Specific characteristics of scirrhous hepatocellular carcinoma.

BACKGROUND/AIMS: Scirrhous hepatocellular carcinoma has been defined within general hepatocellular carcinoma. To define scirrhous hepatocellular carcinoma, the present study identified the specific characteristics as compared with general hepatocellular carcinoma. METHODOLOGY: The scirrhous hepatocellular carcinoma was defined when almost all areas of the tumor were occupied with scirrhous structures. It was identified 14 patients with scirrhous hepatocellular carcinoma and 300 patients with general hepatocellular carcinoma (control), all underwent hepatectomy from 1988 to 1994. It was compared the clinical background of the patients, prognosis, and pathological features, which included immunohistological staining using Hepatocyte Paraffin 1. RESULTS: All scirrhous hepatocellular carcinoma showed whitish, hard forms resembling intrahepatic cholangiocarcinoma. The rates of average ICGR15, positive hepatitis C virus antibody, and microscopic invasion to the bile duct were 12%, 33%, and 20%, respectively, each significantly different than general hepatocellular carcinoma. The cumulative 10-year survival rate of scirrhous hepatocellular carcinoma and general hepatocellular carcinoma were 70% and 31%, respectively. With immunohistological staining, 43% of scirrhous hepatocellular carcinoma showed negative staining for Hepatocyte Paraffin 1. CONCLUSIONS: The scirrhous hepatocellular carcinoma has specific characteristics such as lower rates of hepatitis C virus infection, better prognosis, and different histological findings; therefore, scirrhous hepatocellular carcinoma should be strictly classified under a new category.

Immunohistological evaluation of single small hepatocellular carcinoma with negative staining of monoclonal antibody Hepatocyte Paraffin 1.

BACKGROUND AND OBJECTIVES: The sensitivity and specificity of the monoclonal antibody Hepatocyte Paraffin 1 (Hep Par 1) for hepatocellular carcinoma (HCC) are very high, and the usefulness for differential diagnosis of hepatic tumors has been reported. However, there are some cases of HCC with negative staining for Hep Par 1. We examined the histopathological features of HCC with negative staining for Hep Par 1. METHODS: We examined 69 samples of single nodular HCC less than 2 cm in greatest dimension, resected from 1985 to 1994 in our hospital, with immunohistological staining for Hep Par 1, cytokeratin 19 (CK 19), MUC-1 glycoprotein (MUC-1), and epithelial membrane antigen (EMA). RESULTS: Hep Par 1 staining was positive in 64 cases (93%) and negative in 5 cases (7%). With regard to the histological structure, 3 of the 5 negative cases were scirrhous HCC. With regard to the grade of histological differentiation, 2 cases were poorly differentiated HCC, 3 cases were moderately differentiated HCC, and no well-differentiated HCC was found in the negative cases. CK 19, MUC-1, and EMA staining were negative in all cases. CONCLUSIONS: It is necessary to recognize the existence of Hep Par 1 negative HCC, in particular scirrhous HCC. This may be due to a different mechanism in the earlier stage of hepatocarcinogenesis.

Two cases of hemosuccus pancreaticus in which hemostasis was achieved by transcatheter arterial embolization.

Hemosuccus pancreaticus is a rare complication of chronic pancreatitis. We report two cases of hemosuccus pancreaticus in which hemostasis was achieved by transcatheter arterial embolization (TAE). The first patient was a 47-year-old man with alcoholic chronic pancreatitis. He presented with upper abdominal pain and hematemesis. Upper GI endoscopy failed to detect the source of bleeding, but computed tomography (CT) showed a hypervascular area about 3 cm in diameter in a pseudocyst at the pancreatic tail. Angiography revealed a pseudoaneurysm in the caudal pancreatic artery. Hematemesis was considered to be due to rupture of the pseudoaneurysm. TAE of the splenic artery was performed selectively, and this successfully stopped the bleeding. The second patient was a 52-year-old man with alcoholic chronic pancreatitis. He presented with hematemesis. Upper GI endoscopy detected bleeding from the papilla of Vater. CT showed hemorrhage in a pseudocyst at the pancreatic body. Angiography revealed angiogenesis around the pseudocyst. Hematemesis was considered to result from rupture of the pseudoaneurysm. TAE of the dorsal pancreatic artery and posterior superior pancreaticoduodenal artery was performed and hemostasis was achieved. We conclude that TAE is a minimally invasive and highly effective treatment for hemosuccus pancreaticus.