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2.
Anticancer Res ; 41(1): 317-326, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33419826

RESUMO

BACKGROUND/AIM: Several studies have reported that DM is closely associated with an increased incidence of hepatocellular carcinoma (HCC). To clarify the effects of diabetes mellitus (DM) and antidiabetic medications on the prognosis of patients with non-B non-C (NBNC) HCC following curative initial hepatectomy. PATIENTS AND METHODS: HCC patients (n=156) were divided into three groups according to the presence or absence of chronic viral hepatitis: hepatitis B virus (HBV) group, hepatitis C virus (HCV) group, and NBNC group. The clinical characteristics and survival outcomes were compared. In the NBNC group, univariate and multivariate analyses were conducted to determine prognostic factors. RESULTS: The NBNC group had a higher incidence of DM, ethanol intake, and large nodules than the other groups. Disease-free survival (DFS) was significantly worse in the NBNC group than in the HBV group. In the NBNC group, insulin treatment was an independent prognostic factor for DFS and overall survival (OS). CONCLUSION: Medications for DM that affect insulin resistance might be appropriate prognostic factors for NBNC-HCC.


Assuntos
Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/mortalidade , Diabetes Mellitus/tratamento farmacológico , Insulinas/administração & dosagem , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/mortalidade , Cuidados Pós-Operatórios , Adulto , Idoso , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/cirurgia , Diabetes Mellitus/diagnóstico , Suscetibilidade a Doenças , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Sobrevida
3.
Hepatol Res ; 50(9): 1071-1082, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32510681

RESUMO

AIM: The landscape of cancer-related genetic aberrations in hepatocellular carcinoma (HCC) has gradually become clear through recent next-generation sequencing studies. However, it remains unclear how genetic aberrations correlate with imaging and histological findings. METHODS: Using 117 formalin-fixed paraffin-embedded specimens of primary liver tumors, we undertook targeted next-generation sequencing of 50 cancer-related genes and digital polymerase chain reaction of hTERT. After classifying tumors into several imaging groups by hierarchal clustering with the information from gadoxetic acid enhanced magnetic resonance imaging, contrast-enhanced computed tomography, contrast-enhanced ultrasound, and diffusion-weighted imaging magnetic resonance imaging, the correlation between genetic aberrations and imaging and histology were investigated. RESULTS: Most frequent mutations were hTERT (61.5%), followed by TP53 (42.7%), RB1 (24.8%), and CTNNB1 (18.8%). Liver tumors were classified into six imaging groups/grades, and the prevalence of hTERT mutations tended to increase with the advancement of imaging/histological grades (P = 0.026 and 0.13, respectively), whereas no such tendency was evident for TP53 mutation (P = 0.78 and 1.00, respectively). Focusing on the mutations in each tumor, although the variant frequency (VF) of hTERT did not change (P = 0.36 and 0.14, respectively) in association with imaging/histological grades, TP53 VF increased significantly (P = 0.004 and <0.001, respectively). In multivariate analysis, stage III or IV (hazard ratio, 3.64; P = 0.003), TP53 VF ≥ 50% (hazard ratio, 3.79; P = 0.020) was extracted as an independent risk for recurrence in primary HCC patients. CONCLUSIONS: Increased prevalence of hTERT mutation and increased TP53 mutation VF are characteristic features of HCC progression, diagnosed with imaging/histological studies.

