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  • Review|Open Access

    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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  • Minireview|Open Access

    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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  • Review|Open Access

    Management of advanced hepatocellular carcinoma: review of current and potential therapies

    Asmaa Gomaa , Imam Waked
    Over the past few years, despite improvement in screening and diagnosis of hepatocellular carcinoma (HCC), advanced stage remains the most common presentation at diagnosis, with limited management options, especially options available to patients in limited resource countries. There is currently no effective systemic chemotherapy, targeted, or immunologic therapy for advanced stage HCC. Sorafenib is the only approved front-line molecular-targeted treatment,with slight survival benefit. Regorafenib has recently been approved as second line therapy for HCC after failure of sorafenib. Ongoing...
    Published on: 15 Jun 2017
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  • Original Article|Open Access

    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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  • Topic: Advances in Minimally Invasive Cirrhotic Surgery|Open Access

    Case report of the fourth laparoscopic liver resection and review of repeat laparoscopic resection for recurrent hepatocellular carcinoma in cirrhotic liver

    Zenichi Morise , Masashi Isetani , Norihiko Kawabe Norihiko Kawabe , Hirokazu Tomishige , Hidetoshi Nagata , Satoshi Arakawa , Masahiro Ikeda , Kenshiro Kamio
    A 73-year-old woman with liver cirrhosis caused by hepatitis C virus (HCV) underwent treatment of three hepatocellular carcinomas (HCCs) in liver segment 4, following three previous laparoscopic liver resections (LLRs) over 73 months. Contrast-enhanced computed tomography showed three 0.5-1.2 cm HCCs deep within the portal territories of subsegments 4a and 4b. The patient underwent laparoscopic resection of 4a and 4b, with the preservation of the portal branch to 4c, after minimal adhesiolysis around segment 4. The operation lasted 284 min, there was 50 mL of intra-operative bleeding and...
    Published on: 19 Sep 2016
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  • Topic: Advances in Minimally Invasive Cirrhotic Surgery|Open Access

    Indications and technique for laparoscopic liver resection in patients with hepatocellular carcinoma and liver cirrhosis

    Yuichiro Otsuka , Masaru Tsichiya , Toshio Katagiri , Yoshihisa Kubota , Jun Ishii , Tetsuya Maeda , Hironori Kaneko
    Liver resection is the preferred initial treatment option for solitary or limited multifocal hepatocellular carcinoma (HCC). However, because of the characteristics of HCC, including its high recurrence rate and the frequent presence of chronic hepatitis and cirrhosis, both curability and invasiveness must be considered when selecting a treatment for HCC. Laparoscopic liver resection (LLR) is minimally invasive and increasingly performed worldwide as a curative surgical option for treatment of liver tumors. The 2014 International Consensus Conference on LLR concluded that minor LLRs are now...
    Published on: 19 Sep 2016
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  • Review|Open Access

    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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  • Topic: Novel Approaches for HCC|Open Access

    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|Open Access

    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|Open Access

    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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  • Original Article|Open Access

    Detecting hepatic nodules and identifying feeding arteries of hepatocellular carcinoma: efficacy of cone-beam computed tomography in transcatheter arterial chemoembolization

    Yasuhiro Ushijima , Tsuyoshi Tajima , Akihiro Nishie , Yoshiki Asayama , Kousei Ishigami , Masakazu Hirakawa , Daisuke Kakihara , Daisuke Okamoto , Hiroshi Honda
    Aim: To evaluate the effectiveness of using cone-beam computed tomography (CBCT) in transcatheter arterial chemoembolization (TACE) to detect hapatocellular carcinoma (HCC) nodules and their feeding arteries. Methods: Twenty-four patients with HCCs who underwent TACE using CBCT in addition to conventional digital subtraction angiography (DSA) were enrolled. After both conventional DSA and CBCT through the hepatic artery were acquired, TACE were performed. The nodules were defined as an HCC when dense accumulation of iodized oil was found within the nodule on CT obtained 2 weeks after the...
    Published on: 25 Aug 2016
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  • Case Report|Open Access

    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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  • Original Article|Open Access

    In vitro antitumor efficacy of Kochia indica extract on human hepatocellular carcinoma cell line with or without 5-fluorouracil

    Nabil Mohie Abdel-Hamid , Ghada A. Tabl , Yousry E. El-Bolkiny , Walaa O. Zeina
    Aim: Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and the sixth most common cancer worldwide. The resistance to chemotherapy is a major obstacle in the treatment of HCC, necessitating the discovery of additional agents. There is a growing use of anticancer complementary and alternative medicine worldwide. Therefore, the aim of present study was focused on the confirmation of the suitability and validity of the new markers which would be achieved by demonstrating their significant change and reproducible expression during disease and disease management. Methods:...
    Published on: 21 Jul 2017
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  • Case Report|Open Access

    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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  • Topic: Advances in Minimally Invasive Cirrhotic Surgery|Open Access

    Laparoscopic resection of hepatocellular carcinoma in patients with and without cirrhosis: the Brisbane experience

    Daniel J. Kilburn , Universe Leung , David J. Cavallucci , Cassandra Jeavons , Mehan Siriwardhane , Richard Bryant , Thomas R. O’Rourke , Shinn Yeung , Nicholas A. O’Rourke
    Aim: Laparoscopic liver resection for hepatocellular carcinoma (HCC) is increasingly common around the world. There may be significant advantages over open resections. However, due to technical difficulties, they are performed in few centers with expertise in liver and advanced laparoscopic surgery. In this study the authors summarize the experience to date. Methods: A retrospective analysis of consecutive patients undergoing laparoscopic liver resection for HCC in 2 tertiary academic hepatobiliary units in Brisbane, Australia, between 1999 and 2015 was performed. Operative characteristics,...
    Published on: 30 Sep 2016
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  • Commentary|Open Access

    Comment on “Preliminary outcome of microwave ablation of hepatocellular carcinoma: breaking the 3-cm barrier?”

    Paola Tombesi , Francesca Di Vece , Francesca Ermili , Sergio Sartori
    Published on: 25 Aug 2016
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  • Case Report|Open Access

    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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  • Original Article|Open Access

    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|Open Access

    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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  • Topic: Advances in Minimally Invasive Cirrhotic Surgery|Open Access

    Laparoscopic liver resection in the cirrhotic patient

    Ben Robichaux , Jesse Sulzer , Joseph F. Buell
    Aim: The adoption of laparoscopic liver resection has been expansive in the last 2 decades with the exception of cirrhotic patients. The current study examines the outcomes of our cirrhotic resections to determine the potential limitations of this technique. Methods: Retrospective analysis of 114 cirrhotic patients. Seventy-five (65.8%) laparoscopic resections were compared to 39 open resections. Seventy-six (66.7%) resections in the series were minor resections (less than 3 segments). Surgical approach and extent of resection were analyzed using student’s t test and regression multivariate...
    Published on: 19 Sep 2016
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