Caso Clínico: Hepatocarcinoma Combinado con Carcinoma Nueroendocrino Primario de Higado. Hospital de Especialidades José Carrasco Arteaga / Case Report: Management of Septic Abdomen Using VAC System

INTRODUCCIÓN: El hepatocarcinoma asociado con carcinoma neuroendocrino primario de hígado es una neoplasia rara; existiendo así el de tipo combinado y por colisión. CASO CLÍNICO: Paciente masculino de 52 años de edad, se detectó una masa a nivel de ambos lóbulos hepáticos. Se realizó una segmentectomia más resección ganglionar con resultado de patología positivo para hepatocarcinoma multinodular grado II combinado con carcinoma neuroendocrino. Estudios de extensión negativos para malignidad. EVOLUCIÓN: No se evidenció recurrencia de la lesión en los controles por imagen y los marcadores de antígeno carbohidrato 125, antígeno carbohidrato 19-9 yalfa feto proteína permanecieron negativos a los 6 meses luego de la cirugía. CONCLUSIÓN: El hepatocarcinoma combinado con carcinoma neuroendocrino primario de hígado, es una neoplasia poco frecuente que requieremás estudios que corroboren el tratamiento y pronóstico. (au)

INTRODUCTION: Hepatocarcinoma associated with primary neuroendocrine carcinoma of the liver is a rare neoplasm; There is the type of combined and collision. CASE REPORT: A 52 year old male patient who was diagnosed with a mass at both hepatic lobes. A segmentectomy plus nodal resection was performed, with results for multinodular grade II hepatocarcinoma combined with neuroendocrine carcinoma. Extension studies were negative for malignancy. EVOLUTION: There was no recurrence of lesion in the image controls; carbohydrate antigen 125, carbohydrate antigen 19-9 and Alpha-fetoprotein remained negative after 4 months of surgery. CONCLUSION: Hepatocarcinoma combined with primary neuroendocrine carcinoma of the liver is a rare neoplasm that requires more studies to strengthen treatment and prognosis.(au)

Avaliação radiológica das neoplasias hepáticas primárias / Radiological evaluation of primary liver neoplasms

O fígado é um órgão em que, muito frequentemente, se verificam lesões focais de natureza neoplásica primária. A avaliação correta destas lesões é fundamental, uma vez que sua etiologia pode ser desde lesões inocentes sem qualquer significado clínico até processos malignos ou com potencial maligno, cujo tratamento precoce pode determinar a cura do paciente. Os exames de imagem cumprem um papel de relevo na detecção e caracterização destas lesões. Este artigo tem como objetivo descrever as características radiológicas das principais lesões hepáticas focais, descrevendo os principais achados nos exames de ultrassonografia, tomografia computadorizada e ressonância magnética.

The liver is an organ in which, very often, occurs focal lesion of primary neoplasic nature. The correct evaluation of these lesions is essential, since its etiology may be innocent, without any clinical significance, to malignant processes or malignant potential, which may provide early treatment to cure the patient. Imaging studies play an important role in the detection and characterization of these lesions. This article aims to describe the radiological characteristics of the main focal hepatic lesions, describing the main finding on ultrasound examination, computed tomography and magnetic resonance imaging.

Tumores hepáticos benignos / Benign liver tumor

Los tumores hepáticos benignos corresponden a un grupo heterogéneo de lesiones, que carecen de condiciones clínicas de malignidad. La gran mayoría son pequeños y asintomáticos, y son pesquisados en forma incidental. El principal problema clínico es asegurar la naturaleza benigna de esta masa. La primera aproximación diagnóstica se realiza mediante una ecografía. La tomografía computada y resonancia magnética con uso de contrastes vasculares en distintas fases se han desarrollado en forma espectacular, lo que ha permitido obviar en un gran número de casos el diagnóstico histológico. Sin embargo otras lesiones irremediablemente deberán ir a un estudio anatomopatológico. La mayoría de los centros no recomiendan la biopsia percutánea, dado su alto riesgo de complicaciones y pobres resultados. Por lo tanto según las características del estudio se definirá finalmente si el paciente se destina a seguimiento o a una resección quirúrgica. El hemangioma corresponde al tumor hepático benigno más frecuente, seguido por la hiperplasia nodular focal y el adenoma. Los adenomas casi siempre tienen indicación quirúrgica, dado su riesgo de complicación y malignización. En el resto, es planteable la resección frente a la presencia de síntomas, desarrollo de complicaciones y duda diagnóstica. La morbimortalidad quirúrgica que se describe es muy baja.

Postoperatorio crítico de un paciente con colangiocarcinoma y cirrosis / Critical postoperative of a patient with cirrhosis and cholangiocarcinoma

We present a patient that has alcoholic hepatic failure and cholangiocarcinoma, morbity obesity and sickness apnea that has a post surgery complication with severe sepsis,acute renal failure, hepatic failure and septic shock for nosocomial pneumonia. The principal complication was acute renal failure that requires continious hemodiafiltration, for 3 weeks approximately, and intermittent hemodialisis for 5 weeks more. The patient survive with no chronical complication and has a normal performance.