4.
Pathol Res Pract ; 216(3): 152817, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32008868

RESUMO

Calretinin, a mesothelioma marker, is sometimes expressed in lung cancer, which may complicate the differential diagnosis of mesothelioma. Here, the clinicopathological and immunohistochemical characteristics of calretinin-positive lung cancer were examined to reduce confusion with malignant mesothelioma. Calretinin expression in 307 consecutive cases of lung cancer was evaluated immunohistochemically. Survival was analyzed using the Kaplan-Meier method and log-rank test. Calretinin expression was identified in 67 (22%) tumors, including those with partial and weak expression [15% (37/250) of adenocarcinomas, 54% (25/46) of squamous cell carcinomas, 75% (3/4) of adenosquamous carcinomas, and 29% (2/7) of sarcomatoid carcinomas]. In calretinin-positive adenocarcinoma (n = 37), expression percentages of Wilms tumor-1, podoplanin, thyroid transcription factor-1, and claudin-4 were 6, 3, 52, 82%, respectively, whereas in calretinin-positive squamous cell carcinoma (n = 25) the percentages were 8, 12, 12, 68%, respectively, indicating that other mesothelial markers were only rarely expressed and that claudin-4 expression was common. Although not an independent marker, calretinin expression was associated with a poor prognosis for stage I tumors of adenocarcinoma (p < 0.001) and of all histological subtypes (p < 0.001). In conclusion, calretinin-positive lung tumors share characteristics with those of smokers and advanced stages and can be differentiated from mesothelioma with the use of other mesothelial and epithelial markers.


Assuntos
Adenocarcinoma de Pulmão/diagnóstico , Calbindina 2/biossíntese , Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias Pleurais/diagnóstico , Adenocarcinoma de Pulmão/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/metabolismo , Calbindina 2/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Mesotelioma Maligno , Pessoa de Meia-Idade , Fumar/efeitos adversos
5.
Int J Surg Case Rep ; 44: 176-180, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29524856

RESUMO

INTRODUCTION: Gastrointestinal duplication cyst is a congenital rare disease that may occur in any region from mouth to anus. Among them, gastric duplication cysts are very rare. CASE REPORT: Here we report A 23-year-old Japanese man who visited our hospital to evaluate an abdominal tumor. Abdominal computed tomography showed a well-circumscribed homogenous low-density mass measuring 6.2 × 6.0 cm between the pancreatic tail and the upper posterior wall on the gastric greater curvature, and the mass seemed to originate from the pancreatic tail. We found intraoperatively that the mass adhered to the stomach and pancreatic tail strongly, so we performed laparoscopic partial gastrectomy and spleen-preserving distal pancreatectomy. Pathological findings showed that the lining epithelium of the cystic mass consisted of the gastric foveolar epithelium with fundic glands. Furthermore, the pancreatic tissue of the pancreatic tail and the muscular layer of the cystic mass were intermingled. DISCUSSION: GDCs are usually diagnosed at a younger age and in adults, they are very rare. Therefore, surgical resection is considered to be the best treatment due to the difficulty of diagnosis, and also that it mimics a pancreatic cystic tumor, and malignant transformation. Complete resection of the cyst is the ideal technique and laparoscopic surgery should be selected whenever possible. CONCLUSION: We experienced a case of GDC continuous to both stomach and pancreatic tail. Laparoscopic surgery is safety and useful even if GDC is continuous with both the stomach and the pancreas.

