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  • Minireview

    Updates on hepatorenal syndrome and strategies bridging to liver transplantation

    Chung Yeung Cheung , Kenneth S.H. Chok
    Hepatorenal syndrome is not an uncommon life-threatening complication arising from liver cirrhosis. The diagnostic criteria for this syndrome have been revised throughout the years, with recent revisions aimed at improving earlier diagnosis and treatment. Liver transplantation remains the only definitive treatment for hepatorenal syndrome. Due to the scarcity of liver grafts, many patients die waiting. This review focuses on the different strategies to bridge patients to liver transplantation and to improve the postoperative outcome.
    Published on: 12 Apr 2017
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  • Original Article

    Late recurrence of hepatocellular carcinoma after liver transplantation

    Julia A. Zhang , Sandi A. Kwee , Linda L. Wong
    Aim: Hepatocellular carcinoma (HCC) is the third leading cause of cancer deaths worldwide and liver transplant (LT) prolongs survival. However, 15-20% will experience recurrent HCC, most occurring within 2 years of LT. HCC patients with late recurrences (> 5 years after LT) may have distinctive clinical/biological characteristics. Methods: A retrospective review was conducted of 88 patients who underwent LT for HCC during 1993-2015, analyzing demographics, clinical factors, explant pathology, and outcome. Results: Median follow-up was 6.4 years. HCC recurred in 15 (17.0%) patients with...
    Published on: 10 Apr 2017
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  • Original Article

    Attenuation of liver stiffness in sorafenib-treated patients with advanced hepatocellular carcinoma

    Chien-Fu Hung , Dong Liu , Tsung-Han Wu , Chao-Wei Lee , Kuang-Tse Pan , Ching-Ting Wang , Hsiu-Ying Chai , Ming-Chin Yu , Yi-Cheng Chen
    Aim: Sorafenib is a multi-tyrosine kinase inhibitor and the standard therapy for advanced hepatocellular carcinoma (HCC). This retrospective study aimed to observe the anti-fibrotic effect of sorafenib in patients with advanced HCC. Methods: Seventeen patients with advanced HCC were recruited. Shear wave velocity (SWV) using acoustic radiation force impulse elastography and non-invasive serum markers for liver fibrosis, such as the aspartate aminotransferase (AST) to alanine aminotransferase ratio (AAR), the AST to platelet ratio index, the fibrosis-4 index and the Lok index, were recorded...
    Published on: 24 Mar 2017
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  • Topic: Novel Approaches for HCC

    Immunotherapy for hepatocellular carcinoma: the force awakens in HCC?

    Lynn G. Feun , Ying-Ying Li , Medhi Wangpaichitr , Chun-Jing Wu , Niramol Savaraj
    Systemic therapy for hepatocellular carcinoma (HCC) has been disappointing. The only drug approved by Food and Drug Administration recently has been sorafenib. Sorafenib has modest benefits with a low response rate and an improvement in time to progression of only 2-3 months. Multiple randomized trials, which compare the new agent to sorafenib as either first line or second line therapy, have been negative, showing no improved clinical benefit. Recently, in a large phase III randomized trial, regorafenib has shown superiority to placebo as a second line treatment for HCC. However, this drug...
    Published on: 22 Mar 2017
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  • Original Article

    Comparison of p53 and prohibitin expression in the spectrum of hepatitis, cirrhosis, and hepatocellular carcinoma

    Lívia Maria Della Porta , Fernando Silva Ramalho , Carlos Augusto Oliveira , Deisy Mara Silva , Marlei Josiele Augusto , Leandra Náira Zambelli Ramalho
    Aim: To investigate the correlation of p53 and prohibitin (PHB) expression in the spectrum of hepatitis, cirrhosis, and human hepatocellular carcinoma (HCC). Methods: Hepatic biopsies from patients with HCC (n = 60), cirrhosis (CIR, n = 30), hepatitis C virus (HCV, n = 30), and normal livers (NL, n = 20) were examined for immunohistochemical expression of RelA/p65, tumor necrosis factor receptor-1 (TNFR1), TNF-related apoptosis-inducing ligand (TRAIL), p53, and PHB. The samples were also analysed by nuclear factor kappa B (NFκB) Southwestern histochemistry and a transferase-mediated...
    Published on: 28 Feb 2017
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  • Original Article

