Abstract: This case describes successful combined treatment of patient with large hepatocellular carcinoma BCLC «B», occupying the entire right lobe of the liver, extending to the fourth segment and occupying the right lateral flank till small pelvis. As the first stage, selective tumor chemoembolization, mechanical chemoembolization of right portal vein branches with the aim of vicarious hypertrophy of remaining liver segments were performed. One and half months after performed procedure, the volume of remnant parenchyma was 31% of the total volume. According to the test with indocyanine green, the plasma elimination rate (ICG-PDR) was 12,2%/min, and the residual concentration at 15 minutes was 16%. Subsequently, was performed surgical intervention: Starzl laparotomy, revision of abdominal organs, cholecystectomy, right-sided hemihepatectomy + SI, drainage of the common bile duct according to Vishnevsky, lymphadenectomy of the hepatoduodenal ligament, drainage of abdominal cavity. Postoperative period was complicated by formation of an external biliary fistula and hepatic failure, regarded as class «B» according to criteria of the International Research Group for Liver Surgery (ISGLS), which required medical correction of patient's condition without use of extracorporeal detoxification methods. Later, patient was diagnosed with foci of recurrence of disease in the remaining parenchyma of the liver, for which endovascular treatment was carried out. Currently, patient is alive (6 years after surgery) and is receiving systemic treatment for the extrahepatic spread of the underlying disease. References 1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394-424. https://doi.org/10.3322/caac.21492 2. Llovet JM, Br? C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Seminars in liver disease. 1999; 19(3): 329-338. 3. Vishnevsky VA, Ayvazyan KA, Ikramov RZ, et al. Sovremennye printsipy lecheniya gepatotsellyulyarnogo raka. Annaly khirurgicheskoy gepatologii 2020; 25(2): 15-26 [In Russ]. https://doi.org/10.16931/1995-5464.2020215-26 4. Mizuguchi T, Kawamoto M, Meguro M, et al. Preoperative liver function assessments to estimate the prognosis and safety of liver resections. Surg Today. 2014; 44(1): 1-10. https://doi.org/10.1007/s00595-013-0534-4 5. European Association for the Study of the Liver. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018; 69(1): 182-236. https://doi.org/10.1016/j.jhep.2018.03.019 6. Kamiyama T, Orimo T, Wakayama K, et al. Survival outcomes of hepatectomy for stage B Hepatocellular carcinoma in the BCLC classification. World J Surg Oncol. 2017; 15(1): 156. https://doi.org/10.1186/s12957-017-1229-x 7. Kim H, Ahn SW, Hong SK, et al. Korean Liver Cancer Association. Survival benefit of liver resection for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma. Br J Surg. 2017; 104(8): 1045-1052. https://doi.org/10.1002/bjs.10541 8. Samuel M, Chow PK, Chan Shih-Yen E, et al. Neoadjuvant and adjuvant therapy for surgical resection of hepatocellular carcinoma. Cochrane Database Syst Rev. 2009; 1: CD001199. https://doi.org/10.1002/14651858.CD001199.pub2 9. Tremosini S, Reig M, de Lope CR, et al. Treatment of early hepatocellular carcinoma: Towards personalized therapy. Dig Liver Dis. 2010; 42(3): 242-8. https://doi.org/10.1016/S1590-8658(10)60512-9 10. Bolondi L, Burroughs A, Dufour JF, et al Heterogeneity of patients with intermediate (BCLC B) Hepatocellular Carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis. 2012; 32(4): 348-59. https://doi.org/10.1055/s-0032-1329906 11. Kudo M, Arizumi T, Ueshima K, et al. Subclassification of BCLC B Stage Hepatocellular Carcinoma and Treatment Strategies: Proposal of Modified Bolondi's Subclassification (Kinki Criteria). Dig Dis. 2015; 33(6): 751-8. https://doi.org/10.1159/000439290 12. Wada H, Eguchi H, Noda T, et al. Selection criteria for hepatic resection in intermediate-stage (BCLC stage B) multiple hepatocellular carcinoma. Surgery. 