6.
J Magn Reson Imaging ; 47(5): 1268-1275, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29030995

RESUMO

BACKGROUND: Liver MR elastography (MRE) is available for the noninvasive assessment of liver fibrosis; however, no previous studies have compared the diagnostic ability of MRE with that of liver biopsy. PURPOSE: To compare the diagnostic accuracy of liver fibrosis staging between MRE-based methods and liver biopsy using the resected liver specimens as the reference standard. STUDY TYPE: A retrospective study at a single institution. POPULATION: In all, 200 patients who underwent preoperative MRE and subsequent surgical liver resection were included in this study. Data from 80 patients were used to estimate cutoff and distributions of liver stiffness values measured by MRE for each liver fibrosis stage (F0-F4, METAVIR system). In the remaining 120 patients, liver biopsy specimens were obtained from the resected liver tissues using a standard biopsy needle. FIELD STRENGTH/SEQUENCE: 2D liver MRE with gradient-echo based sequence on a 1.5 or 3T scanner was used. ASSESSMENT: Two radiologists independently measured the liver stiffness value on MRE and two types of MRE-based methods (threshold and Bayesian prediction method) were applied. Two pathologists evaluated all biopsy samples independently to stage liver fibrosis. Surgically resected whole tissue specimens were used as the reference standard. STATISTICAL TESTS: The accuracy for liver fibrosis staging was compared between liver biopsy and MRE-based methods with a modified McNemar's test. RESULTS: Accurate fibrosis staging was achieved in 53.3% (64/120) and 59.1% (71/120) of patients using MRE with threshold and Bayesian methods, respectively, and in 51.6% (62/120) with liver biopsy. Accuracies of MRE-based methods for diagnoses of ≥F2 (90-91% [108-9/120]), ≥F3 (79-81% [95-97/120]), and F4 (82-85% [98-102/120]) were statistically equivalent to those of liver biopsy (≥F2, 79% [95/120], P ≤ 0.01; ≥F3, 88% [105/120], P ≤ 0.006; and F4, 82% [99/120], P ≤ 0.017). DATA CONCLUSION: MRE can be an alternative to liver biopsy for fibrosis staging. LEVEL OF EVIDENCE: 3. Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1268-1275.


Assuntos
Biópsia por Agulha , Técnicas de Imagem por Elasticidade , Cirrose Hepática/diagnóstico por imagem , Imageamento por Ressonância Magnética , Idoso , Teorema de Bayes , Feminino , Humanos , Cirrose Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Período Pré-Operatório , Padrões de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos
7.
Magn Reson Med Sci ; 17(2): 168-173, 2018 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-28819085

RESUMO

PURPOSE: To compare the abilities of three intravoxel incoherent motion (IVIM) imaging approximation methods to discriminate the histological grade of hepatocellular carcinomas (HCCs). METHODS: Fifty-eight patients (60 HCCs) underwent IVIM imaging with 11 b-values (0-1000 s/mm2). Slow (D) and fast diffusion coefficients (D*) and the perfusion fraction (f) were calculated for the HCCs using the mean signal intensities in regions of interest drawn by two radiologists. Three approximation methods were used. First, all three parameters were obtained simultaneously using non-linear fitting (method A). Second, D was obtained using linear fitting (b = 500 and 1000), followed by non-linear fitting for D* and f (method B). Third, D was obtained by linear fitting, f was obtained using the regression line intersection and signals at b = 0, and non-linear fitting was used for D* (method C). A receiver operating characteristic analysis was performed to reveal the abilities of these methods to distinguish poorly-differentiated from well-to-moderately-differentiated HCCs. Inter-reader agreements were assessed using intraclass correlation coefficients (ICCs). RESULTS: The measurements of D, D*, and f in methods B and C (Az-value, 0.658-0.881) had better discrimination abilities than did those in method A (Az-value, 0.527-0.607). The ICCs of D and f were good to excellent (0.639-0.835) with all methods. The ICCs of D* were moderate with methods B (0.580) and C (0.463) and good with method A (0.705). CONCLUSION: The IVIM parameters may vary depending on the fitting methods, and therefore, further technical refinement may be needed.


Assuntos
Carcinoma Hepatocelular , Imagem de Difusão por Ressonância Magnética/métodos , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Curva ROC
8.
Invest Radiol ; 53(4): 191-199, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29084013

