intraoperative cystic rupture are challenges for surgeons. CASE PRESENTATION: A 28-year-old woman from the pastoral area presented to the surgical office complaining of abdominal pain and new-onset jaundice that began 9 days earlier. An enhanced computed tomography scan demonstrated a 6.0 × 5.3 cm pancreatic head cystic mass that compressed the common bile duct and induced choledochectasia. The preoperative diagnosis was pancreatic head cystadenoma, and laparotomic pancreaticoduodenectomy was initiated successfully. The intra- and postoperative diagnosis was pancreatic hydatid cyst. The patient was discharged uneventfully 7 days after the operation. A 1-year course of albendazole (15 mg/kg/day) was admitted. CONCLUSION: Pancreatic hydatid cysts are rare and often misdiagnosed as other types of cysts. History of living in an area in which the causative organism is endemic and positive anti-echinococcus IgG antibody status could help with the diagnosis. Radical resection combined with oral albendazole administration is the standard treatment for pancreatic hydatid cysts. Avoiding perioperative cystic rupture and abdominal echinococcosis implantation metastasis is crucial for the success of the operation.

Combined hepatocellular-cholangiocarcinoma: An analysis of clinicopathological characteristics after surgery.

Combined hepatocellular-cholangiocarcinoma (CHCC) is a rare type of primary liver cancer (PLC). The aim of this study was to investigate the disease characteristics in CHCC patients and compare them with those in hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC).The perioperative and follow-up data of CHCC patients (n = 15), HCC patients (n = 577), and ICC patients (n = 61) were retrospectively analyzed, and the clinicopathological characteristics were compared among these 3 groups.In the CHCC group, the serum level of AFP was significantly higher than that of the ICC group (P = .002), and the CA19-9 level was higher than that of the HCC group (P = .011). The positive rates of CK7 and CK19 expression were higher in CHCC group than in HCC group (both P < .001), while the positive rates of Glypican-3 and Hepatocyte expression were higher in CHCC group than in ICC group (both P < .001). Meanwhile, the CHCC patients were likely to have undergone more MJH/LT than the HCC patients (P = .037) and the ICC patients (P = .011). Macrovascular invasion and lymph node metastasis in the CHCC group were significantly higher but satellite lesions were similar, compared to the HCC group. Both the 1-year disease-free survival (DFS) and the 1-year overall survival (OS) for the CHCC patients were worse than those for the HCC patients. AFP ≥ 400 ng/ml, tumor size ≥5 cm, tumor number ≥2, macro- and microvascular invasion, distant metastasis and positive margin were risk factors for both DFS and OS for the PLC patients. Multivariate analysis also confirmed that ICC and lymph node metastasis were risk factors for DFS and MJH/LT was risk factor for OS.CHCC patients appear to have intermediate clinical characteristics in comparison with the HCC and ICC patients, and the 1-year DFS and OS for the CHCC patients was worse than the HCC patients, but similar to the ICC patients.

Coexpression of UCA1 and ITGA2 in pancreatic cancer cells target the expression of miR-107 through focal adhesion pathway.

OBJECTIVES: Abnormal expressions of microRNAs (miRNAs) are demonstrated in pancreatic cancer (PaC), but a major part of the mechanism remains elusive. This study mainly aimed to structure a coexpressed network of long noncoding RNA (lncRNA) and messenger RNA (mRNA) in PaC, as well as to explore their direct targets. METHODS: LncRNA and mRNA microarrays were used to determine the expression profiles in PaC cells. Analysis of Kyoto Encyclopedia of Genes and Genomes pathway was performed to identify pathways associated with differentially expressed mRNAs. Coexpression profiles were identified by constructing differentially expressed lncRNA-mRNA regulatory network and further validated by quantitative real-time polymerase chain reaction assay and western blot assay. The bioinformatics computational method was applied to predict the biological target of lncRNA and mRNA, which was identified by luciferase reporter assay. Migration/invasion ability and apoptosis rate of cells were assessed by transwell assay and flow cytometry assay. RESULTS: It was identified that the level of urothelial cancer associated 1 (UCA1) was increased in PaC cells, and the inhibition of UCA1 suppressed migration and invasion ability of the cancer cells. The luciferase reporter assay recognized that miR-107 was targeted by UCA1, and integrin subunit α 2 (ITGA2) was further targeted by miR-107. This confirmed the prediction of lncRNA-miRNA-mRNA regulation mechanism. In the regulatory pathways, UCA1 and ITGA2 promoted PaC progression via focal adhesion pathway related proteins such as ITGA3, SRC protooncogene/nonreceptor tyrosine kinase, protein tyrosine kinase 2, and AKT serine/threonine kinase 1. CONCLUSION: The study revealed a regulatory network of UCA1-miR-107-ITGA2 and validated UCA1 and ITGA2 as potential prognostic factors for PaC.

Laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization for staged hepatectomy: A case report.

RATIONALE: Staged hepatectomy is an important surgical method for large hepatocellular carcinoma (HCC). However, the insufficient future liver remnant (FLR) is still the major barrier in stage II hepatectomy. We herein reported a case of laparoscopic associating liver tourniquet and portal ligation combined rescue transhepatic arterial embolization (TAE) for staged hepatectomy. PATIENT CONCERNS: Laparoscopic associating liver tourniquet and portal ligation for staged hepatectomy (ALTPS) was performed for cirrhotic HCC in stage I. To stimulate the growth of FLR, a "rescue" TAE was initiated before stage II. DIAGNOSE: HCC with hepatitis B cirrhosis. OUTCOMES: Two weeks later after TAE, the FLR achieved sufficient hypertrophy and stage II surgery was successfully performed. The patient was discharged 7 days after the second stage without serious complication. During the follow-up at postoperative 6 months, the patient underwent radiofrequency ablation, because contrast-enhanced ultrasonography showed 1 cm tumor recurrence in the remnant liver. LESSONS: Rescue TAE plays an important role to stimulate the increasing of FLR after ALTPS.

Clinical study on Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis in pancreaticoduodenectomy.

OBJECTIVE: To study the influence of Suspension Pancreatic-Duct-Jejunum End-to-Side Continuous Suture Anastomosis (SPDJCS) on the incidence of pancreatic fistula after pancreaticoduodenectomy, and to analyze its applicability, safety, and efficacies. METHODS: A prospective controlled trial was conducted with 165 cases receiving pancreaticoduodenectomy in the Department of Hepatopancreatobiliary Surgery from January 2010 to May 2012. The patients were divided into Group A (end-to-end/end-to-side invaginated anastomosis, n=52), Group B (end-to-side mucosal anastomosis, n=48), and Group C (SPDJCS, n=65). The preoperative data, intraoperative data, and operative outcomes (incidence of pancreatic fistula, operation time, intraoperative blood loss, peritoneal drainage, peritoneal hemorrhage, peritoneal abscess, delayed gastric emptying, pulmonary infection, postoperative infection, blood transfusion, and perioperative mortality) were compared among the 3 groups. RESULTS: The total incidence of pancreatic fistula was 13.9% (23/165) in all the 165 patients. The incidence in Group A and Group B was 23.1% (12/52) and 18.8% (9/48), both higher than that in Group C [3.1% (2/65), both P<0.05]. Group C showed significantly better outcomes than group A and B in terms of the operation time (5.5±1.2 hours vs. 6.1±1.1 hours, 5.5±1.2 hours vs. 6.3±1.5 hours), volume of blood loss (412.0±205.0 mL vs. 525.0±217.0 mL, 412.0±205.0 mL vs. 514.0±217.0 mL), and postoperative drainage amount of plasma tubes (175.0±65.0 mL vs. 275.0±80.0 mL, 175.0±65.0 mL vs. 255.0±75.0 mL) (all P<0.05), while Group A and Group B displayed no difference in these aspects (P>0.05). As complications other than pancreatic fistula were concerned, the three groups were not different from each other (P>0.05). CONCLUSIONS: SPDJCS may have the effect of reducing the incidence of pancreatic fistula after pancreaticoduodenectomy. It could be safe, practical and convenient technique of anastomosis for pancreaticojejunostomy.