2016; 160(5): 1227-1235. https://doi.org/10.1016/j.surg.2016.05.023 13. Wang W, Yang LY, Huang GW, et al. Genomic analysis reveals RhoC as a potential marker in hepatocellular carcinoma with poor prognosis. Br J Cancer. 2004; 90(12): 2349-55. https://doi.org/10.1038/sj.bjc.6601749 14. Yang LY, Wang W, Peng JX, et al. Differentially expressed genes between solitary large hepatocellular carcinoma and nodular hepatocellular carcinoma. World J Gastroenterol. 2004; 10(24): 3569-73. https://doi.org/10.3748/wjg.v10.i24.3569 15. Chen J, Lai L, Lin Q, et al. Hepatic resection after transarterial chemoembolization increases overall survival in large/multifocal hepatocellular carcinoma: a retrospective cohort study. Oncotarget. 2017; 8(1): 408-417. https://doi.org/10.18632/oncotarget.13427 16. Pirtskhalava TL, Granov DA, Maystrenko DN. Kombinirovannaya rezektsiya pecheni i nizhnei poloi veny pri gepatotsellyulyarnom rake. Annaly khirurgicheskoy gepatologii. 2016; 21(2): 52-55 [In Russ]. https://doi.org/10.16931/1995-5464.2016252-55 17. Granov AM, Tarazov PG, Granov DA, et al. Uspeshnoe kombinirovannoe lechenie patsienta s retsidiviruyushchei gepatotsellyulyarnoi kartsinomoi. Vestnik khirurgii imeni II Grekova. 2015; 174(2): 98-100 [In Russ]. 18. Granov DA, Polehin AS, Tarazov PG, et al. Khimioehmbolizatsiya pechenochnykh arterii u bol'nykh gepatotsellyulyarnym rakom na fone tsirroza pered transplantatsiei pecheni: prognosticheskoe znachenie kontsentratsii al'fafetoproteina. Russian Journal of Transplantology and Artificial Organs. 2020; 22(4): 52-57 [In Russ].
Abstract: The basis of computed tomography diagnosis is the definition of densitometric parameters at different phases of the study. Aim. Was to perform comparative analysis of computed tomography features of focal nodular hyperplasia and hepatocellular carcinoma. Materials and methods. During the reseach clinical and morphological comparisons were performed on the base of 36 patients’ CT’s results: 21 patient with hepatocellular carcinoma (HCC) and 15 patient with focal nodular hyperplasia of the liver without associated liver cirrhosis. At the preoperative stage all patients underwent spiral computed tomography with bolus contrast enhancement (on the four phases of the study). Results. During native phase of computed tomography HCC nodes are more often hipodense irrespective of the degree of histological differentiation and focal nodular hyperplasia - izodense. After intravenous injection of contrast agent, computed tomography picture of hepatocellular carcinoma and focal nodular hyperplasia depended on the phase of the study During the arterial phase tissue of focal nodular hyperplasia in the vast majority of cases was hiperdense relative to the surrounding liver parenchyma. Hepatocellular carcinoma had similar values much less frequently in contrast to the focal nodular hyperplasia. The venous phase was characterized by the presence of hiperdense characteristics in focal nodular hyperplasia areas and, conversely, in hepatocellular carcinoma tissue signs of hiperdense were not observed. Hyperdence formations in delayed phase of computed tomography indicate the presence of focal nodular hyperplasia, and vice versa, hypodense are sufficient to prevent its presence. Conclusion. Estimation of densitometric parameters of focal nodular hyperplasia and hepatocellular carcinoma allows to determine features of computed tomography imaging of tumors at different phases of the examination, and this allows to make a differential diagnosis between them.
