Invasão microvascular no carcinoma hepatocelular : é possível predizer pelos parâmetros quantitativos da tomografia computadorizada?

To investigate whether quantitative computed tomography (CT) measurements can predict microvascular invasion (MVI) in hepatocellular carcinoma (HCC). This was a retrospective analysis of 200 cases of surgically proven HCCs in 125 consecutive patients evaluated between March 2010 and November 2017. We quantitatively measured regions of interest in lesions and adjacent areas of the liver on unenhanced CT scans, as well as in the arterial, portal venous, and equilibrium phases on contrast-enhanced CT scans. Enhancement profiles were analyzed and compared with histopathological references of MVI. Univariate and multivariate logistic regression analyses were used in order to evaluate CT parameters as potential predictors of MVI. Of the 200 HCCs, 77 (38.5%) showed evidence of MVI on histopathological analysis. There was no statistical difference between HCCs with MVI and those without, in terms of the percentage attenuation ratio in the portal venous phase (114.7 vs. 115.8) and equilibrium phase (126.7 vs. 128.2), as well as in terms of the relative washout ratio, also in the portal venous and equilibrium phases (15.0 vs. 8.2 and 31.4 vs. 26.3, respectively). Quantitative dynamic CT parameters measured in the preoperative period do not appear to correlate with MVI in HCC525287292O objetivo deste estudo foi investigar se parâmetros quantitativos da tomografia computadorizada (TC) podem predizer invasão microvascular (IMV) no carcinoma hepatocelular (CHC). Foram analisados, retrospectivamente, 200 CHCs comprovados de 125 pacientes submetidos consecutivamente a transplante ou ressecção hepática entre março/2010 e novembro/2017. Foram realizadas medidas quantitativas da densidade das lesões e do parênquima hepático adjacente pré-contraste e nas fases arterial, portal e de equilíbrio das TCs. Parâmetros de impregnação foram comparados com a presença de IMV nos laudos anatomopatológicos. Regressões logísticas univariadas e multivariadas foram utilizadas para avaliar os parâmetros da TC como potenciais preditores de IMV. Dos 200 CHCs, 77 (38,5%) tinham IMV no anatomopatológico. Não houve diferença estatística na razão de atenuação entre CHCs com IMV e os sem IMV na fase portal (114,7 para IMV positiva e 115,8 para IMV negativa) ou de equilíbrio (126,7 para IMV positiva e 128,2 para IMV negativa), nem na razão de washout relativa nas fases portal e de equilíbrio (15,0 para IMV positiva e 8,2 para IMV negativa na fase portal, e 31,4 para IMV positiva e 26,3 para IMV negativa na fase de equilíbrio

Evaluation And Comparison Of Microvessel Density Using The Markers Cd34 And Cd105 In Regenerative Nodules, Dysplastic Nodules And Hepatocellular Carcinoma

