-
The American Journal of Case Reports Jun 2024BACKGROUND Orbital metastasis originating from hepatocellular carcinoma (HCC), particularly as an initial manifestation in patients without a known history of HCC, is... (Review)
Review
Orbital Metastasis as the First Manifestation of Hepatocellular Carcinoma, and Its Effective Treatment with Combined Dual Immunotherapy: A Case Report and Review of the Literature.
BACKGROUND Orbital metastasis originating from hepatocellular carcinoma (HCC), particularly as an initial manifestation in patients without a known history of HCC, is rare. Few reports exist on the treatment of patients having HCC with orbital metastasis using targeted therapy or immunotherapy. CASE REPORT We report a case of advanced-stage HCC in a 65-year-old man who first presented with progressive, painless blurred vision and proptosis of the right eye for 2 weeks. The patient had no history of chronic liver disease or cancer. Computed tomography revealed an enhancing hyperdense extraconal mass in the right orbit; a biopsy revealed metastatic HCC. Abdominal CT, which was performed to investigate the primary cancer, revealed a 1.2×1.6-cm arterial-enhancing nodule with venous washout in hepatic segment 5, associated with liver cirrhosis. The patient's serum alpha-fetoprotein level was 70.27 ng/dL. Chest computed tomography revealed lung metastasis. Thus, first-line systemic therapy combining durvalumab and tremelimumab was initiated alongside palliative radiotherapy targeting the right orbit, which began 1 week after the first dose of dual immunotherapy. The patient had significant clinical improvement, reduced proptosis, and serum alpha-fetoprotein levels. CONCLUSIONS Although orbital metastasis is a rare manifestation of HCC, physicians should recognize and consider aggressive investigations for early diagnosis, especially in patients with existing risk factors for HCC. Dual immunotherapy with durvalumab and tremelimumab in combination with radiotherapy can be considered a potential treatment option for managing advanced HCC with orbital metastasis.
Topics: Humans; Male; Carcinoma, Hepatocellular; Liver Neoplasms; Aged; Orbital Neoplasms; Antibodies, Monoclonal, Humanized; Antibodies, Monoclonal; Immunotherapy; Antineoplastic Combined Chemotherapy Protocols; Tomography, X-Ray Computed; Antineoplastic Agents, Immunological
PubMed: 38825807
DOI: 10.12659/AJCR.944002 -
Digestive Diseases and Sciences Jun 2024In many Asian hepatocellular carcinoma (HCC) guidelines, resection is an option for multiple HCCs. It is difficult to compare small but multiple tumors vs. fewer large...
BACKGROUND
In many Asian hepatocellular carcinoma (HCC) guidelines, resection is an option for multiple HCCs. It is difficult to compare small but multiple tumors vs. fewer large tumors in terms of the traditional tumor burden definition. We aimed to evaluate the role of liver resection for multiple HCCs and determine factors associated with survival benefits.
METHODS
We reviewed 160 patients with multiple HCCs who underwent liver resection between July 2003 and December 2018. The risk factors for tumor recurrence were assessed using Cox proportional hazards modeling, and survival was analyzed using the Kaplan-Meier method.
RESULTS
In all 160 patients, 133 (83.1%) exceeded the Milan criteria. Total tumor volume (TTV) > 275 cm and serum alpha-fetoprotein (AFP) level > 20 ng/mL were associated with disease-free survival. Patients beyond the Milan criteria were grouped into three risk categories: no risk (TTV ≤ 275 cm and AFP ≤ 20 ng/mL, n = 39), one risk (either TTV > 275 cm or AFP > 20 ng/mL, n = 76), and two risks (TTV > 275 cm and AFP > 20 ng/mL, n = 18). No-risk group had comparable disease-free survival (p = 0.269) and overall survival (p = 0.215) to patients who met the Milan criteria.
CONCLUSION
Patients with TTV ≤ 275 cm and AFP ≤ 20 ng/mL can have good outcomes even exceed the Milan criteria.
PubMed: 38824258
DOI: 10.1007/s10620-024-08500-y -
Discover Oncology May 2024Deficiency of citrin, the liver-type aspartate-glutamate carrier, arises from biallelic mutations of the gene SLC25A13. Although citrin deficiency (CD) is associated...