Abstract: Hepatocellular carcinoma (HCC) of liver is a widespread oncologic disease. The main risk factor of HCC development is liver cirrhosis. The aim of this article is to describe findings of HCCs in diagnostic imaging, including ultrasound, computed tomography, and magnetic resonance imaging. References 1. Cruite 2. Gomes M.A., Priolli D.G., Tralhro J.G., Botelho M.F. Hepatocellular carcinoma: epidemiology, biology, diagnosis, and therapies. Rev. Assoc. Med. Bras. 2013; 59(5): 514-524. 3. Weinmann A., Koch S., Niederle I.M. et al. Trends in Epidemiology, Treatment, and Survival of Hepatocellular Carcinoma Patients Between 1998 and 2009: An Analysis of 1066 Cases of a German HCC Registry. J. Clin. Gastroenterol. 2013 Sep 25. [Epub ahead of print]. 4. Hyder O., Dodson R.M., Nathan H. et al. Referral patterns and treatment choices for patients with hepatocellular carcinoma: a United States population-based study. J. Am.Coll. Surg. 2013; 217(5): 896-906. 5. 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Abstract: Aim: was to estimate first own results of arterial radioembolization (RE) in patients with primary or metastatic liver malignancy. Materials and methods: in 2009, RE of the right (n=3) or left (n=1) hepatic artery using Yttrium-90 glass microspheres (Therasphere) was performed in 4 patients: 3 with hepatocellular carcinoma on cirrhosis complicated by portal vein branch thrombosis (contraindication for chemoembolization), and 1 patient with colorectal liver metastases. Results: all RE procedures were technically successful. The radiation dose to the tumor was 1 20-150 Gy The post embolization syndrome was minimal and uncomplicated. After RE, partial tumor response and stabilization were noted in 2 patients each. Patients survived from 14 to 32 months. Conclusion: RE is well-tolerated and safe procedure causing significant local damage of liver tumor. According to our first experience, RE is a very promising method for treatment of hepatic malignancies. References 1. 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Imaging. 2011; 38(12): 2114-2116. 6. Atassi B., Bangash A.K., Lewandowski R.J., Ibrahim, Kulik L., Mulcahy M.F., Ryu R.K., Sato K.T., Miller F.H., Omary R.A., Salem R. Biliary sequelae following radioembolization with Yttrium-90 microspheres. J. Vasc. Interv. Radiol. 2008; 19(5): 691-697. 7. Jakobs T.F., Saleem S., Atassi B., Reda E., Lewandowski R.J., Yaghmai V., Miller F., Ryu R.K., Ibrahim 5., Sato K.T., Kulik L.M., Mulcahy M.F., Omary R., Murthy R., Reiser M.F., Salem R. Fibrosis, portal hypertension, and hepatic volume changes induced by intra-arterial radiotherapy with 90Yttrium microspheres. Dig. Dis. Sci. 2008; 53(9): 2556-2563. 8. Naymagon S., Warner R.R.P., Patel K., Harpaz N., Machac J., Weintraub J.L., Kim M.K. Gastroduodenal ulceration associated with radioembolization for the treatment of hepatic tumors: An institutional experience and review of the literature. Dig. Dis. Sci. 2010; 55(9): 24502458. 9. Salem R., Lewandowski R.J., Mulcahy M.F., Riaz A., Ryu R.K., Ibrahim S., Atassi B., Baker T., Gates V., Miller F.H., Sato K.T., Wang E., Gupta R., Benson A.B., Newman S.B., Omary R.A., Abecassis M., Kulik L. Radioembolization for hepatocellular carcinoma using Yttrium-90 microspheres: A comprehensive report of long-term outcomes. Gastroenterology. 2010; 138(1): 52-64. 10. Salem R., Gilbertsen M., Butt Z., Memon K., Vouche M., Hickey R., Baker T., Abecassis M.M., Atassi R., Riaz A., Cella D., Burns J.L., Ganger D., Benson A.B., Miulcahy M.F., Kulik L., Lewandowsi R. Increased quality of life among hepatocellular carcinoma patients treated with radioembolization, compared with chemoembolization. Clin. Gastroenterol. Hepatol. 2013; 11(10): 1358-1365. 11. Kim YH., Kim D.Y Yttrium-90 radioembolization for hepatocellular carcinoma: What we know and what we need to know. Oncology. 2013; 84 (suppl.1): 34-39. 12. Memon K., Kulik L., Lewandowski R.J., Mulcahy M.F., Benson A.B., Ganger D., Riaz A., Gupta R., Vouche M., Gates V.L., Miller F.H., Omary R.A., Salem R. Radioembolization for hepatocellular carcinoma with portal vein thrombosis: Impact of liver function on systemic treatment options at disease progression. J. Hepatol. 2013; 58(1): 73-80. 