Abordagem do hepatocarcinoma na cirrose: análise dos escores, índices e classificações / Approach to hepatocarcinoma in cirrhosis: analysis of scores, indices, and classifications

A cirrose hepática se constitui no mais importantes risco para o desenvolvimento do carcinoma hepatocelular. O estágio e a forma de crescimento tumoral, bem como a severidade da doença de base, a condição fisiológica do doente e o tratamento aplicado são fatores que determinam o prognóstico desses pacientes. Com o intuito de discriminar diferentes estratégias terapêuticas, de acordo com os fatores prognósticos, vários sistemas de classificação foram desenvolvidos. Esta revisão avalia os sistemas atualmente em utilização e suas aplicações. De fato, nenhum sistema classificatório prognòstico preenche os critérios para estratificação dos pacientes em grupos com diferentes prognòsticos e recomendações terapêuticas.

Hepatoblastoma--report of three cases.

Hepatoblastoma accounts for only 0.5% of all paediatric tumours. The vast majority of these cases are seen under five years of age and a third of patients have some form of congenital anomaly syndrome or other childhood tumour. Most recent classification describes six subtypes of hepatoblastoma. Surgical resection is the best treatment preceded by accurate staging and chemotherapy or radiotherapy. Hepatoblastoma can be diagnosed by Fine Needle Aspiration Cytology (FNAC). We report here three cases of hepatoblastoma diagnosed by FNAC and subsequently confirmed by histopathology following resection of hepatic tumours.

Histologic subtypes of hepatocellular carcinoma in the southern Thai population.

Since there has been no report on histologic subtypes of hepatocellular carcinoma (HCC) and its significance in the Thai population, the present study was conducted to elucidate the situation through appraisal of histologic and laboratory records. A total of 180 archived microscopic slides of HCC in Sonklanagarind Hospital from 1991 to 1998 were of good enough quality with sufficient tissue to be reviewed. The reclassified histologic subtypes were correlated with microscopic features and laboratory data. Of the 180 cases, 147 were males and hepatitis B was the main etiologic factor. The histologic subtypes of HCC were trabecular 63.3%, compact 15.6%, scirrhous 7.8%, pseudoglandular 5%, and fibrolamellar 0.6%. There was no correlation between histologic subtypes and morphological findings, as well as HBV, HCV, and cirrhotic status. A correlation between AFP levels and the AST/ALT ratio was evident.

Ultrastructure of Chronic Liver Diseases: The Cytoskeleton of the Hepatocyte / 대한간학회지

No abstract available.

New Scoring Systems for Severity Outcome of Liver Cirrhosis and Hepatocellular Carcinoma: Current Issues Concerning The Child-Turcotte-Pugh Score and The Model of End-Stage Liver Disease (MELD) Score / 대한간학회지

It has been approximately 30 years since Child-Turcotte-Pugh score has been used as a predictor of mortality in patients with liver cirrhosis and hepatocellular carcinoma (HCC). Recently, new prognostic models such as Model for End-Stage Liver disease (MELD), Short- and Long-term Prognostic Indices (STPI and LTPI), Rockall score, and Emory score were proposed for predicting survival in patients with liver cirrhosis treated by transjugular intrahepatic portosystemic shunt (TIPS). In MELD scoring, three independent variables which showed a wide range of results including serum creatinine, serum bilirubin and international normalization ratio (INR) of prothrombin time were evaluated in log(e) scale in comparison with simply categorized-into-three scoring system of Child-Turcotte-Pugh. The etiology of liver cirrhosis was applied to the score of MELD: alcoholic or cholestatic, 0; viral or others, 1. Concurrent statistic (C-statistic) of MELD (0.73-0.84) was slightly superior or insignificantly different to that (0.67-0.809) of Child-Turcotte-Pugh score. In February 2002, UNOS status 2a and 2b were replaced with MELD score for priority allocation of liver transplantation. MELD score does not reflect the severity of patients with HCC or metabolic disorders. For assessing prognosis in patients with liver cirrhosis or HCC, there seems little reason to replace the well established Child-Turcotte-Pugh score. Herein the literatures was briefly reviewed.