Deficiency of citrin, the liver-type aspartate-glutamate carrier, arises from biallelic mutations of the gene SLC25A13. Although citrin deficiency (CD) is associated with higher risk of hepatocellular carcinoma (HCC) in adult patients, this association remains inconclusive in pediatric cases. The patient in this paper had been diagnosed to have CD by SLC25A13 analysis at the age 10 months, and then in response to dietary therapy, her prolonged jaundice and marked hepatosplenomegaly resolved gradually. However, she was referred to the hospital once again due to recurrent abdominal distention for 2 weeks at her age 4 years and 9 months, when prominently enlarged liver and spleen were palpated, along with a strikingly elevated serum alpha-fetoprotein (AFP) level of 27605 ng/mL as well as a large mass in the right liver lobe and a suspected tumor thrombus within the portal vein on enhanced computed tomography. After 4 rounds of adjuvant chemotherapy, right hepatic lobectomy and portal venous embolectomy were performed at her age 5 years and 3 months, and metastatic hepatoblastoma was confirmed by histopathological analysis. Afterwards, the patient underwent 5 additional cycles of chemotherapy and her condition remained stable for 7 months after surgery. Unfortunately, hepatoblastoma recurred in the left lobe at the age 5 years and 10 months, which progressed rapidly into liver failure, and led to death at the age 6 years and 1 month. As far as we know, this is the the first case of hepatoblastoma in a patient with CD, raising the possibility of an association between these two conditions.
PubMed: 38819760
DOI: 10.1007/s12672-024-01059-0 -
Pediatric Surgery International May 2024Hepatocellular carcinoma (HCC), the second most common pediatric malignant liver tumor after hepatoblastoma, represents 1% of all pediatric tumors.
PURPOSE
Hepatocellular carcinoma (HCC), the second most common pediatric malignant liver tumor after hepatoblastoma, represents 1% of all pediatric tumors.
METHODS
A retrospective study was conducted on children with HCC treated at our center from March 2002 to October 2022, excluding those with inadequate follow-up or records. Demographic data, initial complaints, alpha-fetoprotein (AFP) values, underlying disease, size and histopathological features of the masses, chemotherapy, and long-term outcomes were analyzed.
RESULTS
Fifteen patients (8 boys, 7 girls) with a mean age of 11.4 ± 4.1 years (0.8-16.4 years) were analyzed. The majority presented with abdominal pain, with a median AFP of 3.9 ng/mL. Hepatitis B cirrhosis in one patient (6.6%) and metabolic disease (tyrosinemia type 1) in two patients (13.3%) were the underlying diseases. Histopathological diagnoses were fibrolamellar HCC (n:8; 53.3%), HCC (n:6; 40%). Four of the 15 patients underwent liver transplantation, and 9 underwent surgical resection. Due to late diagnosis, two patients were considered inoperable (13.3%). The survival rate for the four patients who underwent liver transplantation was found to be 75%.
CONCLUSION
Surgical treatment of various variants of HCC can be safely performed in experienced centers with a multidisciplinary approach, and outcomes are better than in adults.
Topics: Humans; Male; Liver Neoplasms; Carcinoma, Hepatocellular; Female; Retrospective Studies; Child; Adolescent; Child, Preschool; Liver Transplantation; Infant; Treatment Outcome; Hepatectomy; Survival Rate; Follow-Up Studies
PubMed: 38819667
DOI: 10.1007/s00383-024-05721-0 -
Cancer Medicine Jun 2024This study aims to investigate α-fetoprotein (AFP) trajectories for prediction of survival outcomes after hepatic arterial infusion chemotherapy (HAIC) treatment in...
AIM
This study aims to investigate α-fetoprotein (AFP) trajectories for prediction of survival outcomes after hepatic arterial infusion chemotherapy (HAIC) treatment in large hepatocellular carcinoma (HCC).
METHODS
From May 2014 to June 2020, 889 eligible patients with large HCC underwent HAIC were retrospectively enrolled from five hospitals. A latent class growth mixed (LCGM) model was applied to distinguish potential AFP level dynamic changing trajectories. Inverse-probability-of-treatment weighted (IPTW) analyses were performed to eliminate unmeasured confounders through marginal structural models. Multivariate Cox proportional hazard regression analyses were used to determine the overall survival (OS) in patients with large HCC. Performance of these serum markers for survival prediction was compared by areas under receiver operating characteristic analysis with the Delong test.
RESULTS
The median follow-up time was 23.7 (interquartile range, 3.8-115.3). A total of 1009 patients with large HCC, who underwent HAIC with AFP repeatedly measured 3-10 times, were enrolled in the study. Three distinct trajectories of these serum AFP were identified using the LCGM model: high stable (37.0%; n = 373), low stable (15.7%; n = 159), and sharp-falling (47.3%; n = 477). Multivariate Cox proportional hazard regression analyses found that ALBI stage 2-3, BCLC-C stage and high-stable AFP trajectories were associated with OS. AFP trajectories yield the optimal predictive performance in all risk factors.
