"Very early" intrahepatic cholangiocarcinoma in cirrhotic patients: should liver transplantation be reconsidered in these patients?

A retrospective cohort multicenter study was conducted to analyze the risk factors for tumor recurrence after liver transplantation (LT) in cirrhotic patients found to have an intrahepatic cholangiocarcinoma (iCCA) on pathology examination. We also aimed to ascertain whether there existed a subgroup of patients with single tumors ≤2 cm ("very early") in which results after LT can be acceptable. Twenty-nine patients comprised the study group, eight of whom had a "very early" iCCA (four of them incidentals). The risk of tumor recurrence was significantly associated with larger tumor size as well as larger tumor volume, microscopic vascular invasion and poor degree of differentiation. None of the patients in the "very early" iCCA subgroup presented tumor recurrence compared to 36.4% of those with single tumors >2 cm or multinodular tumors, p = 0.02. The 1-, 3- and 5-year actuarial survival of those in the "very early" iCCA subgroup was 100%, 73% and 73%, respectively. The present is the first multicenter attempt to ascertain the risk factors for tumor recurrence in cirrhotic patients found to have an iCCA on pathology examination. Cirrhotic patients with iCCA ≤2 cm achieved excellent 5-year survival, and validation of these findings by other groups may change the current exclusion of such patients from transplant programs.

[Early diagnosis of primary liver cancer: imaging versus genetics]. / Diagnóstico precoz del cáncer primario de hígado: imagen versus genética.

Early diagnosis of hepatocellular carcinoma (HCC) in nodules smaller than 2 cm detected by screening ultrasounds becomes essential given that, at that stage, no vascular invasion is usually detected and treatment is associated with a high rate of long-term survival. Improvements in imaging techniques in the last few years have allowed a conclusive diagnosis of HCC in these small nodules without invasive procedures. However, a conclusive diagnosis of HCC by imaging is not always possible and, in more than half of cases, biopsy is needed. On the other hand, histological confirmation of HCC in such tiny nodules is very complex, and in most cases impossible because of the limited sample obtained. In addition, serum tumor markers currently available show low accuracy and are useless for early diagnosis. Progress in the knowledge of molecular mechanisms associated with malignant transformation will allow the use of new techniques that will facilitate diagnosis for HCC in very early stages.

Role of prostaglandins on lymphocyte transformation in Crohn's disease.

We analyzed the response to phytohemagglutinin (PHA) of peripheral blood (PBL), intraepithelial (IEL) and lamina propia (LPL) lymphocytes in eight patients with Crohn's disease (CD). We also studied the effect of indomethacin, a prostaglandin synthetase inhibitor, and monocyte depletion on mitogen-induced stimulation of these cells. The blastic stimulation index was significantly lower in PBL and intestinal mucosa lymphocytes of CD than in controls (p less than 0.001). This index increased after addition of indomethacin in PBL and LPL and after monocyte depletion in PBL. The suppressor index on blastic stimulation, obtained when indomethacin had been added to the cultures was higher in PBL and intestinal mucosa lymphocytes of patients with CD than in controls. After monocyte depletion, this suppressor index decreased significantly in PBL and did not change in controls. These data suggest that prostaglandins could be one of the responsible factors for hyporesponsiveness of lymphocytes in CD.

Intestinal and peripheral blood lymphocyte subpopulations in Crohn's disease.

Cellular immunity has been implicated in the pathogenesis of Crohn's disease. In the present work, we have studied T-lymphocytes subsets in peripheral blood and intestinal mucosa of eight patients with active disease, using monoclonal antibodies. Intraepithelial and lamina propia OKT-3 +ve cells were significantly lower than in peripheral blood (p less than 0.001). We have found an increase of B cells and OKT-8 +ve cells in intestinal mucosa with a significant decrease in helper/suppressor ratio. These findings are in accordance with a high suppressor-cytotoxic function in patients with active diseases.

Could alpha 1 antitrypsin deficiency have any role in the development of celiac sprue after gastric operations?

We report a 50-year-old woman with alpha 1 antitrypsin deficiency (PiSZ phenotype) who developed clinical features of malabsorption after vagotomy and pyloroplasty. The intestinal biopsy demonstrated total villous atrophy with hypertrophy of the crypts. After gluten withdrawal, digestive function and the appearance of the intestinal biopsy returned to normal. We raise the possibility of an association between alpha 1 antitrypsin deficiency and celiac sprue.

Laparoscopic diagnosis of tuberculous ascites.

We report 14 patients with tuberculous peritonitis presenting as persistent and exudative ascites. We found a primary site of tuberculous infection in only 10% of the patients. PPD test was positive in 9 patients. Ascitic fluid showed a protein content in excess of 3.5 g/dl. and more than 300 cells/mm3, mainly lymphocytes, in all patients, Ziehl stain and the culture for Tb. bacilli were negative in all cases. The confirmatory diagnosis was made by laparoscopy and peritoneal biopsy. Good views were obtained on all occasions, and there was no morbidity. Appearances were similar in all cases. Multiple white tubercles were scattered over the parietal and visceral peritoneum. filmy adhesions were present. Four patients had cirrhotic liver disease confirmed by laparoscopy. The biopsy specimen showed caseating granulomata, and the auramine stain was positive in four cases. We conclude that laparoscopy and biopsy is a safe and effective method of obtaining an early diagnosis in patients with tuberculous ascites, especially if they also have cirrhosis.