Cheng-Chung Wu

Second and third hepatectomies for recurrent hepatocellular carcinoma are justified

Liver resection is the main curative treatment for hepatocellular carcinoma (HCC), but recurrence rates are high. The remnant liver is the most common site of recurrence, but the role of repeat hepatectomy in the treatment of recurrent HCC is controversial.

The Hepatitis Viral Status in Patients With Hepatocellular Carcinoma: a Study of 3843 Patients From Taiwan Liver Cancer Network.

AbstractHepatocellular carcinoma (HCC) is the leading cancer death in Taiwan. Chronic viral hepatitis infections have long been considered as the most important risk factors for HCC in Taiwan. The previously published reports were either carried out by individual investigators with small patient numbers or by large endemic studies with limited viral marker data. Through collaboration with 5 medical centers across Taiwan, Taiwan liver cancer network (TLCN) was established in 2005. All participating centers followed a standard protocol to recruit liver cancer patients along with their biosamples and clinical data. In addition, detailed viral marker analysis for hepatitis B virus (HBV) and hepatitis C virus (HCV) were also performed. This study included 3843 HCC patients with available blood samples in TLCN (recruited from November 2005 to April 2011). There were 2153 (56.02%) patients associated with HBV (HBV group); 969 (25.21%) with HCV (HCV group); 310 (8.07%) with both HBV and HCV (HBV+HCV group); and 411 (10.69%) were negative for both HBV and HCV (non-B non-C group). Two hundred two of the 2463 HBV patients (8.20%) were HBsAg(-), but HBV DNA (+). The age, gender, cirrhosis, viral titers, and viral genotypes were all significantly different between the above 4 groups of patients. The median age of the HBV group was the youngest, and the cirrhotic rate was lowest in the non-B non-C group (only 25%). This is the largest detailed viral hepatitis marker study for HCC patients in the English literatures. Our study provided novel data on the interaction of HBV and HCV in the HCC patients and also confirmed that the HCC database of TLCN is highly representative for Taiwan and an important resource for HCC research.

Thick calcification from a GIST of the stomach penetrating into pericolic soft tissue - report of a case

Thick calcification is a rare presentation of gastrointestinal stromal tumor (GIST). Penetration into gastric mucosa and pericolic soft tissue has never been reported. We report a case of gastric GIST with cystic degeneration and thick calcification in an 81-year old female, who presented with hematemesis and severe abdominal pain. Thick calcification of this tumor penetrating into pericolic soft tissue was noted and successfully treated by distal gastrectomy and partial colectomy. For gastrointestinal tumors with thick calcification, even with benign behavior, surgical intervention should be considered for both oncological considerations and prevention of catastrophes like perforation or penetration into surrounding soft tissue.

Surgically Curable Non-Iron Deficiency Microcytic Anemia: Castleman’s Disease

Background: Castleman’s disease (CD) is a rare, benign lymphoproliferative disorder that can involve single lymph node stations or can be systemic. Unicentric CD in patients with microcytic anemia is rarely described in the English literature. Case Report: We describe the case of a 19-year-old Chinese woman with hyaline vascular type of unicentric CD presenting as severe non-iron deficiency microcytic anemia. We report the clinical course from the initial presentation to diagnosis and surgical cure, and discuss the most up-to-date information on CD. Conclusions: CD should be included in the differential diagnosis of microcytic anemia. Imaging tools and pathological studies should be considered in order to make a more accurate diagnosis and to avoid the use of ineffective treatments.