    Antioxidant activity and free radical-scavenging of cape gooseberry (Physalis peruviana L.) in hepatocellular carcinoma rats model

    Hanaa A. Hassan , Nermin E. Ghareb , Ghassan F. Azhari
    Aim: Oxidative damage of cellular components by free radicals and other reactive oxygen molecules is believed to be associated with the development of degenerative diseases. The aim of the present study was to evaluate the antioxidant capacity and free radical scavenging activity of cape gooseberry juice (CGJ) in diethylnitrosamine-(DENA) and CCl4 (3 mL/kg b.w.)-induced hepatocellular carcinoma (HCC) rats model. Methods: The rats were divided into 4 groups (6 rats each group). Group 1 (control): the rats of this group did not receive any treatments; group 2 (CGJ): rats were daily...
    Published on: 28 Feb 2017
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  • Review

    Further understanding of mechanisms involved in liver cancer chemoresistance

    Oscar Briz , Maria J. Perez , Jose J. G. Marin
    An important limitation for the success of chemotherapy in the treatment of primary liver cancer (hepatocellular carcinoma, hepatoblastoma and cholangiocarcinoma) is the marked efficacy of mechanisms of chemoresistance (MOC). These have been previously classified into five groups depending on whether they result in: a reduced drug uptake or enhanced drug export (MOC-1); poor intracellular activation of prodrugs or higher inactivation of active drugs (MOC-2); changes in the molecular targets that impairs the action of the drug by increasing the activity of the metabolic route to be inhibited...
    Published on: 19 Jan 2017
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  • Case Report

    Sorafenib from palliative to neoadjuvant chemotherapy in hepatocellular carcinoma with major vascular invasion: experience of two cases

    Naganathan Selvakumar , Sandeep Vohra , Deep Sika Arora , Subash Gupta
    Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide and the incidence is higher in cirrhosis. Treatment options depend on tumor stage, status of liver function, and the general condition of the patient. Major vascular invasion is a contraindication for liver transplantation. Sorafenib has been found to be useful in association with transarterial chemoembolization as an effective chemotherapeutic agent to prolong survival in inoperable HCCs. Here we describe our experience where sorafenib was used as palliation but later turned out to be a neoadjuvant. Both cases had...
    Published on: 12 Jan 2017
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  • Review

    Radiological diagnosis of hepatocellular carcinoma in non-cirrhotic patients

    Alba Castán , Ylenia Navarro , Luis Sarría , Raquel Larrosa , Mario Serradilla , Alejandro Serrablo
    Hepatocellular carcinoma (HCC) arising in non-cirrhotic livers is relatively rare. Compared with HCC arising in cirrhotic livers they have some quirks. HCC in healthy livers are large tumors at diagnosis, and are detected due to the onset of abdominal symptoms, outside of any scheduled monitoring program. In non-cirrhotic patients, HCC has the same appearance as the classic image of cirrhotic HCC substrate. The presence of capsule, extensive intratumoral necrosis and typical behavior in the dynamic study after administration of intravenous contrast are present in most of the non-cirrhotic...
    Published on: 12 Jan 2017
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  • Review

    Novel predictive and prognostic strategies of hepatitis B virus related hepatocellular carcinoma

    Wen-Bin Liu , Fan Yang , Ding-Yi Shao , Guang-Wen Cao
    Hepatocellular carcinoma (HCC) is a common malignancy and an important cause of cancer death worldwide. Chronic hepatitis B virus (HBV) infection is the major cause of HCC. Recent studies of HBV-induced carcinogenesis not only discovered many new biomarkers but also developed a novel theory: Cancer Evolution-Development (Cancer Evo-Dev). Cancer Evo-Dev provides an evolutionary insight of developing more reasonable predictive and prognostic strategies. Characterizing chronic inflammatory microenvironment of cancer evolution, genetic polymorphisms of inflammatory factors, and HCC-related HBV...
    Published on: 23 Dec 2016
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  • Commentary