RESUMO

OBJECTIVE: The aim of this study was to evaluate the efficacy of multiphasic hepatic arterial phase (HAP) imaging using DISCO (differential subsampling with Cartesian ordering) in increasing the confidence of diagnosis of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This retrospective study was approved by the institutional review board, and the requirement for informed patient consent was waived. Consecutive patients (from 2 study periods) with malignant liver nodules were examined by gadoxetic acid-enhanced magnetic resonance imaging using either multiphasic (6 phases; n = 135) or single (n = 230) HAP imaging, which revealed 519 liver nodules other than benign ones (HCC, 497; cholangiocarcinoma, 11; metastases, 10; and malignant lymphoma, 1). All nodules were scored in accordance with the Liver Imaging Reporting and Data System (LI-RADS v2014), with or without consideration of ring-like enhancement in multiphasic HAP images as a major feature. RESULTS: In the multiphasic HAP group, 178 of 191 HCCs were scored as LR-3 to LR-5 (3 [1.69%], 85 [47.8%], and 90 [50.6%], respectively). Upon considering ring-like enhancement in multiphasic HAP images as a major feature, 5 more HCCs were scored as LR-5 (95 [53.4%]), which was a significantly more confident diagnosis than that with single HAP images (295 of 306 HCCs scored as LR-3 to LR-5: 13 [4.41%], 147 [49.8%], and 135 [45.8%], respectively; P = 0.0296). There was no significant difference in false-positive or false-negative diagnoses between the multiphasic and single HAP groups (P = 0.8400 and 0.1043, respectively). CONCLUSIONS: Multiphasic HAP imaging can improve the confidence of diagnosis of HCCs in gadoxetic acid-enhanced magnetic resonance imaging.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Gadolínio DTPA , Aumento da Imagem/métodos , Processamento de Imagem Assistida por Computador/métodos , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Meios de Contraste , Feminino , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/patologia , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
9.
Clin Ther ; 39(4): 738-750.e4, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28363694

RESUMO

PURPOSE: The objective of the study was to evaluate the cost-effectiveness of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis and treatment of hepatocellular carcinoma (HCC) in Japan compared with extracellular contrast media-enhanced MRI (ECCM-MRI) and contrast media-enhanced computed tomography (CE-CT) scanning. METHODS: A 6-stage Markov model was developed to estimate lifetime direct costs and clinical outcomes associated with EOB-MRI. Diagnostic sensitivity and specificity, along with clinical data on HCC survival, recurrence, treatment patterns, costs, and health state utility values, were derived from predominantly Japanese publications. Parameters unavailable from publications were estimated in a Delphi panel of Japanese clinical experts who also confirmed the structure and overall approach of the model. Sensitivity analyses, including one-way, probabilistic, and scenario analyses, were conducted to account for uncertainty in the results. FINDINGS: Over a lifetime horizon, EOB-MRI was associated with lower direct costs (¥2,174,869) and generated a greater number of quality-adjusted life years (QALYs) (9.502) than either ECCM-MRI (¥2,365,421, 9.303 QALYs) or CE-CT (¥2,482,608, 9.215 QALYs). EOB-MRI was superior to the other diagnostic strategies considered, and this finding was robust over sensitivity and scenario analyses. A majority of the direct costs associated with HCC in Japan were found to be costs of treatment. The model results revealed the superior cost-effectiveness of the EOB-MRI diagnostic strategy compared with ECCM-MRI and CE-CT. IMPLICATIONS: EOB-MRI could be the first-choice imaging modality for medical care of HCC among patients with hepatitis or liver cirrhosis in Japan. Widespread implementation of EOB-MRI could reduce health care expenditures, particularly downstream treatment costs, associated with HCC.


Assuntos
Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/economia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/economia , Imageamento por Ressonância Magnética/economia , Imageamento por Ressonância Magnética/métodos , Meios de Contraste , Análise Custo-Benefício , Gadolínio DTPA , Humanos , Japão , Anos de Vida Ajustados por Qualidade de Vida , Tomografia Computadorizada por Raios X/métodos
11.
Eur Radiol ; 27(2): 518-525, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27255397