Purpose: The progression of hepatocellular carcinoma (HCC) is multifactorial and angiogenesis plays a fundamental role, mainly because HCC is a highly vascularized tumor. Methods: In this study, we determined microvessel density (MVD) using the immunohistochemical markers, CD34 and CD105 (Endoglin), in 44 hepatectomy specimens, encompassing 44 malignant nodules (HCC), 44 regenerative nodules (RN), and 15 dysplastic nodules (DN). The evaluation included the determination of MVD in all nodules. For statistical analysis, a descriptive analysis was carried out using measurements of position and dispersion for continuous variables; ANOVA was used to compare between groups, considering p < 0.05 as statistically significant. Results: We observed a significant difference when comparing CD34 and CD105 immunoexpression in HCC, DN, and RN. CD105 was predominantly expressed in the peripheral regions in HCC, with mean MVD scores of 6.2 ± 4.1 and 10.7 ± 4.4 at the center and periphery of the nodules, respectively, with significant differences between groups (p < 0.0001). CD34 had higher mean MVD scores than CD105 in HCC, with a more uniform positivity pattern. CD105 immunoexpression in DN exhibited a pattern similar to HCC. However, in RN, CD105 exhibited a higher MVD score in the central portion of the nodules. CD105 was expressed in a subset of newly formed microvessels in HCC and demonstrated an elevated mean MVD in cirrhotic or regenerative nodules. Conclusions: MVD determined by CD34 and CD105 expression may be used as an additional parameter to distinguish benign from malignant liver nodules. © 2014 Asian Pacific Association for the Study of the Liver.82260265Tsukuma, H., Hiyama, T., Tanaka, S., Nakao, M., Yabuuchi, T., Kitamura, T., Nakanishi, K., Kawashima, T., Risk factors for hepatocellular carcinoma among patients with chronic liver disease (1993) New England Journal of Medicine, 328 (25), pp. 1797-1801. , DOI 10.1056/NEJM199306243282501El-Serag, H.B., Rudolph, K.L., Hepatocellular Carcinoma: Epidemiology and Molecular Carcinogenesis (2007) Gastroenterology, 132 (7), pp. 2557-2576. , DOI 10.1053/j.gastro.2007.04.061, PII S0016508507007998Theise, N.D., Park, Y.N., Curado, M.P., Hepatocellular carcinoma (2010) WHO Classification of Tumours of the Digestive System, pp. 205-216. , Bosman FT, Carneiro F, Hruban RH, Theise ND, editors. Lyon: IARC PressTheise, N.D., Park, Y.N., Kojiro, M., Dysplastic nodules and hepatocarcinogenesis (2002) Clinics in Liver Disease, 6 (2), pp. 497-512. , DOI 10.1016/S1089-3261(02)00006-5, PII S1089326102000065Villanueva, A., Newell, P., Chiang, D.Y., Friedman, S.L., Llovet, J.M., Genomics and signaling pathways in hepatocellular carcinoma (2007) Semin Liver Dis, 27 (1), pp. 55-76Pang, R.W., Joh, J.W., Johnson, P.J., Monden, M., Pawlik, T.M., Poon, R.T., Biology of hepatocellular carcinoma (2008) Ann Surg Oncol, 15 (4), pp. 962-971Hytiroglou, P., Morphological Changes of Early Human Hepatocarcinogenesis (2004) Seminars in Liver Disease, 24 (1), pp. 65-75. , DOI 10.1055/s-2004-823097Park, Y.N., Yang, C.-P., Fernandez, G.J., Cubukcu, O., Thung, S.N., Theise, N.D., Neoangiogenesis and sinusoidal 'capillarization' in dysplastic nodules of the liver (1998) American Journal of Surgical Pathology, 22 (6), pp. 656-662. , DOI 10.1097/00000478-199806000-00002Semela, D., Dufour, J.-F., Angiogenesis and hepatocellular carcinoma (2004) Journal of Hepatology, 41 (5), pp. 864-880. , DOI 10.1016/j.jhep.2004.09.006, PII S0168827804003940Deli, G., Jin, C.