Journal of Liver Cancer

Review Article

Disease modifiers and novel markers in hepatitis B virus-related hepatocellular carcinoma: Lung-Yi Mak; J Liver Cancer. 2024;24(2):145-154. Published online August 5, 2024; DOI: https://doi.org/10.17998/jlc.2024.08.03

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Abstract PDF: Chronic hepatitis B (CHB) infection is responsible for 40% of the global burden of hepatocellular carcinoma (HCC) with a high case fatality rate. The risk of HCC differs among CHB subjects owing to differences in host and viral factors. Modifiable risk factors include viral load, use of antiviral therapy, co-infection with other hepatotropic viruses, concomitant metabolic dysfunctionassociated steatotic liver disease or diabetes mellitus, environmental exposure, and medication use. Detecting HCC at early stage improves survival, and current practice recommends HCC surveillance among individuals with cirrhosis, family history of HCC, or above an age cut-off. Ultrasonography with or without serum alpha feto-protein (AFP) every 6 months is widely accepted strategy for HCC surveillance. Novel tumor-specific markers, when combined with AFP, improve diagnostic accuracy than AFP alone to detect HCC at an early stage. To predict the risk of HCC, a number of clinical risk scores have been developed but none of them are clinically implemented nor endorsed by clinical practice guidelines. Biomarkers that reflect viral transcriptional activity and degree of liver fibrosis can potentially stratify the risk of HCC, especially among subjects who are already on antiviral therapy. Ongoing exploration of these novel biomarkers is required to confirm their performance characteristics, replicability and practicability.

Case Reports

A single hepatic mass with two tales: hepatic tuberculosis and hepatocellular carcinoma: Yi De Ian Koh, Wei-Qiang Leow; J Liver Cancer. 2023;23(2):397-401. Published online September 8, 2023; DOI: https://doi.org/10.17998/jlc.2023.08.30

1,227 Views
67 Downloads
2 Citations

Abstract PDF

Hepatic tuberculosis (HTB) is an uncommon manifestation of tuberculous infections, and there has been no proven causal link between HTB and hepatocellular carcinoma (HCC). We herein present a rare case of a synchronous presentation of HTB and HCC within a single hepatic mass. A 57-year-old Chinese gentleman with recently diagnosed sigmoid adenocarcinoma was found to have a left lower lobe pulmonary nodule and solitary hepatic mass on staging computed tomography. Biopsies showed the hepatic mass to have both HTB and HCC components. This serves as a reminder that HTB is an important differential to consider for space-occupying lesions in the liver. Histological evaluation of suspected hepatic malignancies is recommended to exclude the presence of HTB in appropriate clinical settings.

Citations

Citations to this article as recorded by

Characterization of pathological features and immune microenvironment in hepatic tuberculosis and pulmonary tuberculosis
Qiang Niu, Runrui Wu, Ke Pan, Xinlan Ge, Wen Chen, Rong Liu
Frontiers in Cellular and Infection Microbiology.2024;[Epub] CrossRef
Multiloculated thoracoabdominal tuberculosis: A radiological presentation of disseminated tuberculosis
Muhammad Bilal Ibrahim, Reyan Hussain Shaikh, Arshia Jahangir, Ali Husnain Khan, Hiba Noor
Radiology Case Reports.2024; 19(12): 6302. CrossRef

Hepatic basidiobolomycosis masquerading as cholangiocarcinoma: a case report and literature review: Roopali Sehrawat, Nalini Bansal, Ajitabh Srivastava, Dharmender Malik, Vivek Vij; J Liver Cancer. 2023;23(2):389-396. Published online August 17, 2023; DOI: https://doi.org/10.17998/jlc.2023.06.07

1,395 Views
62 Downloads

Abstract PDF: Basidiobolus ranarum is known to cause subcutaneous mycoses; however, rare cases of hepatic and gastrointestinal involvement by basidiobolomycosis have been reported. Hepatic basidiobolomycosis may be confused with a carcinoma on imaging, and histological examination and fungal culture can help distinguish between these two. We report a rare case of basidiobolomycosis in a 16-year-old male with liver and gastrointestinal involvement.

