Pathways and gene expression profiles in hepatocellular carcinoma.

Hepatocarcinogenesis is a process attributed to progressive genomic changes which alter the hepatocellular phenotype producing cellular intermediates evolving into clearly neoplastic cells (hepatocellular carcinoma, HCC). During the preneoplastic phase, the liver is often the site of chronic hepatitis and/or cirrhosis, and this process leads to the production of monoclonal populations of aberrant and dysplastic hepatocytes that develop genetic and chromosomal alterations. At the moment three main molecular pathways of liver carcinogenesis have been described and several attempts of genetic classification of HCC have been proposed. The definition of genomic and molecular changes which occur during the development of HCC should improve the classification and prognostis of liver tumors. The development of sorafenib and other new targeted developing therapies were rendered possible by the discovery and understanding of the molecular and genetic pathogenesis of hepatocellular carcinoma. Besides viruses, such as Hepatitis B virus (HBV) and Hepatitis C virus (HCV), may contribute to cancer development by several ways; however, additional factors, such as host immunity and chronic inflammation and host cellular mutations also play a role in the transformation process. The understanding of these pathways will in the future enable the clinician to focus the treatment patients with HCC and customize single or combination therapy.

[Radiofrequency ablation: a new approach in the treatment of hepatocellular carcinoma]. / Termoablazione mediante radiofrequenza: nuovo approccio nella terapia locoregionale dell'HCC.

HCC is a tumor with increasing incidence that usually develops on cirrhotic liver; therefore the prognosis depends on both tumor size and liver function. HCC generally shows a slow growth and (not very important) symptoms; so, the periodic surveillance of cirrhotic patients, by using US examination and alpha-fetoprotein level, allows an early diagnosis of the tumor. Several techniques have proved useful in the treatment of HCC but, in comparison with other currently available percutaneous therapies, RF ablation appears to have several advantages. Authors' results suggest that RF ablation is an effective and safe procedure for the therapy of local hepatic neoplasms. However, further studies will be required to demonstrate that RF ablation is more effective than percutaneous ethanol injection (PEI) in the treatment of HCC.

[The Boario project. A study of the prevalence of lithiasis in a spa population]. / Progetto boario. Studio della frequenza della malattia litiasica in una popolazione termale.

In order to better evaluate some epidemiological findings observed during previous studies on large samples of free living populations we carried out a case-control study on a randomly selected group of subjects in a health spa, Boario Terme. Seven-hundred and thirty subjects, aged 40-69 years, participated in the study. The study protocol included an ultrasonographic examination of the upper abdomen, a physical examination, a questionnaire, and a blood sample. Prevalence of gallstone disease was two times higher in females (37.2%) than in males (19.7%) (RRMH = 1.88). Fifty out of the 80 gallstone subjects were not aware of the disease prior the study (62.5%), and 60 did not experience any specific biliary symptom (colic) in the 5 years prior the study. The so-called "nonspecific symptoms" were not found related to gallstone disease. Gallstone disease was positively related to number of pregnancies, obesity, and economical status. In conclusion the present study confirmed some results observed during previous epidemiological studies. In regards to symptoms present data suggest that biliary colic is the only specific symptom for gallstone disease. In addition, the high number of asymptomatic gallstones observed in this study suggests the need of more investigations on high-risk populations in order to make earlier diagnosis and eventually to prevent the disease.