RESUMO

OBJECTIVES: To evaluate the longitudinal risk to patients with cirrhosis of hypervascular hepatocellular carcinoma (HCC) developing from hypovascular hepatic nodules that show positive uptake of gadoxetic acid (hyperintensity) on hepatocyte phase images. METHODS: In 69 patients, we evaluated findings from serial follow-up examinations of 633 hepatic nodules that appeared hypovascular and hyperintense on initial gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) until the nodules demonstrated hypervascularity and were diagnosed as hypervascular HCC. Cox analyses were performed to identify risk factors for the development of hypervascular HCCs from the nodules. RESULTS: The median follow-up was 663 days (range, 110 to 1215 days). Hypervascular HCCs developed in six of the 633 nodules (0.9 %) in five of the 69 patients. The only independent risk factor, the nodule's initial maximum diameter of 10 mm or larger, demonstrated a hazard ratio of 1.25. The one-year risk of hypervascular HCC developing from a nodule was 0.44 %. The risk was significantly higher for nodules of larger diameter (1.31 %) than those smaller than 10 mm (0.10 %, p < 0.01). CONCLUSIONS: Hypervascular HCC rarely develops from hypovascular, hyperintense hepatic nodules. We observed low risk even for nodules of 10 mm and larger diameter at initial examination. KEY POINTS: • Hypervascularization was rare on follow-up examination of hypovascular, hyperintense nodules • The risk of hypervascularization in a nodule increased with large size • Hypovascular, hyperintense nodules require neither treatment nor more intense follow-up.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Cirrose Hepática/complicações , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética/métodos , Neovascularização Patológica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste/metabolismo , Feminino , Gadolínio DTPA/metabolismo , Hepatócitos/patologia , Humanos , Cirrose Hepática/patologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
12.
J Magn Reson Imaging ; 46(2): 375-382, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-27859956

RESUMO

PURPOSE: To evaluate the usefulness of the Bayesian method for hepatic fibrosis staging with magnetic resonance elastography (MRE). MATERIALS AND METHODS: The sample of this retrospective study comprised patients with chronic liver disease (n = 309), in whom histopathological fibrosis staging and MRE using either a 1.5T (n = 214) or a 3T magnetic resonance imaging (MRI) system (n = 95) had been performed. The optimal cutoff stiffness value was determined and used to calculate the discrimination ability of fibrosis staging by the cutoff method. The Bayesian method calculated post-MRE probability of each fibrosis stage, yielding MRE-based fibrosis staging without a cutoff value as well as the confidence of staging. We compared the discrimination ability in all patients and in a subgroup of patients with high (≥90%) posterior probability. RESULTS: The discrimination ability for hepatic fibrosis staging was comparable between the Bayesian method and the cutoff method in all patients because the accuracy of staging with the Bayesian method and the cutoff method in all patients was not different (P = 1.0000). However, in patients with high posterior probability by the Bayesian method, the accuracy of staging with the Bayesian method was significantly improved compared with that of the cutoff method in all patients; for discriminating stage ≥F2 from F0-F1 (98.9% vs. 94.8%, P = 0.0069); for ≥F3 (99.6% vs. 92.6%, P < 0.0001); and for F4 (100% vs. 94.2%, P = 0.0002). CONCLUSION: The Bayesian method has a highly accurate discrimination ability for noninvasive hepatic fibrosis staging using MRE, if the posterior probability is high. LEVEL OF EVIDENCE: 3 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;46:375-382.


Assuntos
Técnicas de Imagem por Elasticidade , Interpretação de Imagem Assistida por Computador , Cirrose Hepática/diagnóstico por imagem , Imageamento por Ressonância Magnética , Adulto , Idoso , Idoso de 80 Anos ou mais , Teorema de Bayes , Feminino , Humanos , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Probabilidade , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
13.
Gan To Kagaku Ryoho ; 43(2): 263-6, 2016 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-27067696