Huge Hepatic Angiomyolipoma Mimicking Low Grade Hepatocellular Carcinoma: Hyeo Seong Hwang, Dae Hoon Han; J Liver Cancer. 2021;21(1):76-80. Published online March 31, 2021; DOI: https://doi.org/10.17998/jlc.21.1.76

4,119 Views
71 Downloads

Abstract PDF: A 41-year-old man was diagnosed with a huge symptomatic liver mass and was referred to our hospital for liver biopsy and further evaluation. He presented with right upper quadrant tenderness. Enhanced abdominal computed tomography and magnetic resonance imaging revealed a 12.5-cm relatively well-defined heterogeneous enhancing mass in the right inferior liver with a large exophytic component containing a fat component and progressive delayed enhancement. The patient underwent right inferior sectionectomy. The pathological diagnosis was confirmed as angiomyolipoma, 12.3×9.2×5.0 cm in size, with tumor necrosis in 20% of the tissue. Hepatic angiomyolipoma is known as a benign tumor, but in our case, because of the large tumor size and coagulative necrosis, this tumor had malignant potential; surgical resection was deemed to be appropriate, and close follow-up monitoring was essential postoperatively.

A Case of Spontaneous Rupture of Hepatocellular Carcinoma Supplied by the Right Renal Capsular Artery Treated by Transcatheter Arterial Embolization: Joo Yeon Jang, Ung Bae Jeon, Jin Hyeok Kim, Tae Un Kim, Hwaseong Ryu, Mong Cho, Young Mi Hong, Maeran Kim; J Liver Cancer. 2019;19(1):59-63. Published online March 31, 2019; DOI: https://doi.org/10.17998/jlc.19.1.59

5,724 Views
97 Downloads

Abstract PDF: We present a case of spontaneous rupture of hepatocellular carcinoma with poor liver function managed by transcatheter arterial embolization (TAE). The patient’s bilirubin level was 2.1 mg/dL, albumin level was 2.4 g/dL, and prothrombin time international normalized ratio was 2.1. In addition, the patient had also developed a large number of ascites. The tumor was supplied by the right renal capsular artery, as observed on angiography. With successful TAE, no hepatic failure occurred. We believe TAE can be a safe and effective treatment option, even in patients with poor liver function, if tumors are supplied only by extrahepatic collateral vessels.

Multiple Hepatic Metastasis and Lymphatic Metastasis of Solid Pseudopapillary Neoplasm of Pancreas: Kim, You Gyung , Kim, Byung Ik , Kim, Seul Ki , Kim, Hak Soo , Kim, Hong Ju , Cho, Yong Kyun , Jeon, Yu Gyu; J Liver Cancer. 2018;18(2):168-174. Published online September 30, 2018; DOI: https://doi.org/10.17998/jlc.18.2.168

3,025 Views
48 Downloads
1 Citation

Abstract PDF

Solid pseudo-papillary neoplasm (SPN) of pancreas is a rare epithelial neoplasm of pancreas with a low malignant potential, occurs most commonly in young females. Here, we report a rare case of woman who has severe hepatomegaly due to multiple hepatic metastases of SPN of pancreas. At the time of diagnosis, a SPN was detected at only pancreas and there was no evidence of metastasis. So, she received subtotal pancreatectomy and total splenectomy. After 2 years of follow up, multiple small hepatic metastases were presented. In spite of three times of radiofrequency ablation, the burden of hepatic metastasis has increased continuously and multiple intra-abdominal lymph nodes metastases were detected, and ascites and peripheral edema occurred. However, because of benign feature of SPN and extremely rare incidence of recurrence and metastasis, there is no specific treatment guideline for metastatic SPN. Through multidisciplinary care service, we planned to do radiotherapy followed by a transarterial chemoembolization (TACE). But the patient could not have a scheduled radiation therapy due to deterioration of liver function. So changing the strategy of treatment, followed by TACEs were done alone. Although the size of SPN is not reduced, the extent of SPN and complication of SPN (ascites, peripheral edema, abdominal pain and so on) are being controlled.

Citations

Citations to this article as recorded by

Solid Pseudopapillary Epithelial Neoplasm of the Pancreas in the Paediatric Population: A Report of Two Cases
Ravi Maharaj, Nahmorah J Bobb, Christo Cave, Keshan V Ramnarace, Jamar Critchlow
Cureus.2022;[Epub] CrossRef

Original Article

Postoperative Chemoradiotherapy for R1 Resected Intrahepatic Cholangiocarcinoma: Kim, Kyung Su , Kim, Hwi Young , Kim, Kyubo , Yi, Nam Joon , Suh, Kyung Suk , Chie, Eui Kyu; J Liver Cancer. 2018;18(2):115-120. Published online September 30, 2018; DOI: https://doi.org/10.17998/jlc.18.2.115