Impact of Severe Oesophagogastric Varices on Liver Resection for Hepatocellular Carcinoma in Cirrhotic Patients

BackgroundThe aim of the present study was to clarify both short-term and long-term results of patients with concomitant hepatocellular carcinoma (HCC) and high-risk oesophagogastric varices (OGV).MethodsThis retrospective study identified 927 cirrhotic patients who underwent curative resection of HCC between 1995 and 2012 in single institution. Patients were separated into 3 groups (A, B, and C) according to general rules for recording endoscopic findings of oesophagogastric varices proposed in Japan in 1991. Groups A, B, and C consisted of patients without OGV (F0), patients with mild to moderate OGV (F1 to F2), and patients with high-risk OGV (F3 and/or red color sign), respectively. All patients in group C underwent prophylactic endoscopic variceal ligation/sclerotherapy. Post-operative complications, mortality, overall survival, and disease-free survival were compared among 3 groups.ResultsNo patient had post-operative variceal bleeding. Complication rates of Clavien-Dindo grade II to V in three groups were 13.6, 14.0, and 6.9xa0%, respectively (Pxa0>xa00.05). Operative mortality, 5-year overall survival rate, and disease-free survival rate among the 3 groups were not significantly different (Pxa0>xa00.05).ConclusionsProphylactic endoscopic variceal ligation/sclerotherapy effectively prevented from post-operative variceal bleeding in patients with high-risk OGV. Operative mortality, major morbidity, and survival of patients with high-risk OGV were similar to those of patients without OGV or those with mild OGV. Liver resection remains a feasible choice for cirrhotic patients with concomitant HCC and high-risk OGV.

The Influence of High Serum Testosterone Levels on the Long-term Prognosis in Male Patients Undergoing Hepatectomy for Early Stage Hepatocellular Carcinoma without Vascular Invasion

BackgroundThe influence of high serum testosterone levels on the long-term prognosis in male patients undergoing hepatectomy for hepatocellular carcinoma (HCC) remains to be fully elucidated. The aim of the present study was to conduct a retrospective investigation of the impact of high serum testosterone levels on the risk of tumor recurrence and long-term prognosis in male patients undergoing hepatectomy for early stage HCC without vascular invasion.MethodsBetween August 1995 and March 1999, 42 male patients undergoing curative hepatectomy for HCC of tumor-node-metastasis (TNM) stages I and II without vascular invasion were enrolled in the study. Preoperative serum testosterone concentration was measured. The clinicopathological features, tumor recurrence rates, and 5-year disease-free and actuarial survival after hepatectomy were compared between the patients with serum testosterone levels in the upper half (group I, nxa0=xa021) and the patients in the lower half (group II, nxa0=xa021).ResultsThe background and clinicopathological features did not differ significantly between groups I and group II. All survivors were followed up for more than 5 years. Until March 2005, patients in group I, with serum testosterone levels in the upper half, had a significantly higher percentage of 5-year tumor recurrence than group II, with lower testosterone levels (76.2% versus 28.6%; pxa0<xa00.005). The patients in group I also had a significantly inferior 5-year disease-free (pxa0<xa00.01) and actuarial (pxa0<xa00.05) survival rates than patients in group II.ConclusionsMale patients with high serum testosterone levels undergoing hepatectomy for early stage HCC without vascular invasion have significantly higher 5-year tumor recurrence rates and an inferior long-term prognosis than patients with low testosterone levels. These findings signal a strategy of adjuvant anti-androgen treatment selectively targeted for the male patients with high serum testosterone levels after hepatectomy for early stage HCC without vascular invasion to achieve better long-term outcome.

Liver resection for hepatocellular carcinoma in patients with hematological malignancies