RESUMO

CASE: A 32 year-old man was diagnosed with retroperitoneal choriocarcinoma with metastasis to the lungs and liver. One cycle of modified BEP regimen did not sufficiently decrease the hCG. Therefore, we chose the GETUG 13 protocol of dose dense chemotherapy. After 6 days of cisplatin administration(3 cycles), he was diagnosed with acute hyperuricemia and kidney injury. He was treated with intravenous hydration and rasburicase. The hyperuricemia improved after a few days.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Coriocarcinoma/tratamento farmacológico , Hiperuricemia/induzido quimicamente , Neoplasias Retroperitoneais/tratamento farmacológico , Doença Aguda , Injúria Renal Aguda/tratamento farmacológico , Adulto , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Etoposídeo/administração & dosagem , Etoposídeo/efeitos adversos , Humanos , Hiperuricemia/tratamento farmacológico , Masculino , Neoplasias Retroperitoneais/patologia , Urato Oxidase/uso terapêutico
14.
Magn Reson Med Sci ; 15(1): 49-59, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26104079

RESUMO

PURPOSE: We investigated the added value of the hypointensity on hepatocyte-phase (HP) imaging of gadoxetic acid-enhanced MRI (EOB-MRI) in the 2014 version of the Liver Imaging Reporting and Data System (LI-RADS) for distinguishing hepatocellular carcinoma (HCC) from benign hepatic lesions in patients with chronic liver disease. METHODS: We retrospectively evaluated targeted lesions (111 HCCs, 28 benign hepatic lesions) of 139 patients (101 men, 38 women; aged 18 to 89 years, mean age, 68 ± 11 years) with chronic liver disease. EOB-MRI and dynamic contrast-enhanced computed tomography (CECT) were performed within 3 months. Two abdominal radiologists independently reviewed 3 imaging datasets: (1) EOB-MRI without an HP image using the LI-RADS system (MR imaging without HP); (2) EOB-MRI with an HP image using a modified version of the LI-RADS system in which hypointensity on the HP image was used as an additional major criterion of malignancy (MR imaging with HP); and (3) dynamic contrast-enhanced computed tomography (CECT) images using the LI-RADS system. We evaluated intra- and inter-reader agreement with kappa statistics along with 95% confidence intervals and compared diagnostic sensitivity and specificity of the 3 imaging datasets with McNemar's test. RESULTS: The sensitivities of MR imaging were statistically higher with HP (Reader 1, 95% [107/111]; Reader 2, 95% [106/111]) than without HP (Reader 1, 84% [93/111], P = 0.002; Reader 2, 86% [96/111], P = 0.002). Specificity was comparably high between MR imaging with HP (Reader 1, 96% [27/28]; Reader 2, 96% [27/28]) and dynamic CECT (Reader 1, 100% [28/28], P = 0.317; Reader 2, 100% [28/28], P = 0.317) and MR imaging without HP (Reader 1, 96% [27/28], P = 1.00; Reader 2, 100% [28/28], P = 0.317). CONCLUSION: The use of an HP image from EOB-MRI as an additional major criterion improved the sensitivity of LI-RADS to distinguish HCCs from benign hepatic lesions while retaining high specificity.


Assuntos
Carcinoma Hepatocelular/diagnóstico , Meios de Contraste , Gadolínio DTPA , Aumento da Imagem/métodos , Neoplasias Hepáticas/diagnóstico , Imageamento por Ressonância Magnética/estatística & dados numéricos , Sistemas de Informação em Radiologia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/patologia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Seguimentos , Hepatócitos/patologia , Humanos , Processamento de Imagem Assistida por Computador/estatística & dados numéricos , Hepatopatias/complicações , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Variações Dependentes do Observador , Intensificação de Imagem Radiográfica/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
15.
J Hepatol ; 64(1): 87-93, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26343958