    Comments on “The severity of non-alcoholic fatty liver disease is associated with gut dysbiosis and shift in the metabolic function of the gut microbiota”

    Anna Egresi , Krisztina Hagymási , Gabriella Lengyel
    Published on: 13 Dec 2016
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  • Original Article

    Effect of obesity on perioperative outcomes after laparoscopic hepatectomy

    Seeyuen J. Lee , Adam Hauch , Erica Kane , Christoper DuCoin , Michael Darden , Geoffrey Parker , Emad Kandil , Joseph F. Buell
    Aim: Laparoscopic hepatectomy is increasing in utilization, however the procedure has not been adequately examined in the obese patient. This study aims to analyze the effect of obesity on perioperative outcomes after laparoscopic hepatectomy. Methods: Retrospective analysis of 396 laparoscopic hepatectomies in normal [body mass index (BMI) < 25], overweight (BMI ≥ 25), obese (BMI ≥ 30), and severely obese (BMI ≥ 35) patients using multivariate regression models to determine the risk factors for post-operative complications. Results: Normal BMI (n = 78; 20%), overweight (n = 209; 52%),...
    Published on: 13 Dec 2016
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  • Original Article

    Role of contrast-enhanced ultrasound in the evaluation of vascularization of hepatocellular carcinoma

    Francesco Loria , Giuseppe Loria , Salvatore Basile , Giuseppe Crea , Luciano Frosina , Francesca Frosina
    Aim: Early individualization of hepatocellular carcinoma is crucial to obtain good therapeutic results, thanks to several options such as percutaneous therapies, surgical resections and transplant. Aim of this study is to evaluate the vascularization of hepatocarcinoma using contrast enhanced ultrasound (CEUS) in comparison with multislice computed thomography (MSCT). Methods: Between January 2009 and May 2014, 67 patients affected by hepatocarcinoma, who presented an overall of 92 nodules, were examined and enrolled in the study. Results: There was a significant difference in the...
    Published on: 22 Nov 2016
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  • Original Article

    Evaluating normalization approaches for the better identification of aberrant microRNAs associated with hepatocellular carcinoma

    Jing Shen , Qiao Wang , Irina Gurvich , Helen Remotti , Regina M. Santella
    Aim: Dysregulated microRNAs (miRNAs) have been identified in hepatocellular carcinoma (HCC), but only a small proportion have been confirmed. An appropriate normalizer is crucial to determining the accuracy and reliability of data from miRNA studies. Methods: Different normalization strategies were used to validate genome-wide miRNA profiles in HCC tumor and non-tumor tissues, and to determine the consistency and discrepancy of data on dysregulated miRNAs. Results: Two sets of stable miRNAs (miR-30c/miR-30b and miR-30c/miR-126) were identified in HCC tissues by geNorm and NormFinder tools,...
    Published on: 18 Nov 2016
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  • Case Report

    Aggressive primary hepatic histiocytic sarcoma: case report and literature review

    Guang Yang , Jeremy Deisch , Haixia Qin , Craig Zuppan , Anwar S. Raza
    Histiocytic sarcoma is an uncommon non-Langerhans histiocyte disorder of mature tissue histiocytes. The authors presented an example of this rare tumor in a 14-year-old girl who presented with left upper quadrant pain, loss of appetite, and weight loss. A large 18 cm × 10 cm heterogeneous solid and cystic enhancing mass was found in the left lobe of the liver. Based on the histomorphology and positivity for histiocyte-specific markers in a needle biopsy, a diagnosis of histiocytic sarcoma was made. Chemotherapy was initiated, but the tumor did not respond well, and she died about 7 weeks...
    Published on: 7 Nov 2016
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  • Case Report

