Multidisciplinary approach for HCC patients: hepatology for the oncologists

Hepatocellular carcinoma (HCC) is a complex and heterogeneous disease, often associated with underlying conditions, like cirrhosis or other relevant co-morbidities that worsen the prognosis and make the clinical management more challenging. Current recommendations emphasize the importance of a multidisciplinary approach for the management of HCC patients and stress the crucial role of careful prevention and the management of cirrhosis-associated complications. This article discusses the importance of a multidisciplinary approach in the treatment of HCC patients. Current recommendations for the treatment of cirrhotic patients with HCC are also reviewed

[Humoral and histological correlations in chronic aggressive hepatitis without necrotic bridges].

By excluding the CALD complicated by B.H.N. we have been left with a range of C.A.H. patterns hardly distinguishable from C.P.H. on one side and from Cirrhosis on the other. We have tried to subdivide this range into three subgroups according to the extension of necrosis, fibrosis, inflammation, regeneration. Furthermore, we compared the biochemical parameters of activity of these subgroups in which we subdivided C.A.H. without B.H.N. to each other and with those of C.P.H. and C.L.H. Results shaw no statistical significative difference in the compared groups. Thus, we conclude for a priority of the histological patterns on biochemical parameters in the management of this disease

Hepatitis A virus and non-A, non-B virus superinfections in HBsAg chronic carriers.

Clinical course, morphologic changes, immunohistochemical localization of HBV-associated markers (HBsAg, HBcAg), and serum HBV-DNA production are described in 2 chronic HBsAg carriers superinfected with HAV and hepatitis non-A, non-B virus. Our data suggest that the superinfections do not cause more severe disease and do not influence the clinical course of the HBsAg chronic carriers. Our observations indicate that a careful diagnosis of hepatocytolysis is necessary in HBV chronic infection, in order to discriminate causes that are able to induce severe damage in underlying disease

Type II mixed cryoglobulinaemia as an oligo rather than a mono B-cell disorder: evidence from GeneScan and MALDI-TOF analyses

Objective. To identify and characterize rheumatoid factor (RF)-producing B-cells and cryoprecipitate immunoglobulin (Ig) M in hepatitis C virus (HCV)-positive patients. Methods. We purified and characterized, by peptide mass fingerprinting integrated with an NCBI IgBlast data bank search, the IgM component of cryoprecipitate and analysed the VDJ pattern of bone marrow B-cells by gene scan analysis of 17 HCV-positive patients with type II mixed-cryoglobulinaemia. Results. IgM purified from all of the patients presented an RF specificity. In three of these patients a high and predominant B-cell clone (≥30%) was found in the bone marrow. B-cell-receptor sequences were determined and immunophenotyping of these clones was performed. Peptide masses originating after tryptic digestion of the B-cell-receptor combinatory regions and those originating by tryptic digestion of the cryoprecipitated IgM from the same patient were comparable. In the remaining patients an oligoclonal/polyclonality was found. However, in some of these patients we were able to find peptides that matched with the B-cell-receptor sequences of overexpanded B cells, indicating that, even in the absence of a clear monoclonal expansion, a fraction of total cryoprecipated IgM may derive from overexpanded B-cell clones found in patients' bone marrow. Conclusions. In the majority of mixed cryoglobulinaemia-HCV-positive patients, both in the serum and in B cells from the bone marrow, an oligoclonal pattern is the main molecular picture. When a monoclonal B-cell clone is found, its B-cell-receptor shows an antigen-binding fragment identical to that of cryoprecipitable RF-IgM. Phenotypically, B cells are CD20-positive but CD5-negative, suggesting that the B-1 B-cell subset is not likely to produce high-affinity IgM-RF molecules

HCV-NS3 and IgG-Fc crossreactive IgM in patients with type II mixed cryoglobulinemia and B-cell clonal proliferations

13nonenoneDE RE V; SANSONNO D; SIMULA M. P; CAGGIARI L; GASPAROTTO D; FABRIS M; TUCCI F. A; RACANELLI V; TALAMINI R; CAMPAGNOLO M; GEREMIA S.; DAMMACCO F; DE VITA SDE RE, V; Sansonno, D; SIMULA M., P; Caggiari, L; Gasparotto, D; Fabris, M; TUCCI F., A; Racanelli, V; Talamini, R; Campagnolo, M; Geremia, Silvano; Dammacco, F; DE VITA, S