RESUMO

BACKGROUND & AIMS: Human hepatocarcinogenesis in cirrhosis is thought to be multistep and characterized by a spectrum of nodular lesions, ranging from low to high grade dysplastic nodules (LGDN and HGDN) to early and progressed hepatocellular carcinoma (eHCC and pHCC). The aim of this study was to investigate the morphophenotypical changes of this sequence and their potential translational significance. METHODS: We scored the vascular profile, ductular reaction/stromal invasion and overexpression of five biomarkers (GPC3, HSP70, GS, CHC, and EZH2), in a series of 100 resected nodules (13 LGDN, 16 HGDN, 42 eHCC and 29 small pHCC). RESULTS: The score separated the four groups of nodules as individual entities (p<0.01). In the sequence, biomarker's overexpression progressively increased with parallel decrease of ductular reaction; the vascular remodeling started very early (LGDN) but did not further develop in a proportion of HCC. eHCC was the most heterogeneous entity, with marginal overlap with HGDN and pHCC. Liver environment (fibrosis, etiology) did not impact on the phenotype of the different nodules. A subclass of eHCC (16/42) without evidence of stromal invasion was identified, suggesting a "preinvasive stage" (p<0.05). For diagnosis, the application of four and five biomarkers (rather than the usual three) improved the sensitivity of the assay for the detection of eHCC (76% and 93% vs. 52%); biomarkers in alternative combinations, and also increased the sensitivity of the assay (GS+CHC+EZH2: 76%; GS+CHC+EZH2+HSP70: 90%). CONCLUSIONS: This study supports the multistep nature of human hepatocarcinogenesis, and suggests that eHCC is more heterogeneous than previously thought. This provides further information of the potential translational significance into clinical practice.


Assuntos
Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/patologia , Idoso , Antígenos CD34/análise , Carcinoma Hepatocelular/etiologia , Feminino , Humanos , Queratina-7/análise , Neoplasias Hepáticas/etiologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Fenótipo , Remodelação Vascular
16.
Liver Cancer ; 4(3): 154-62, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26674263

RESUMO

BACKGROUND: During the follow-up of patients with chronic liver disease, hypervascular hepatocellular carcinomas (HCCs) can develop either from pre-existing high-risk nodules or by de novo hepatocarcinogenesis. The purpose of this study was to evaluate, by retrospective analysis, the detectability and signal intensity on previous hepatocyte-phase gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) of hypervascular HCC initially detected on current EOB-MRIs. METHODS: We examined 50 initially detected hypervascular HCCs that showed typical enhancement features on EOB-MRI in 39 patients whose previous EOB-MRI images obtained 6-19 months earlier were available. The detectability of each hypervascular HCC on the hepatocyte phase images of previous EOB-MRIs was assessed. The imaging features on hepatocyte-phase images of previous EOB-MRIs at the locations where hypervascular HCCs were found on the current EOB-MRI images were classified as detectable or undetectable. The signal intensities of detectable nodules (defined as group A) on hepatocyte-phase images of previous EOB-MRIs were classified as hypo-, iso-, or hyperintensity. Nodules undetectable on the hepatocyte-phase images of previous EOB-MRIs were assigned to group B. RESULTS: Twenty-two (22/50, 44%) hypervascular HCCs were detectable on the earlier hepatocyte phase images (group A). In contrast, 28 (28/50, 56%) hypervascular HCCs were not detectable on the hepatocyte phase of earlier EOB-MRI images (group B). CONCLUSION: When the previous EOB-MRI images were used as the reference, more than half (28/50, 56%) of hypervascular HCCs initially appearing on the current EOB-MRI images were found not to have developed from nodules detectable on the previous MRIs through the traditionally accepted process of multistep carcinogenesis. Instead, they seemed to have developed via an "imaging-occult" process of carcinogenesis in patients with chronic liver diseases.

