Heiko Mix

Uncommon Metastasis of a Glioblastoma Multiforme in Liver and Spleen

A case of a glioblastoma multiforme is presented. Craniotomy was performed with total resection of the right temporal tumor. Postoperatively, the patient received adjuvant radiotherapy, but 6 months after therapy he developed severe nausea and weight loss. Recurrence of an intracranial tumor in the right temporal region with nodules in the liver and spleen were detected by CT scan. Fine-needle biopsies of the liver confirmed the diagnosis of a glioblastoma metastasis with characteristic immunohistochemical staining for glial fibrillary acidic protein. This rare case of an intracerebral glioblastoma metastasizing to liver and spleen was managed by systemic chemotherapy.

Hangzhou criteria are more accurate than Milan criteria in predicting long-term survival after liver transplantation for HCC in Germany

BackgroundMilan criteria are used for patient selection in liver transplantation for hepatocellular carcinoma (HCC). Hangzhou criteria have been shown in China to enable access to liver transplantation for more patients when compared to Milan criteria without negative effects on long-term survival. The purpose of this study was to evaluate the Hangzhou criteria in a German cohort.MethodsOne hundred fifty-nine patients transplanted for HCC between 1975 and 2010 were investigated. Patients were categorized into four groups depending on the fulfillment of Milan and Hangzhou criteria. General and tumor baseline characteristics were compared. Overall and tumor-free survival rates were investigated with the Kaplan-Meier analysis.ResultsOne-, 3-, 5-, and 10-year survival rates for patients fulfilling Milan criteria (n = 68) were 89.7, 83.7, 75.8, and 62.1%, respectively, versus 89.8, 82.2, 75.2, and 62.6% for patients fulfilling Hangzhou criteria (n = 109) (p = 0.833). When comparing patients exceeding Milan or Hangzhou criteria, survival rates were 75.3, 53.2, 48.1, and 41.1% versus 63.3, 31.4, 26.9, and 22.1%, respectively (p = 0.019). The comparison of tumor-free survival rates in patients fulfilling Milan or Hangzhou criteria was statistically not significant (p = 0.785), whereas the comparison of the groups exceeding the criteria showed significantly worse survival for patients outside Hangzhou criteria (p = 0.007). The proportion of patients fulfilling Hangzhou criteria (68.6%) was significantly larger as compared to the proportion fulfilling Milan criteria (42.8%) (p < 0.001).ConclusionHangzhou criteria are more accurate in predicting long-term survival after liver transplantation for HCC in Germany. Deployment of the Hangzhou criteria for patient selection could enlarge the pool of transplantable patients.

Chapter 1 Digestive System and Autoimmunity

Publisher Summary This chapter discusses the digestive system and autoimmunity. The mucosa of the gastrointestinal tract is a major site of pathogen entry. The gut-associated immune system needs to remain hyporesponsive to food antigens and commensal bacteria, while mounting an efficient response against pathogens. Immune responses are coordinated and regulated in order to cure effectively an infection, and to avoid chronic inflammation. Autoimmune diseases are considered as immune responses with defects in mechanisms that control self tolerance. Every organ of the digestive system can be the target of an autoimmune response, either in systemic or in organ-specific autoimmune diseases. Although many self-tolerance mechanisms exist, defects in a single checkpoint can lead to autoimmune disease. Clinical manifestations of autoimmune diseases are often seen only after a latent period of many years, and then only against a few proteins or organs. Common analysis of DNA polymorphisms are not effective in identifying predisposing defects, rather exon resequencing of individuals with autoimmune disease is required.