2,619 Views
89 Downloads
2 Citations

Abstract PDF

Background/Aims
To investigative the potential role of postoperative chemoradiotherapy (CCRT) after R1 resection of intrahepatic cholangiocarcinoma (IHCC).
Methods
Between January 2000 and December 2012, medical records of 18 patients who underwent curative surgery with R1 resection for IHCC were retrospectively reviewed.
Results
Median age was 68 years and 12 patients (66.7%) were male. Median tumor size was 5.0 cm (range, 2.2-11.0) and 12 patients (66.7%) had T3 or higher disease. Lymph nodes were involved in four patients (22.2%). Vascular invasion and perineural invasion were present in 10 (55.6%) and 12 patients (66.7%), respectively. Postoperative CCRT given with 5-fluorouracil or gemcitabine were delivered to 7 patients (38.9%). Median radiation dose was 50.4 Gy (range, 45-54). Univariate analysis showed that median loco-regional recurrence-free survival (LRRFS), progression-free survival (PFS) and overall survival (OS) were prolonged for patients treated with CCRT (median LRRFS; 5.6 months vs. not reached, P<0.001, median PFS; 5.6 vs. 8.3 months, P=0.047, median OS; 15.0 vs. 26.6 months, P=0.064).
Conclusions
Postoperative CCRT improved the loco-regional control and PFS in IHCC patients with R1 resection. Further study is warranted to validate the role of postoperative CCRT for these patients.

Citations

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Precision therapy for intrahepatic cholangiocarcinoma: A case report on adjuvant treatment in a recurrent patient after surgery and literature review
Bao Ying, Tao Tang, Li-Xing Zhang, Jian-Wei Xiong, Kai-Feng Zhao, Jia-Wei Li, Guo Wu
Oncology Letters.2023;[Epub] CrossRef
Stereotactic radiotherapy for intrahepatic cholangiocarcinoma
Aditya Borakati, Farid Froghi, Ricky H Bhogal, Vasileios K Mavroeidis
World Journal of Gastrointestinal Oncology.2022; 14(8): 1478. CrossRef

Case Report

A Case of Complete Response with Biliary Stenosis after Hepatic Arterial Injection and Stereotactic Body Radiotherapy to Hepatoecllular Carcinoma with Portal Vein Thrombosis: Rim, Chai Hong , Im, Hyung Joon , Jung, Young Geol , Chung, Hwan Hoon , Seo, Sang Joon , Yoon, Won Sup; J Liver Cancer. 2018;18(1):75-79. Published online March 31, 2018; DOI: https://doi.org/10.17998/jlc.18.1.75

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40 Downloads

Abstract PDF: Curative treatment of hepatocellular carcinoma (HCC) with portal vein invasion is difficult to achieve, and the prognosis is dismal. Combining external beam radiotherapy (EBRT) with hepatic arterial infusion chemotherapy (HAIC) has shown favorable local therapeutic effects for patients with HCC exhibiting portal vein invasion. Stereotactic body radiotherapy (SBRT) is a recently developed EBRT modality that shows excellent tumor control. The combination of SBRT and HAIC for HCC with portal vein invasion has not been well-studied. We report a patient with HCC and portal vein invasion who achieved 15 months of survival with complete response status after combination SBRT and HAIC. The patient later experienced grade 3 biliary stricture and died of liver abscesses of unknown etiologies that subsequently appeared.

Original Article

Diagnostic Performance of Diffusion-weighted Imaging for Hepatic Neuroendocrine Tumor: Comparison with Combined Diffusion-weighted Imaging and Contrast-enhanced Magnetic Resonance Imaging: Suk Ki Jang, Jung Hoon Kim, Mi Hye Yu, Joon Koo Han; J Liver Cancer. 2016;16(2):92-100. Published online September 30, 2016; DOI: https://doi.org/10.17998/jlc.16.2.92

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12 Downloads

Abstract PDF: Background/Aims
To investigate the diagnostic performance of diffusion-weighted imaging (DWI) for hepatic neuroendocrine tumors (NET) compared with combined DWI and contrastenhanced magnetic resonance imaging (MRI) .
Methods
Fifteen patients with hepatic NET (n=128) underwent enhanced MRI and DWI with multiple-b values. We analyzed three different sets: Precontrast set; DWI set (added DWI); combined set (added enhanced image). Two reviewers rated possibility of NET using a 5-point scale for each image set. Their diagnostic performance was compared using Jackknife alternative free-response ROC (JAFROC).
Results
Diagnostic performance was better on the combined set (figure of merit [FOM]=0.852, 0.761) than the precontrast set (FOM=0.427, 0.572, P<0.05) and the DWI set (FOM=0.682, 0.620, P<0.05). However, DWI improved performance compared with precontrast set without statistical difference. In small NETs (<1 cm), all sets showed low sensitivity (10.7-65.9%) with high specificity (95.4-100%). Interobserver agreement was moderate in all image sets (k=0.521 to 0.589).
Conclusions
Combined DWI and enhanced MRI were more useful for detecting NET. Although statistically insignficant, there was a trend in improved diagnostic performance with DWI.