BackgroundImprovements in antimetabolite drugs have prolonged the survival of patient with hematological malignancies. However, these drugs may have hepatotoxic side effects and may induce acute liver failure, chronic liver fibrosis, cirrhosis, or even hepatocellular carcinoma (HCC). Although liver resection remains a curative option for HCC, its role in HCC with hematological malignancies has never been fully explored.MethodsA retrospective review of 1725 patients who underwent curative liver resection for newly diagnosed HCC between 1994 and 2016 was conducted. Among these patients, 16 had a history of hematological malignancies (HM group). Their hematological malignancies were well-controlled at the time of liver resection. The clinicopathological characteristics of the HM group, along with their short- and long-term outcomes after liver resection, were compared with those of the other 1709 patients without hematological malignancy (non-HM group).ResultsAll HM group patients were seropositive for hepatitis marker surface for hepatitis B and C. No significant differences were observed in any background characteristics between the two groups. The postoperative complication rate and 90-day mortality in the HM and non-HM groups were 25 and 20.4%, Pxa0=xa00.754, and 0 and 0.6%, Pxa0=xa01.000, respectively. The 5-year disease-free and overall survival rates for the HM and non-HM groups were 42.3 and 35.1%, Pxa0=xa00.552, and 69.5 and 56.9%, Pxa0=xa00.192, respectively.ConclusionsHepatitis markers should be examined during chemotherapy for hematological malignancies. Regular liver imaging studies are recommended for seropositive cases. When HCC occurs secondary to a well-controlled hematological malignancy, liver resection is suggested in selected patients.

Hepatocellular Carcinoma Arising from Ectopic Liver: Report of a Case

Unlike an ectopic pancreas, an ectopic liver is an unusual condition. Hepatocellular carcinoma (HCC) arising from an ectopic liver is extremely rare. Herein, we report a case of a 41-year-old male patient who suffered from a painful left upper abdominal mass for three months. He had undergone a resection of a left upper retroperitoneal tumor at another hospital 4 years previously. The liver was normal and free of tumor at that time. The pathology revealed a carcinoma of unknown origin. Imaging studies showed a left upper abdominal mass behind the stomach and spleen. His serum-fetoprotein (AFP) was 19.65 ng/m (normal＜8 ng/ml). After laparotomy, the liver was normal without connection to the tumor. He underwent wedge resection of the stomach, partial resection of the left diaphragm, segmental resection of the jejunum and transverse colon. Pathological examination showed a hepatocellular carcinoma. He remained disease-free one year after operation. No recurrence has been observed during the regular follow-up at our department.

Papillary Carcinoma of Thyroid with Breast Metastasis: Report of a Case

Papillay carcinoma is a common thyroid malignancy. It metastasizes predominantly to the lymph node, lungs and bones. Breast metastasis is extremely rare. Only three cases have been reported in the English literature. A 43-year-old female who was diagnosed to have papillary carcinoma of the thyroid underwent total thyroidectomy. After operation, I-^131 ablation therapy was given. Breast metastasis was found 9 months later. After breast tumor excision and second I-^131 ablation therapy, she has so far remained disease-free for 27 months. Local excision of the breast metastastic lesion with high dose I-^131 treatment appeared to be an appropriate option for this patient.

Intra-operative Frozen Section for Sentinel Lymph Node: A Pathologic Study of 262 Patients with Breast Cancer

Background: Sentinel lymph node biopsy (SLNB) has been developed for assessment of the staging of breast cancer patients to minimize the morbidity of complete axillary lymph node dissection (ALND). This study evaluates the sensitivity and specificity of intra-operative frozen section (FS) examination of sentinel lymph node biopsy. Materials and Methods: Between January 2000 and February 2004, samples were collected from breast cancer patients at the Taichung Veterans General Hospital who underwent intra-operative FS for SLNB. The frozen tissue also underwent standard paraffin tissue processing afterwards and the result of each paraffin section was regarded as the gold standard of intra-operative FS. Results: A total of 952 sentinel lymph nodes from 262 patients were harvested. The overall sensitivity and specificity for intra-operative FS were 68.6% (72/105) and 99.6% (844/847) respectively. When further stratified according to metastatic size, the sensitivity for macrometastases, micrometastases, and submicrometastases were 95.5% (64/67), 25% (6/24), and 14.3% (2/14) respectively. Conclusions: Intra-operative FS of SLNB is a highly specific and sensitive method for detecting macrometastases, while showing high specificity and low sensitivity for micrometastases and submicrometastases. For such metastases, more precise methods may help in accurate diagnosis. Following studies of the histological sections of negative sentinel nodes after using frozen sections are necessary to find occult metastases, and a two-step operation is essential for such patients.