A Case of Hepaticoduodenal Fistula Development after Transarterial Chemoembolization in Patient with Hepatocellular Carcinoma

Transarterial chemoembolization (TACE) is recommended as one of the first line therapy for unresectable hepatocellular carcinoma (HCC). Rupture of HCC following TACE is a rare and potentially fatal complication. We report a case of hepaticoduodenal fistula with ruptured HCC and liver abscess complicated by TACE. A 52-year-old male was treated by TACE three times, followed by radiation therapy and systemic chemotherapy. 30 days after the last TACE, right upper quadrant pain of abdomen was developed. About 1 month later, computed tomography of abdomen showed ruptured HCC with debris containing liver abscess and hepaticoduodenal fistula. Esophagogastroduodenoscopy revealed hepaticoduodenal fistula and hepatic parenchyme covered with exudate. The patient was managed with supportive care, but the hepaticoduodenal fistula persistedope

Clinical characteristics and prognosis of hepatocellular carcinoma with different sets of serum AFP and PIVKA-II levels.

OBJECTIVE: α-Fetoprotein (AFP) and prothrombin induced by the absence of vitamin K or antagonist-II (PIVKA-II) are useful tumor markers for hepatocellular carcinoma (HCC). However, little is known about the clinical characteristics and prognosis of HCC with different levels of AFP and PIVKA-II. METHODS: Consecutive 1447 HCC patients were assigned to four groups according to the cutoff values of AFP (400 ng/ml) and PIVKA-II (100 mAU/ml): both values high (AP), one of the values high (Ap and aP), and both values low (ap). The clinical characteristics and the prognosis of group ap were compared with those of the other groups. RESULTS: HCC patients in group ap were more asymptomatic at diagnosis, and had smaller size, fewer numbers, and earlier stages of HCC, and more preserved liver functions (all, P<0.001). The survival rate of group ap was significantly higher than those of the other groups (P<0.001). In multivariate analysis, the combined status of AFP and PIVKA-II values were independent predictors for survival (P<0.001), together with tumor size, number, portal vein thrombosis, Child-Pugh class, and treatment modality. CONCLUSION: HCC patients with low values of both AFP and PIVKA-II had more favorable clinical characteristics and showed a better prognosis than those with elevated levels of AFP or PIVKA-II.ope

Combination of preS deletions and A1762T/G1764A mutations in HBV subgenotype C2 increases the risk of developing HCC.

BACKGROUND: The interactions among hepatitis B virus (HBV) mutations in developing hepatocellular carcinoma (HCC) remain unclear and thus we investigated the risk of HCC related with single or multiple HBV mutations in Korean patients infected with HBV subgenotype C2. METHODS: From January 2003 to December 2008, HBV isolates from 135 patients with HCC were compared with those from 135 patients without HCC, matching for age, gender, and HBeAg status. The prevalence of preS deletions and G1896A and A1762T/G1764A mutations was evaluated. RESULTS: The frequency of preS deletions significantly differed between the non-HCC and HCC groups, with 6 (4.4%) versus 25 (18.5%) patients, respectively (p < 0.001). Additionally, the frequency of A1762T/G1764A mutations was higher in the HCC than the non-HCC group [82 (60.7%) versus 30 (22.2%), p < 0.001]. For combined mutations, the odds ratio (OR) was highest in patients with both preS deletions and the A1762T/G1764A mutation, with 1 (0.7%) versus 11 (8.1%) patients (p = 0.005; OR 11.887). CONCLUSIONS: HCC was associated with preS deletions and A1762T/G1764A mutations, and the combination of both mutations had a stronger association with HCC in Korean patients infected with HBV subgenotype C2.ope