Misdiagnosed or Incidentally Detected Hepatocellular Carcinoma in Explanted Livers: Lessons Learned

Abdelfattah, Mohamed Rabei; Abaalkhail, Faisal; Almanea, Hadeel

doi:10.12659/aot.893782

Cited by 28 publications

(23 citation statements)

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“…The literature is unclear on the frequency of incidental HCC in children because most reports either do not include pediatric transplants or do not differentiate between adults and children, or the etiology of background liver disease. Most reports indicate that approximately 10% of explants contain incidental cancers with a range between 5.7% and 63.3% .…”

Section: Discussionmentioning

confidence: 99%

Pediatric hepatocellular carcinoma in a developing country: Is the etiology changing?

Kumar¹,

Borkar²,

Safwan³

et al. 2016

Pediatric Transplantation

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HCC is the second most common malignant liver tumor of childhood. It typically affects children with a median age of 10-14 yr on background hepatitis B-related liver disease and is often metastatic or locally advanced at diagnosis. Children below the age of five yr typically constitute <10% of all children with HCC. In these children, it occurs on a background of congenital or metabolic liver disease. The records of all children with HCC who presented to our department over a six-yr study period were reviewed. Twelve patients with a median age of 5.9 yr (range 1.6-15.4) were diagnosed to have HCC. All patients underwent liver transplantation, and none were resected. Eleven patients had background congenital or metabolic liver disease. All five of those with hereditary tyrosinemia type 1 who presented to us were found to have HCC. No patient had hepatitis B-related liver (HBV) disease. Eight (66.7%) patients had incidentally discovered HCC on examination of the explant. Incidentally discovered HCC were smaller, well differentiated, and did not show microvascular invasion compared to those diagnosed preoperatively. There was no recurrence with a median follow-up of five months. The patient demographic for pediatric HCC is changing probably as a consequence of successful immunization against HBV. Younger patients with congenital and metabolic liver disease in whom liver transplantation is the ideal treatment are likely to constitute an ever-increasing proportion of patients with pediatric HCC as HBV disease is controlled or eradicated.

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Section: Discussionmentioning

confidence: 99%

Pediatric hepatocellular carcinoma in a developing country: Is the etiology changing?

Kumar¹,

Borkar²,

Safwan³

et al. 2016

Pediatric Transplantation

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“…Unfortunately, accurate diagnosis of these tumors prior to initiation of therapies is difficult. In patients undergoing LT, approximately 0.7%‐3.3% of tumors diagnosed as HCC via radiographic criteria or pathologic examination are later identified as HCC‐CCA on evaluation of the explant pathology . Because of the rarity of the tumors and difficulty in securing a definitive pretreatment diagnosis, determining the appropriate therapeutic intervention to optimize patient outcomes has been difficult.…”

mentioning

confidence: 99%

Propensity‐Matched Analysis of Patients with Mixed Hepatocellular‐Cholangiocarcinoma and Hepatocellular Carcinoma Undergoing Liver Transplantation†

et al. 2018

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Mixed hepatocellular-cholangiocarcinomas (HCC-CCAs) are rare tumors with both hepatocellular and biliary differentiation. While liver transplantation (LT) is the gold standard treatment for patients with unresectable hepatocellular carcinoma (HCC), it is contraindicated in known HCC-CCA because of concerns of poor prognosis. We sought to compare posttransplant oncologic outcomes for HCC-CCA and a matched cohort of HCC LT recipients. A retrospective, single-center analysis (1984-2015) identified 12 patients with mixed HCC-CCA who were matched 1:3 to patients with HCC on both pretransplant (radiologic diameter and alpha-fetoprotein) and explant (pathologic diameter, grade/differentiation, and vascular invasion) tumor characteristics. Compared with HCC patients matched on pretransplant characteristics (n = 36), HCC-CCA had higher explant tumor grade, more poorly differentiated tumors, but similar T stage and vascular invasion. HCC-CCA recipients trended toward inferior recurrence-free survival at 5 years (28% versus 61%; P = 0.12) and greater recurrence (HCC-CCA: 50%, median time to recurrence 297 days versus HCC: 22%, median time to recurrence 347 days; P = 0.07). However, when matched to a separate HCC cohort with similar explant pathology, HCC-CCA had similar 5-year recurrence-free survival (42% versus 44%; P = 0.45) and posttransplant recurrence (50% versus 27%; P = 0.13). All 6 HCC-CCA recurrences occurred with poorly differentiated tumors (median survival 21.3 months), without a single recurrence in 5 of the 12 HCC-CCA patients with well-moderately differentiated tumors (median survival 60.2 months). Mixed HCC-CCA tumors are more likely poorly differentiated tumors compared with HCC with similar pretransplant characteristics. However, compared with HCC with similar pathologic characteristics, they display similar recurrence-free survival and are not inherently more aggressive tumors. Low-grade, well-moderately differentiated HCC-CCAs have excellent survival with a low risk for post-LT recurrence, and they should not be excluded from LT. Improved pretransplant identification of pathologic characteristics in HCC-CCA may allow for successful utilization of LT in this subset of patients.

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“…Early diagnosis is the most effective way to improve prognosis and increase the survival rate of patients with HCC (14,15). HCC is directly related to cirrhosis; thus, it is crucial to detect chronic liver disease (16). …”

Section: Discussionmentioning

confidence: 99%

Correlation between CT features and liver function and p53expression in hepatitis, cirrhosis and hepatocellular carcinoma

Sha

et al. 2018

Oncol Lett

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This study aimed to investigate the correlation between CT features and liver function and p53 expression in hepatitis, cirrhosis and hepatocellular carcinoma (HCC). Forty patients with HCC, 30 patients with cirrhosis and 30 patients with chronic hepatitis were enrolled between December, 2015 and December, 2016. At the same time, normal liver tissues collected from 30 patients with hepatic hemangioma were used as the normal control group. All the patients were scanned by CT. Average body surface area, left outer lobe and caudate lobe volume, and the proportions of left outer lobe and caudate lobe to the whole liver were calculated. Biochemical indexes of liver function were determined. The pathological tissues of all the subjects were analyzed. Compared with the control group, total liver volume of the HCC group was significantly reduced (P<0.05). Compared with the HCC group, the volume of the left outer lobe increased in the hepatitis group and the cirrhosis group. Compared with control group, caudate lobe volume increased significantly in the hepatitis group (P<0.05). Compared with the control group, the volume of the left outer lobe and the proportion of caudate lobe to the whole liver volume was significantly increased in all three groups (P<0.05). Liver function-related indicators in the HCC and cirrhosis groups were significantly different from those in the control group (P<0.05). The expression level of p53 in HCC was significantly higher than that in the control group (P<0.05). The accuracy of diagnosis by using both p53 and CT was higher than the use of p53 or CT alone. CT can accurately measure the volume of each lobe of the liver, and p53 has important clinical values in the diagnosis of liver diseases. Thus, the reasonable combination of the two can effectively improve the diagnostic accuracy.

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Misdiagnosed or Incidentally Detected Hepatocellular Carcinoma in Explanted Livers: Lessons Learned

Cited by 28 publications

References 0 publications

Pediatric hepatocellular carcinoma in a developing country: Is the etiology changing?

Pediatric hepatocellular carcinoma in a developing country: Is the etiology changing?

Propensity‐Matched Analysis of Patients with Mixed Hepatocellular‐Cholangiocarcinoma and Hepatocellular Carcinoma Undergoing Liver Transplantation†

Correlation between CT features and liver function and p53expression in hepatitis, cirrhosis and hepatocellular carcinoma

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