Review Article

Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma and Extrahepatic Metastasis: Jin Su Kim, Su Cheol Park; J Liver Cancer. 2016;16(2):82-85. Published online September 30, 2016; DOI: https://doi.org/10.17998/jlc.16.2.82

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Abstract PDF: Transarterial chemoembolization (TACE) has been widely performed as a treatment for unresectable hepatocellular carcinoma (HCC). Recently extrahepatic metastasis (EHM) of HCC is increasing due to improvement of survival. Sorafenib has been generally accepted as a standard treatment in advanced HCC. However, many HCC patients with EHM are treated with TACE in real-world clinical practice because sorafenib has modest efficacy and the main cause of death in the patients with EHM is hepatic failure. In this review, the usefulness of TACE for the patients with HCC and EHM will be discussed.

Case Report

A Case of Complete Remission in Patient with Extrahepatic Metastasis after Curative Resection of Hepatocellular Carcinoma by Radiotherapy, Lung Resection and Systemic Chemotherapy: Yeong Jin Kim, Hye won Lee, Ji Hoon Lee, Jin Sil Sung, Do Young Kim; J Liver Cancer. 2016;16(1):63-66. Published online March 31, 2016; DOI: https://doi.org/10.17998/jlc.16.1.63

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Abstract PDF: Surgical resection is mainstay treatment of hepatocellular carcinoma (HCC). However, its prognosis is poor, because of the high incidence of HCC recurrence (cumulative 5-year HCC recurrence rate of 70-80%). The most common site of HCC recurrence is the remnant liver, and extrahepatic recurrence occurs in 6.7-13.5% of patients. Because the tumor characteristics in extrahepatic recurrence are usually multiple and aggressive, the optimal treatment modality has not yet been determined. We report a case of complete remission and long term survival over 60 months in patient with extrahepatic metastasis after curative resection of HCC by aggressive treatment, which include lung resection for lung metastasis, radiotherapy for mediastinal lymph node metastasis, and systemic chemotherapy.

Review Article

Treatments Other than Sorafenib for Patients with Advanced Hepatocellular Carcinoma: Do Seon Song, Si Hyun Bae; J Liver Cancer. 2016;16(1):1-6. Published online March 31, 2016; DOI: https://doi.org/10.17998/jlc.16.1.1

1,364 Views
19 Downloads
1 Citation

Abstract PDF

Sorafenib is the standard treatment for advanced hepatocellular carcinoma according to the Barcelona Clinic Liver Cancer staging system. However, because of its unsatisfactory efficacy, adverse effects, and high cost, the use of sorafenib is limited, and other treatment modalities are required. Recent studies reported that treatment modalities other than sorafenib, such as hepatic arterial infusion chemotherapy and transarterial radioembolization, showed comparable or better response rates and survival rates than sorafenib. In this review, treatment modalities that could be used as alternatives to sorafenib will be discussed. (J Liver Cancer 2016;16:1-6)

Citations

Citations to this article as recorded by

Phase I Radiation Dose-Escalation Study to Investigate the Dose-Limiting Toxicity of Concurrent Intra-Arterial Chemotherapy for Unresectable Hepatocellular Carcinoma
Yeona Cho, Jun Won Kim, Ja Kyung Kim, Kwan Sik Lee, Jung Il Lee, Hyun Woong Lee, Kwang-Hun Lee, Seung-Moon Joo, Jin Hong Lim, Ik Jae Lee
Cancers.2020; 12(6): 1612. CrossRef

Case Report

A Case of Hepatocelluar Carcinoma Mimicking Focal Nodular Hyperplasia: Eui Ju Park, Jae Young Jang, Soung Won Jeong, Sae Hwan Lee, Sang Gyune Kim, Young Seok Kim, Hong Soo Kim, Boo Sung Kim, So Young Jin, Ji Young Hwang; Journal of the Korean Liver Cancer Study Group. 2014;14(1):53-59. Published online March 31, 2014; DOI: https://doi.org/10.17998/jlc.14.1.53