13. Moreno-Luna L.E., Yang J.D., Sanchez W., Paz- Fumagalli R., Harnois D.M., Mettler T.A., Gansen D.N., de Groen P.C., Lazaridis K.N., Menon K.W.N., LaRusso M.F., Alberts S.R., Gores G.J., Fleming C.J., Slettedahl S.W.. Harmsen W.S., Therneau T.M., Wiseman G.A., Andrews J.C., Roberts L.R. Efficacy and safety of transarterial radioembolization versus chemoembolization in patients with hepatocellular carcinoma. Cardiovasc. Intervent. Radiol. 2013; 36(3): 714-723. 14. Tsai A.L., Burke C.T., Kennedy A.S., Moore D.T., Mauro M.A., Dixon R.D., Stavas J.M., Bernard S.A., Khandani A.H., O’Neil B.H. Use of yttrium-90 mocrospheres in patients with advanced hepatocellular carcinoma and portal vein thrombosis. J. Vasc. Interv. Radiol. 2010; 21(9): 1377-1384. 15. Mazzaferro V., Sposito C., Bhoori S., Romito R., Chiesa C., Morosi C., Maccauro M., Marchiano A., Bongini M., Lanocita R., Civelli E., Bombardien E., Camerini T., Spreafico C. Yttrium-90 radioembolization for intermediate-advanced hepatocellular carcinoma: A phase 2 study. Hepatology. 2013; 57(5): 1826-1837. 16. Stubbs R.S., Wickremesekera S.K. Selective internal radiation therapy (SIRT): A new modality for treating patients with colorectal liver metastases (review). HPB. 2004; 6(3): 133-139. 17. Bester L., Meteling B., Pocock N., Pavlakis N., Chua T.C., Saxena A., Morris D.L. Radioembolization versus standard care of hepatic metastases: Comparative retrospective cohort study of survival outcomes and adverse events in salvage patients. J. Vasc. Interv. Radiol. 2012; 23(1): 96-105. 18. 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Hoffmann R.-T., Jakobs T.F., Kubisch C.H., Stemmler H.J., Trumm C., Tatsch K., Helmberger T.K., Reiser M.F. Radiofrequency ablation after selective internal radiation therapy with yttrium 90 microspheres in metastatic liver disease - is it feasible? Eur. J. Radiol. 2010; 74(1): 199-205. 23. Wasan H., Kennedy A., Coldwell D., Sangro B., Salem R. Integrating radioembolization with chemotherapy in the treatment paradigm for unresectable colorectal liver metastases (review). Am. J. Clin. Oncol. 2012; 35(3): 293-301. 24. Edeline J., Lenoir L., Boudjama K., Rolland Y, Boulic A., Le Du F., Pracht M., Raoul J.-L., Clement B., Garin E., Boucher E. Volumetric changes after 90Y radioembolization for hepatocellular carcinoma in cirrhosis: An option to portal vein embolization in a preoperative setting? Ann. Surg. Oncol. 2013; 20(8): 2518-2525. 25. Vouche M., Lewandowski R.J., Atassi R., Memon K., Gates V.L., Ryu R.K., Gaba R.C., Mulcahy M.F., Baker T., Sato K., Hickey R., Ganger D., Riaz A., Fryer J., Caicedo J.C., Abecassis M., Kulik L., Salem R. Radiation lobectomy: Time-dependent analysis of future liver remnant volume in unresectable liver cancer as a bridge to resection. J. Hepatol. 2013; 59(5): 1029-1036. 26. Lam M.G.E.H., Louie J.D., Iagaru A.H., Goris M.L., Sze D.Y Safety of repeated yrrium-90 radioembolization. Cardiovasc. Intervent. Radiol. 2013; 36(5): 13201328. 27. Fiore F., Cappelli A., Rodrigues M., Ettorre G.M., Saltarelli A., Geatti O., Ahmadzadehfar H., Haug A.R., Izzo F., Giampalma E., Sangro B., Pizzi G., Notarianni E., Vit A., Wilhelm K., Jacobs T.F., Lastoria S. Comparison of the survival and tolerability of radioembolization in elderly vs younger patients with unresectable hepatocellular carcinoma. J. Hepatol. 2013; 59(4): 753-761.
Abstract: Aim: was to determine the possibility of ultrasound in the diagnosis of hepatocellular carcinoma (HCC). Materials and methods: the study involved 140 patients who underwent surgical treatment for the period 1998-2013 years. HCC was confirmed in 127 patients, 12 patients had benign tumors, such as hepatocellular adenoma, focal nodular hyperplasia. Results: ultrasound features of hepatocellular carcinoma were studied. To determine the informativeness, results were compared with preoperative methods of examination, intraoperative ultrasound (IOUS) and histological examination with surgical evaluation and histologic data. Number of tumor nodules, determined by ultrasound confirmed in 74% of cases with HCC and 83,3% for benign diseases. Dimensions, which were measured by ultrasound, were