17.
Sci Rep ; 5: 16699, 2015 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-26567527

RESUMO

The chaperone system is known to be exploited by viruses for their replication. In the present study, we identified the cochaperone FKBP6 as a host factor required for hepatitis C virus (HCV) replication. FKBP6 is a peptidyl prolyl cis-trans isomerase with three domains of the tetratricopeptide repeat (TPR), but lacks FK-506 binding ability. FKBP6 interacted with HCV nonstructural protein 5A (NS5A) and also formed a complex with FKBP6 itself or FKBP8, which is known to be critical for HCV replication. The Val(121) of NS5A and TPR domains of FKBP6 were responsible for the interaction between NS5A and FKBP6. FKBP6 was colocalized with NS5A, FKBP8, and double-stranded RNA in HCV-infected cells. HCV replication was completely suppressed in FKBP6-knockout hepatoma cell lines, while the expression of FKBP6 restored HCV replication in FKBP6-knockout cells. A treatment with the FKBP8 inhibitor N-(N', N'-dimethylcarboxamidomethyl)cycloheximide impaired the formation of a homo- or hetero-complex consisting of FKBP6 and/or FKBP8, and suppressed HCV replication. HCV infection promoted the expression of FKBP6, but not that of FKBP8, in cultured cells and human liver tissue. These results indicate that FKBP6 is an HCV-induced host factor that supports viral replication in cooperation with NS5A.


Assuntos
Hepacivirus/fisiologia , Proteínas de Ligação a Tacrolimo/metabolismo , Proteínas não Estruturais Virais/metabolismo , Replicação Viral , Sistemas CRISPR-Cas/genética , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Cicloeximida/análogos & derivados , Cicloeximida/farmacologia , Células HEK293 , Humanos , Microscopia de Fluorescência , Domínios e Motivos de Interação entre Proteínas , Multimerização Proteica/efeitos dos fármacos , Interferência de RNA , RNA de Cadeia Dupla/metabolismo , RNA Interferente Pequeno/metabolismo , Proteínas de Ligação a Tacrolimo/antagonistas & inibidores , Proteínas de Ligação a Tacrolimo/genética , Proteínas não Estruturais Virais/química
18.
Clin J Gastroenterol ; 8(4): 223-7, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26153253

RESUMO

The annular pancreas is a rare congenital anomaly in which a ring of the pancreas parenchyma surrounds the second part of the duodenum. Malignant tumors are extremely rare in patients with an annular pancreas. A 64-year-old man presented with appetite loss and vomiting. Abdominal contrast-enhanced computed tomography (CT) indicated pancreas parenchyma surrounding the second part of the duodenum, and a hypovascular area occupying lesion in the annular pancreas. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Histopathology showed pancreatic carcinoma occurring in the complete annular pancreas.


Assuntos
Adenocarcinoma/cirurgia , Pâncreas/anormalidades , Pancreatopatias/cirurgia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Adenocarcinoma/patologia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pâncreas/cirurgia , Neoplasias Pancreáticas/patologia
20.
Magn Reson Med Sci ; 14(3): 211-21, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25994038

RESUMO

PURPOSE: We evaluated the validity and reliability of magnetic resonance elastography (MRE) for staging hepatic fibrosis in patients with chronic hepatitis B. METHODS: The study included 73 patients with chronic hepatitis B and confirmed stages of pathological fibrosis. Two radiologists measured liver stiffness using MRE in all cases. We compared the area under the receiver operating characteristic (ROC) curve (Az) for distinguishing stages of fibrosis compared with MRE liver stiffness measurements and serum fibrosis markers. We used intraclass correlation coefficients to analyze interobserver agreement for measurements of liver stiffness and 2 one-sided t-tests to test the equivalence of the measurements by the 2 observers. RESULTS: ROC analyses revealed the significantly superior discrimination abilities of MRE for liver fibrosis staging (Az = 0.945 to 0.978 [Observer 1] and 0.936 to 0.967 [Observer 2]) to those of serum fibrosis markers (0.491 to 0.742) for both observers (P < 0.0004). The intraclass correlation coefficient between the 2 observers was excellent (ρ = 0.971), and the measurements of liver stiffness by the 2 observers were statistically equivalent within a 0.1-kPa difference (P = 0.0157)CONCLUSION: MRE is a valid and reliable technique for discriminating the stage of hepatic fibrosis in patients with chronic hepatitis B.


Assuntos
Técnicas de Imagem por Elasticidade/métodos , Hepatite B Crônica/patologia , Cirrose Hepática/patologia , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hepatite B Crônica/complicações , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
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