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Abstract PDF: Recently, detection of an incidental hepatic tumor has rapidly increased with the introduction of multi-modality imaging techniques. And then, it is very important to determine whether these tumors are malignant or benign lesions. In some cases, differentiation from other hepatic tumors such as focal nodular hyperplasia or hepatic adenoma and hepatocellular carcinoma can be extremely difficult, both clinical and radiologic finding. Therefore, it is suggested that combination of multi-modality imaging study than using only a single imaging test. Despite advanced imaging studies such as computed tomography (CT), magnetic resonance imaging (MRI), contrast enhanced ultrasonography, and positron emission tomography (PET) showed a high sensitivity and specificity, role of liver biopsy is still remained to confirm the diagnosis. The use of liver biopsy in the diagnosis of hypervascular hepatic tumors is controversial. However if the tumors was shown rapid growth tendency and heterogeneous radiological appearance, liver biopsy or surgical resection should be considered to provide final diagnosis and prompt curative treatment. We report a case of a hepatocelluar carcinoma showing similar radiologic characteristics to focal nodular hyperplasia in patients without high risk factors of hepatocelluar carcinoma.

Original Article

Hepatic Venous Pressure Gradient and Associated Factors in Survival Prediction in Patients with Liver Cirrhosis and Early and Very Early Hepatocellular Carcinoma: Tae Yeob Kim, Moon Young Kim, Jae Young Jang, Ki Tae Suk, Soung Won Jeong, Dong Joon Kim, Joo Hyun Sohn, Soon Koo Baik; Journal of the Korean Liver Cancer Study Group. 2014;14(1):23-30. Published online March 31, 2014; DOI: https://doi.org/10.17998/jlc.14.1.23

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5 Downloads

Abstract PDF: Background/Aims
To analyze the usefulness of hepatic venous pressure gradient (HVPG) in survival prediction in cirrhotic patients with early and very early hepatocellular carcinoma (HCC).
Methods
We consecutively collected data of 45 stable cirrhotic patients (male 41, median age 57.2 years, BCLC A 29) with early-stage HCC undergoing HVPG measurement. Prognostic accuracy of HVPG was analyzed by the area under curve (AUC). Survival curves and the associated factors of HVPG status were obtained using Kaplan-Meier method and logistic regression analysis, respectively.
Results
The AUC value for prediction of survival by HVPG were 0.754 (95% CI, 0.603-0.870, P=0.006). The cut-off value of HVPG to predict death was 12 mmHg. Among the 45 patients, 11 patients (24.4%) died: 11 of 28 patients in the high HVPG group and none of 17 patients in the low HVPG group during followup period (P=0.003). The survival rate with high HVPG group was higher than those of low HVPG group (log rank P=0.008). In Child-Turcott-Pugh (CTP) class, the survival rate with CTP A class was higher than that with CTP B class (log rank P<0.001). The only associated factor with HVPG ≥12 mmHg in CTP A class and early-stage HCC was the presence of medium or large sized esophageal varices (odds ratio 66.8, 95% CI, 1.3-3530.4, P=0.038).
Conclusions
HVPG ≥12 mmHg may be suggested a predictor of survival in cirrhotic patients with early-stage HCC. In CTP A class, the presence of medium or large sized esophageal varices were associated with high HVPG.

Case Report

A Case of Partial Response of Hepatocellular Carcinoma Induced by Concurrent Chemoradiation and Hepatic Arterial Infusion Chemotherapy after Trans-Arterial Chemoembolization: Myung Eun Song, Sangheun Lee, Mi Na Kim, Dong-Jun Lee, Beom Kyung Kim, Seung Up Kim, Jun Yong Park, Sang Hoon Ahn, Chae Yoon Chon, Kwang-Hyub Han, Jinsil Seong, Do Young Kim; Journal of the Korean Liver Cancer Study Group. 2013;13(2):152-157. Published online September 30, 2013; DOI: https://doi.org/10.17998/jlc.13.2.152

1,061 Views
8 Downloads

Abstract PDF: A 63-year-old man patient was referred for treatment of infiltrative hepatocellular carcinoma with hilar invasion after transarterial chemoembolization. Serum alkaline phosphatase and bilirubin were elevated, liver dynamic CT showed infiltrative type mass in left hepatic lobe and right hepatic dome with hilar invasion and left intrahepatic duct dilatation. Also CT showed obliteration of left portal vein and metastasis of lymph node around common bile duct. He was diagnosed as hepatocellular carcinoma (UICC stage IV-A, BCLC stage C). With the percutaneous transhepatic biliary drainage and the concurrent chemoradiation therapy and the 4th cycle of hepatic arterial infusion chemotherapy for infiltrative mass, viable tumor was decreased in resectable size at eight months from initial diagnosis.

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