    An extra-adrenal pheochromocytoma mimicking a primary liver cancer

    Kenneth Siu Ho Chok , Florence Loong , Chung Mau Lo
    Despite doctors’ every effort to be vigilant when diagnosing, sometimes a preoperative diagnosis is disproved by postoperative pathological examination. A patient was diagnosed with hepatocellular carcinoma and received surgery as treatment. On operation, a solitary retroperitoneal mass rather than a liver lesion was seen. On histopathological examination, the retroperitoneal mass was found to be an extra-adrenal pheochromocytoma.
    Published on: 7 Nov 2016
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  • Case Report

    Hepatocarcinoma with metastasis to the anterior mediastinum

    Rogério Camargo Pinheiro Alves , Lorena Sagrilo Auer , Lisa Rodrigues da Cunha Saud , Raquel Coris Arrelaro , Aline Carboni Casado , Bruno Gustavo Ferreira , Denis Szjenfeld , Paula Bechara Poletti
    Liver malignancies are the sixth leading cause of cancer worldwide, whereas hepatocellular carcinoma (HCC) is the most frequent histological type of liver cancer. Extrahepatic metastasis, which rarely involves the mediastinum, is associated with poor prognosis. An 80-year-old male presenting with mild diffuse abdominal pain for 4 months, associated with hyporexia, increased abdominal volume, dry cough, and loss of 4 kg in 1 month, sought medical assistance due to hemoptysis and chest pain. Tomographic study revealed HCC with mediastinal metastasis, after which sorafenib therapy was started....
    Published on: 21 Oct 2016
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  • Original Article

    Is transarterial embolization a valuable treatment option for spontaneous rupture of hepatocellular carcinoma: experience from a tertiary care hospital of South-Asia

    Amna Subhan Butt , Saeed Hamid , Nazish Butt , Fatima Sharif , Tanveer Ul Haq , Wasim Jafri
    Aim: Transarterial embolization (TAE) has been found beneficial in treatment of ruptured Hepatocellular carcinoma (HCC) in earlier studies. So far no data is available from Pakistan. The aim of this study was to evaluate clinicopathological characteristics, outcomes of patients presented with spontaneously ruptured, unresectable HCC treated with or without TAE and to evaluate the factors associated with 30-day mortality. Methods: This was a cross sectional study. Patients ≥ 18 years old, presented with spontaneous rupture of unresectable HCC, were evaluated. The outcome measures were...
    Published on: 21 Oct 2016
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  • Case Report

    Epstein-Barr virus associated secondary hemophagocytic lymphohistiocytosis with an unusual presentation of abdominal compartment syndrome

    Li Lei , Camilla J. Cobb , Jeffrey Cao , Anwar S. Raza
    Hemophagocytic lymphohistiocytosis (HLH) is a cytokine storm syndrome caused by an overactive but ineffective immune reaction. Without prompt diagnosis and treatment, HLH is life-threatening. However, presenting symptoms are often nonspecific, with fatigue and fever being the most common. A high index of suspicion is therefore critical for early diagnosis and timely management. A previously healthy, 65-year-old female who initially presented with fever and abdominal pain developed abdominal compartment syndrome (ACS) requiring decompressive laparotomy on hospital day 6. Intraoperative...
    Published on: 21 Oct 2016
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  • Topic: Advances in Minimally Invasive Cirrhotic Surgery

    Liver resection for hepatocellular carcinoma within a fast-track management: a propensity-score matched analysis between open and laparoscopic approach

    Francesca Ratti , Federica Cipriani , Raffaella Reineke , Marco Catena , Michele Paganelli , Luigi Beretta , Luca Aldrighetti
    Aim: The study was designed to assess the implications of enhanced recovery after surgery (ERAS) approach in patients submitted to open liver resection for hepatocellular carcinoma (HCC) comparing their short term outcome with patients treated by laparoscopic approach, in a case-matched design. Methods: The open-group (n = 60) was matched in a ratio of 1:1 with patients undergoing laparoscopic liver resection for HCC (Lap-group, n = 60), with a matching achieved on a basis of propensity scores including 6 covariates representing patients characteristics and severity of the disease. Primary...
    Published on: 30 Sep 2016
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