confirmed in majority cases (81,1%) with HCC and 100% of cases with benign tumors. Sensitivity and specificity of ultrasound were 99,2% and 25%, CT - 96,9% and 28,6%, MRI - 100% and 33,3% respectively Aspiration biopsy showed the most balanced performance: sensitivity - 94,9%, specificity 45,4%. Lack of true negative results during angiography, IOUS and surgical evaluation did not gave possibilities to calculate the specificity and predictive value of a negative result. Sensitivity of IOUS and surgical evaluation were 98,8% and 97,6%, respectively Of all tumor markers used in the diagnostic process, none of all showed any significant sensitivity, but they were characterized by high specificity and positive predictive method predictability Conclusions: US strategy in the diagnosis of HCC is to identify neoplasm, conducting navigation during fine-needle aspiration biopsy, specifying diagnostics during surgery. Results showed highly informative diagnostic value of ultrasound at all stages of the examination and treatment of patients with HCC. References 1. 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Contrast-enhanced Doppler ultrasonography in the diagnosis of hepatocellular carcinoma and premalignant lesions in patients with cirrhosis. Hepatology. 2001;34:1109-1112. 9. Franga A.V., Elias Junior J., Lima B.L., et al. Diagnosis, staging and treatment of hepatocellular carcinoma. Braz. J. Med. Biol. Res. 2004;37:1689-1705. 10. Saar B., Kellner-Weldon F. Radiological diagnosis of hepatocellular carcinoma. Liver Int. 2008;28:189-199. 11. Yu S.C., Yeung D.T., So N.M. Imaging features of hepatocellular carcinoma. Clin Radiol. 2004;59:145-156. 12. Bruix J., Hessheimer A.J., Forner A., et al. New aspects of diagnosis and therapy of hepatocellular carcinoma. Oncogene. 2006;25:3848-3856. 13. Gomaa A.I., Khan S.A., Leen E.L., et al. Diagnosis of hepatocellular carcinoma. World J. Gastroenterol. 2009 Mar 21;15(11):1301-14. 14. Vilana R., Bru C., Bruix J., et al. Fine-needle aspiration biopsy of portal vein thrombus: value in detecting malignant thrombosis. AJR Am. J. 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Abstract: Aim: was to study CT semiotic features of hepatocellular carcinoma (HCC) with varying degrees of differentiation in liver, unaffected by cirrhosis. Materials and methods: the study is based on clinical and morphological comparisons of 29 patients (19 men and 10 women aged 19-68 years) suffering from HCC without associated cirrhosis. In the preoperative period all patients underwent multislice CT with bolus contrast enhancement (on four phases of the study). On CT scans were determined: localization, size, borders and structure of nodes, including features of the accumulation of contrast agent for determining the degree of histological differentiation. Results: HCC had the appearance of a large solitary node, the average value of the largest diameter and the cross-sectional area amounted to 9.3 cm and 68.4 cm2 respectively in most of examined patients. In the native phase of CT quite distinct contour of the tumor node was determined in 40% of cases at highly differentiated and one-third of moderately differentiated HCC observations, at poorly differentiated variant contour is not expressed.The characteristic feature of CT HCC nodes is the heterogeneous nature of their internal structure, which is best visualized in the arterial phase. Most frequently in observations (in 67.6%) were detected areas of necrosis, rarely observed lesions sclerosis (23.5%) and calcifications (11.8%). Conclusion: Computed tomographic characteristics of HCC in the absence of cirrhosis depenc on the phase of the study, and the degree of histological differentiation of tumors that should be considered in the differential diagnosis and prognosis of the disease. References 1. Siegel R., Ma J., Zou Z., Jemal A. Cancer Statistics, 2014. CA Cancer J Clin 2014; 64: 9-29. 2. 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