-H., Mu, R., Yang, S., Liang, Y., Chen, D., Makuuchi, M., Immunohistochemical assessment of angiogenesis in hepatocellular carcinoma and surrounding cirrhotic liver tissues (2005) World Journal of Gastroenterology, 11 (7), pp. 960-963Terminology of nodular hepatocellular lesions (1995) Hepatology, 22 (3), pp. 983-993. , International Working PartyHytiroglou, P., Park, Y.N., Krinsky, G., Theise, N.D., Hepatic Precancerous Lesions and Small Hepatocellular Carcinoma (2007) Gastroenterology Clinics of North America, 36 (4), pp. 867-887. , DOI 10.1016/j.gtc.2007.08.010, PII S0889855307000817, Pathology and Clinical Relevance of Neoplastic Precursor Lesions of the Gastrointestinal Tract, Liver, and Pancreaticobiliary SystemPathologic diagnosis of early hepatocellular carcinoma: A report of the international consensus group for hepatocellular neoplasia (2009) Hepatology, 49 (2), pp. 658-664. , International Consensus Group for Hepatocellular NeoplasiaRoncalli, M., Borzio, M., Di Tommaso, L., Hepatocellular dysplastic nodules (2008) Ann Ital Chir, 79 (2), pp. 81-89Sakamoto, M., Effendi, K., Masugi, Y., Molecular diagnosis of multistage hepatocarcinogenesis (2010) Jpn J Clin Oncol, 40 (9), pp. 891-896Shiraha, H., Yamamoto, K., Namba, M., Human hepatocyte carcinogenesis (2013) Int J Oncol, 42 (4), pp. 1133-1138. , reviewFolkman, J., Tumor angiogenesis: Therapeutic implications (1971) N Engl J Med, 285 (21), pp. 1182-1186Folkman, J., Tumor angiogenesis (1985) Adv Cancer Res, 43, pp. 175-203Folkman, J., Shing, Y., Angiogenesis (1992) J Biol Chem, 267 (16), pp. 10931-10934Frachon, S., Gouysse, G., Dumortier, J., Couvelard, A., Nejjari, M., Mion, F., Berger, F., Scoazec, J.-Y., Endothelial cell marker expression in dysplastic lesions of the liver: An immunohistochemical study (2001) Journal of Hepatology, 34 (6), pp. 850-857. , DOI 10.1016/S0168-8278(01)00049-6, PII S0168827801000496Di, C.I., Fraggetta, F., Lombardo, R., Azzarello, G., Vasquez, E., Puleo, S., CD 34 expression in chronic and neoplastic liver diseases (2002) Panminerva Medica, 44 (4), pp. 365-367Yang, L., Lu, W., Huang, G., Wang, W., Correlation between CD105 expression and postoperative recurrence and metastasis of hepatocellular carcinoma (2006) BMC Cancer, 6, p. 110Nakamura, T., Changes in expression of bile canalicular CD10 and sinusoidal CD105 (endoglina) in peri-tumoral hepatic tissue (2009) Tumori, 95 (4), pp. 495-500Wang, Y., Zhang, X.H., Guo, P., Yan, L.N., He, D., Tumor microvascular density detected by anti-CD105 and anti-CD34 in hepatocellular carcinoma patients and its predictive value of tumor recurrence after liver transplantation (2010) Sichuan Da Xue Xue Bao Yi Xue Ban, 41 (5), pp. 818-882Ho, J.W., Poon, R.T., Sun, C.K., Xue, W.-C., Fan, S.-T., Clinicopathological and prognostic implications of endoglin (CD105) expression in hepatocellular carcinoma and its adjacent non-tumorous liver (2005) World Journal of Gastroenterology, 11 (2), pp. 176-181Yu, D., Zhuang, L., Sun, X., Chen, J., Yao, Y., Meng, K., Particular distribution and expression pattern of endoglin (CD105) in the liver of patients with hepatocellular carcinoma (2007) BMC Cancer, 7, p. 122Wang, Z.S., Wu, L.Q., Yi, X., Geng, C., Li, Y.J., Yao, R.Y., Connexin-43 can delay early recurrence and metastasis in patients with hepatitis B-related hepatocellular carcinoma and low serum alpha-feto-protein after radical hepatectomy (2013) BMC Cancer, 13 (1), p. 30

Hepatic Hemangioma Surgical Ressection - Indications And Results [indicações E Resultados Da Ressecção Cirúrigica Do Hemangioma Hepático]

Background: To present the results of the surgical treatment in patient bearers of hepatic hemangioma. Methods: We studied 20 patients with liver cavernous hemangioma, operated between February 1991 and February 2005. The patients ages ranged from 16 to 72 years (average of 42 years) with a predominance of female (80%), with 85% of them were symptomatic. All patients were undergoing abdominal ultrasonography (U.S.) and computed tomography contrasting (CT). It was used abdominal incision bilateral subcostal associated with the median incision. Results: During follow-up neither symptom recurrences occurred nor hepatic hemangiomas were detected. Post-operative morbidity included wound infection in one patient (5%), mild hepatic insufficiency in 40% and moderate hepatic insufficiency in 15% of patients. All recovered well and completely. Biliary leakage was diagnosed in one patient (5%) and external drainage was required. No mortality occurred in this series. Normal patient activities returned after the third post-operative month. 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