CONCLUSIONS
The AFP trajectories based on longitudinal AFP change showed outstanding performance for predicting survival outcomes after HAIC treatment in large HCC, which provide a potential monitoring tool for improving clinical decision-making.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; alpha-Fetoproteins; Male; Female; Middle Aged; Infusions, Intra-Arterial; Retrospective Studies; Longitudinal Studies; Aged; Antineoplastic Combined Chemotherapy Protocols; Hepatic Artery; Biomarkers, Tumor; Treatment Outcome; Prognosis
PubMed: 38819606
DOI: 10.1002/cam4.7319 -
Indian Journal of Surgical Oncology May 2024Liver cancer is one of the most prevalent types of cancer and a major contributor to the socioeconomic burden worldwide. The pathogenesis of hepatocellular carcinoma... (Review)
Review
Liver cancer is one of the most prevalent types of cancer and a major contributor to the socioeconomic burden worldwide. The pathogenesis of hepatocellular carcinoma (HCC) is contributed by various etiological factors like virus infection, excessive alcohol consumption, exposure to toxins, or metabolic disorders. Majority of patients are diagnosed with late-stage HCC, which restricts its management to only palliative care. HCC, if diagnosed early, increases the survival and quality of life. Currently available biomarker (alpha-fetoproteins) have several limitations, that impede the early diagnosis and staging of cancer. This warrants the continous search in pursuit of a novel biomarker. Several research works in diverse areas have contributed to the identification of various novel biomarkers that have shown multifaceted application in early disease diagnosis, which further aid in targeted and effective therapy that can prevent cancer progression. This improves the overall health status of the patient along with significant reduction in caretaker's burden. With the aid of novel technologies, several biomarkers have been investigated and validated in mutliple preliminary research works. Therefore in this review, we have outlined various novel biomarkers that showed promising outcomes in their trials and we have highlighted the developing areas that act as game changers in cancer diagnosis and management.
PubMed: 38817995
DOI: 10.1007/s13193-023-01858-x -
Frontiers in Oncology 2024The study aimed to build and validate a competitive risk nomogram to predict the cumulative incidence of hepatocellular carcinoma (HCC) for patients with hepatitis B...
OBJECTIVE
The study aimed to build and validate a competitive risk nomogram to predict the cumulative incidence of hepatocellular carcinoma (HCC) for patients with hepatitis B virus (HBV)-related cirrhosis.
METHODS
A total of 1401 HBV-related cirrhosis patients were retrospectively enrolled from January 1, 2011 to December 31, 2014. Application of 20 times imputation dealt with missing data using multiple imputation by chained equations (MICE). The patients were randomly divided into a training set ( = 1017) and a validation set ( = 384) at a ratio of 3:1. A prediction study was carried out using a competing risk model, where the event of interest was HCC and the competing events were death and liver transplantation, and subdistribution hazard ratios (sHRs) with 95% CIs were reported. The multivariate competing risk model was constructed and validated.
RESULTS
There was a negligible difference between the original database and the 20 imputed datasets. At the end of follow-up, the median follow-up time was 69.9 months (interquartile range: 43.8-86.6). There were 31.5% (442/1401) of the patients who developed HCC, with a 5-year cumulative incidence of 22.9 (95%CI, 20.8%-25.2%). The univariate and multivariate competing risk regression and construction of the nomogram were performed in 20 imputed training datasets. Age, sex, antiviral therapy history, hepatitis B e antigen, alcohol drinking history, and alpha-fetoprotein levels were included in the nomogram. The area under receiver operating characteristic curve values at 12, 24, 36, 60, and 96 months were 0.68, 0.69, 0.70, 0.68, and 0.80, and the Brier scores were 0.30, 0.25, 0.23, 0.21, and 0.20 in the validation set. According to the cumulative incidence function, the nomogram effectively screened out high-risk HCC patients from low-risk patients in the presence of competing events (Fine-Gray test < 0.001).
CONCLUSION
The competitive risk nomogram was allowed to be used for predicting HCC risk in individual patients with liver cirrhosis, taking into account both the association between risk factors and HCC and the modifying effect of competition events on this association.
PubMed: 38817899
DOI: 10.3389/fonc.2024.1398968 -
Cureus Apr 2024Testicular cancer is among the most common solid tumors in young men. Gastrointestinal tract (GIT) metastasis of testicular cancer has been rarely reported. In addition,...
