- Pathogenic Mechanism of Hepatocellular Carcinoma in Non-alcoholic Fatty Liver Disease
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Sun Min Kim, Joo Hyun Sohn
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J Liver Cancer. 2014;14(2):63-72. Published online September 30, 2014
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DOI: https://doi.org/10.17998/jlc.14.2.63
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Abstract
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- Non-alcoholic fatty liver disease (NAFLD) is a clinicopathologic condition that shows excessive
fat accumulation in hepatocytes without significant alcohol intake, other liver diseases and the
history of using hepatotoxic drugs. Recently, the incidence of hepatocellular carcinoma (HCC)
related to NAFLD is increasing. However, the pathogenic mechanism of HCC developed from
NAFLD has not been fully known. The most important pathogenic factor which affects the
development of HCC is cirrhosis itself from any causes including NAFLD. To date, it is considered
that NAFLD can cause HCC through insulin resistance, oxidative stress, and inflammatory
process. In NAFLD, insulin resistance and its resulting hyperinsulinemia increase insulin-like
growth factor-1 (IGF-1), which leads to cell growth and inhibition of apoptosis. Furthermore,
hyperinsulinemia activates c-Jun amino-terminal kinase 1 (JNK1), increases free fatty acid (FFA)
and reactive oxygen species (ROS), and increases the level of some inflammatory cytokines. In
addition to that, various molecular biologic mechanisms such as deregulated NF-κB signaling,
disorder in PI3K-AKT-PTEN pathway, defect in one-carbon metabolism, and dysfunction of microRNAs
are involved in the NAFLD-mediated carcinogenesis. Finally, intestinal dysbiosis may
also play a role in the pathogenesis of HCC. These pathogenic mechanisms will be discussed
shortly in this review. (J Liver Cancer 2014;14:63-72)
- Two Cases of Spontaneous Bacterial Peritonitis Developed Right after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma
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Jung Hoon Lee, Joo Hyun Sohn, Tae Yeob Kim, Ji Young Lee, Ki Sul Chang, Dong Hoon Lee, Eun Sik Park
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Journal of the Korean Liver Cancer Study Group. 2013;13(2):145-151. Published online September 30, 2013
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DOI: https://doi.org/10.17998/jlc.13.2.145
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Abstract
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- Although acute hepatic failure (AHF) after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) is not a rare complication, the development of spontaneous bacterial peritonitis (SBP) is uncommon. We describe two cases who suffered SBP and AHF right after TACE for HCCs. In the first case, 5 days after TACE ascites and jaundice newly developed and SBP was diagnosed at 9 days after TACE. After use of secondary antibiotics (imipenam) due to failure of primary therapy with 3rd cephalosporin, he discharged with resolution of SBP. In the second case, jaundice, abdominal pain and fever developed with increased ascites 3 days after TACE. After 8 days, SBP was diagnosed and treated with imipenam due to primary treatment failure, but clinical course was deteriorated. Eighteen days after discharge, she died of AHF. In patients with increased ascites and fever after TACE, clinician should be considered SBP with AHF among post-TACE complications, and prompt management is needed.
- A Case of Primary Parasternal Abscess in a Cirrhotic and Diabetic Patient with Hepatocellular Carcinoma
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Ji Young Lee, Joo Hyun Sohn, Tae Yeob Kim, Jung Hoon Lee, Ki Sul Chang, Hye Young Lee, Hyo Young Lee
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Journal of the Korean Liver Cancer Study Group. 2013;13(2):164-168. Published online September 30, 2013
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DOI: https://doi.org/10.17998/jlc.13.2.164
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Abstract
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- Parasternal abscess is usually related to cardiac surgery, trauma or IV drug use and curable with antibiotics and surgical drainage. Sternal metastasis or primary parasternal abscess in a patient with hepatocellular carcinoma (HCC) is much rare and the differentiation between two diseases is occasionally difficult. Herein, we report a patient with HCC, diabetes mellitus and a spontaneously occurred parasternal abscess that is initially confused with a sternal metastasis. A-57-year-old man was admitted due to a slowly growing parasternal mass for 2 months. Two years prior to the admission, he had been diagnosed with small (1.6 cm) HCC in segment VII related to chronic hepatitis Band liver cirrhosis and treated with radiofrequency thermal ablation (RFTA). One year after RFTA, small (1.7 cm) HCC recurred in segment I and then he received TACE twiceat interval of 2 months. Eight months after that, multinodular HCCs newly developed in segment V and VIII (TNM stage IIIA) and two times of additional TACE were given. Thereafter he complained of gradually protruding mass with focal redness and mild tenderness on the sternum. But he denied any febrile and chilling sensation. Dynamic CT scans showed an enhanced parasternal lesion with bone destruction, while a bone scan displayed an increased uptake in the same site, resulting in an indistinguishable lesion between an abscess and a sternal metastasis of HCC. An excisional biopsy was performed on the lesion and revealed an abscess with sternal osteomyelitis rather than sternal metastasis. It was cured with surgical excision and antibiotics without complications.
- A Case of Hepatocellular Carcinoma with Invasion to Bile Duct
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Hyun Seok Cho, Joo Hyun Sohn, Tae Jun Byun, Sang Bong Ahn, Tae Yeob Kim, Chang Soo Eun, Yong Cheol Jeon, Dong Soo Han
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Journal of the Korean Liver Cancer Study Group. 2008;8(1):59-63. Published online June 30, 2008
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Abstract
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- A 59-year-old male patient with chronic hepatitis B and liver cirrhosis was admitted due to fever and right
upper quadrant (RUQ) pain. Two years ago, he had been diagnosed with hepatocellular carcinoma with bile duct
invasion and underwent left lateral segmentectomy of liver and cholecystectomy. One year after, hepatocellular
carcinoma recurred in the 4th and 5th segments and transarterial chemoembolization was done for them 3 times
at 2 or 3 month intervals. On this visit, he complained of general weakness, RUQ pain, fever, and weight loss.
Total bilirubin was 3.1 mg/dL, ALT/AST was 81/109 IU/L, and AFP was 2.14 ng/mL. Abdomen computed
tomography showed diffuse dilatation of both intrahepatic bile ducts and several small low density lesions with
rim enhancement in the 4th and 8th segments. Cholangitis with liver abscesses was suspected and treatment with
antibiotics started. ERCP showed narrowing of proximal and hilar portions of common bile duct and irregular
shaped filling defects in the right anterior, posterior and left medial portion of intrahepatic ducts, which were
believed as tumor thrombi. Despite of endoscopic retrograde biliary drainage, he died of aggravated biliary sepsis
and hepatic failure.
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