Valor de la biopsia con aguja fina guiada por ultrasonido en el diagnóstico de tumores hepáticos / Value of the fine needle biopse guided by ultrasound in the diagnostic of hepatocarcinoma

Se registró un estudio de registros clínicos donde se evaluó la exactitud diagnóstica de 50 biopsias hepáticas tomadas con aguja fina y guiadas por ultrasonido en igual número de pacientes con lesiones focales desde Enero de 1993 hasta Diciembre de 1996. El diagnóstico de malignidad se corroboró en 45 casos (90 por ciento) de los cuales fueron 32 metástasis (71.1 por ciento) y 13 hepatocarcinomas (28.22 por ciento) . Las lesiones benignas se diagnosticaron en 5 pacientes (10 por ciento): 2 adenomas, 1 lipoma, 1 quiste hemorrágico y 1 TBC. La sensibilidad diagnóstica de la técnica global fue de 100 por ciento con 90 por ciento de especificidad del 96,77 por ciento con una eficacia del 93,33 por ciento. Hubo complicaciones menores en el 2 por ciento; 7,69 por ciento de falsos negativos y 2 muestras con material insuficiente. la biopsia por aguja fina guiada por ultrasonido, es la técnica invasiva de elección parar el diagnóstico de las lesiones hepáticas focales benignas y malignas en forma rápida y con bajo costo

Role of guided fine needle aspiration cytology in diagnosis and classification of liver malignancies.

Ultrasound or CT-guided fine needle aspiration was performed on 212 patients with space occupying lesions of the liver during a period of 5 years (1986-1990) to study the utility of fine needle aspiration (FNAC) in the diagnosis of hepatic malignancies. The initial FNAC diagnosis was malignancy in 91 cases. However, following review of the smears by one of the investigators (DKD) 93 (43.9%) cases were found to be malignant. Age of the patients with malignancy ranged from 20 days to 85 years. Male to female ratio was 57:36. The clinical diagnosis was malignancy in 58% which improved to 72% following imaging whereas nonspecific diagnosis was reduced from 34% to 20%. The primary malignancies consisted of 21 cases of hepatocellular carcinoma (HCC) and 7 hepatoblastomas. There were 61 metastatic lesions which included 43 adenocarcinomas, 6 small cell anaplastic carcinomas, 3 leiomyosarcomas, 2 cases each of malignant melanoma, paraganglioma and germ cell tumour, and one case each of squamous cell carcinoma, neuroendocrine tumour and undifferentiated carcinoma/soft tissue sarcoma. In two cases decision between HCC and secondaries was not possible. There were also two cases of non-Hodgkin's lymphoma. Thirty six percent of primary malignancies and 58% of secondaries were correctly diagnosed or suggested as one of the possibilities by combined clinical examination and imaging prior to FNAC. Thus, US/ CT guided FNAC played an important role in diagnosis and classification of malignancies of liver.

Diagnóstico por imágenes de lesiones hepáticas focales sólidas / Imaging diagnosis of focal solid liver injuries

The imaging diagnosis of begign and malign focal solid hepatic disease are analized by the authors

Cáncer hepático primario: características epidemiológicas, clínicas y bioquímicas / Primary hepatic cancer: epidemiological, clinical and biochemical characteristics

En este trabajo se revisaron retrospectiva y prospectivamente algunos aspectos clínicos, epidemiológicos, bioquímicos y de gabinete del cáncer hepático primario (CHP) en pacientes internados en nuestro hospital. Este estudio comprende 76 pacientes estudiados de 1971 a 1990. 49 hombres y 27 mujeres. La edad promedio fue de 67.1 ñ 11.7 años. El carcinoma hepatocelular (CHC) fue el tipo histológico más frecuente (84.1 por ciento), seguido por el colangiocarcinoma (CC) con 8.7 por ciento, el carcinoma mixto (CM) con 4.4 por ciento y finalmente el hepatoblastoma (HB) con 2.9 por ciento. A parte, se revisó material de 1485 autopsias, encontrándose que la prevalencia de CHP fue de 0.74 por ciento y los sitios más frecuentes de metástasis fueron los pulmones (66 por ciento) y la vena porta (50 por ciento). El 80 por ciento de los casos de CHC diagnosticado por autopsia presentaban concomitantemente cirrosis hepática. Los síntomas generales y el dolor abdominal fueron las manifestaciones clínicas más comunes (72.5 por ciento). Además, se observó la fosfatasa alcalina elevada en el 77 por ciento de los casos, hiperbilirrubinemia en el 62 por ciento y anemia en el 62 por ciento. En el 61.7 por ciento el tumor fue bilateral o difuso. Todos los tumores solitarios medían más de 5 cms de diámetros por ecografía al momento del diagnóstico. La AFP fue normal en el 18 por ciento de los casos de CHC y el 40 por ciento de estos pacientes tuvo al menos un marcador positivo para el virus de la hepatitis B

Hepatoblastoma mixto: confusión diagnóstica / Mixed hepatoblastoma: diagnostic confussion

Se presenta un caso clínico, con diagnóstico de tumor hepático, específicamente un hepatoblastoma, cuyo estudio histopatológico, fue reportado como hepatoblastoma con osteosarcoma. Dos tipos de neoplasias malignas, de tejidos diferentes, hepático y óseo, de estirpe histopatológica también diferente, presentes en un mismo órgano, la glándula hepática. En la literatura nacional y extranjera, se reportan casos similares, aunque por demás raros, definidos como entidad patológica propia, dentro de los tumores hepáticos primarios denominados como tumor mixto de hígado o hepatoblastoma mixto.