Testicular cancer is among the most common solid tumors in young men. Gastrointestinal tract (GIT) metastasis of testicular cancer has been rarely reported. In addition, metastasis occurs most commonly through retroperitoneal lymph nodes. Manifestations like abdominal pain and obstruction can be present if metastasis to GIT was considered. We report here a case of a 34-year-old male who was admitted to our GIT unit complaining of episodic epigastric pain. Computed Tomogram (CT) scan demonstrated a soft tissue like lesion involving the lumen of duodenum. Moreover, the patient had a right radical orchiectomy 18 months prior to the presentation due to a stage IA non-seminomatous germ cell tumor with no lymphovascular invasion and free surgical margins. Esophagogastroduodenoscopy (EGD) revealed a malignant appearing duodenal lesion and biopsy showed that it was compatible with germ cell tumor. Metastatic embryonal carcinoma to duodenum was diagnosed and confirmed by immunohistochemical stains. Then, the patient's situation was discussed and decided to be on a plan of four cycles of chemotherapy regimens. Testicular malignancy metastasis to GIT is uncommon, but it's important to know that there is a contact between GIT and testicular lymphatic drainage through para-aortic lymph nodes. So, even if it's rare to occur, it's still possible, and we should always be concerned about it. Mostly, diagnosis of testicular tumors begins with evaluating tumor markers such as alpha-fetoprotein (AFP), beta-subunit of human chorionic gonadotropin (B-hCG), and lactate dehydrogenase (LDH). But in contrast, all of these markers were within the normal range of their values in our case. Suspicion for metastasis and GIT involvement must be raised when dealing with a young male who had a history of testicular tumor such as embryonal carcinoma which was reported here in our case. That is very essential for avoiding potential complications and saving time in order to start management.
PubMed: 38817519
DOI: 10.7759/cureus.59332 -
Cureus Apr 2024Alpha-fetoprotein (AFP) is considered one of the best-known predictive serum markers, playing a crucial role in cancer investigation and subsequent treatment. In most...
Alpha-fetoprotein (AFP) is considered one of the best-known predictive serum markers, playing a crucial role in cancer investigation and subsequent treatment. In most adult cells, the production of this marker is suppressed after embryogenesis. However, its increased level raises concerns about underlying malignant conditions, which provide a valuable diagnostic tool for medical professionals in oncology. The existing AFP-producing adenocarcinomas exhibit unique clinical characteristics, including high malignancy and early metastatic potential, which result in poorer outcomes. To illustrate these characteristics, we decided to describe a case report of a 70-year-old African American female with a significantly elevated level of AFP. Further pathology results confirmed a duodenal adenocarcinoma versus adenocarcinoma from the pancreas. While AFP-producing adenocarcinoma has multiple underlying molecular mechanisms that correlate with poor prognosis, definitive treatment based on molecular pathways has yet to be defined. Therefore, further research is needed for new therapeutic modalities.
PubMed: 38817451
DOI: 10.7759/cureus.59384 -
Archives of Gynecology and Obstetrics May 2024To explore the association between the concentration of maternal serum biomarkers and the risk of fetal carrying chromosome copy number variants (CNVs).
OBJECTIVE
To explore the association between the concentration of maternal serum biomarkers and the risk of fetal carrying chromosome copy number variants (CNVs).
METHODS
Pregnant women identified as high risk in the second-trimester serological triple screening and underwent traditional amniotic fluid karyotype analysis, along with comparative genomic hybridization array (aCGH)/copy number variation sequencing (CNV-seq), were included in the study. We divided the concentration of serum biomarkers, free beta-human chorionic gonadotropin (fβ-hCG), alpha fetoprotein (AFP) and unconjugated estriol (uE3), into three levels: abnormally low, normal and abnormally high. The prevalence of abnormally low, normal and abnormally high serum fβ-hCG, AFP and uE3 levels in pregnant women with aberrant aCGH/CNV-seq results and normal controls was calculated.
RESULTS
Among the 2877 cases with high risk in the second-trimester serological triple screening, there were 98 chromosome abnormalities revealed by karyotype analysis, while 209 abnormalities were detected by aCGH/CNVseq (P<0.001) . The carrying rate of aberrant CNVs increased significantly when the maternal serum uE3 level was less than 0.4 multiple of median (MoM) of corresponding gestational weeks compared to normal controls, while the carrying rate of aberrant CNVs decreased significantly when the maternal serum fβ-hCG level was greater than 2.5 MoM compared to normal controls. No significant difference was found in the AFP group.
CONCLUSION
Low serum uE3 level (<0.4 MoM) was associated with an increased risk of aberrant CNVs.
PubMed: 38814455
DOI: 10.1007/s00404-024-07514-1