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Fulltext Ultrasound and abdominal masses

Md Alif AK

Med J Malaysia, 1982 Mar;37(1):82-7.
PMID: 7121355
Matched MeSH terms: Liver Neoplasms/diagnosis
Fulltext Primary hepatic angiosarcoma: difficulty in clinical, radiological, and pathological diagnosis

Yang KF, Leow VM, Hasnan MN, Subramaniam MK

Med J Malaysia, 2012 Feb;67(1):127-8.
PMID: 22582567 MyJurnal

Hepatic angiosarcoma is a rare primary mesenchymal malignancy. Prognosis is poor and mortality occurs early. The diagnosis is challenging. Our case was an asymptomatic 70 year-old man referred, with incidental ultrasonography finding of multiple liver nodules. Diagnostic laparoscopic liver biopsy and the histopathological examination reported a haemangioma. Six months later, he became symptomatic and his health condition deteriorated rapidly.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Fulltext Screening for hepatocellular carcinoma

Merican I

Med J Malaysia, 1996 Mar;51(1):12-7.
PMID: 10967973

Hepatocellular carcinoma (HCC) is one of the commonest cancers in Asian males. In Malaysia, it is one of the ten most common cancers amongst the male population. Most of our patients with HCC present to us rather late and almost all die within 4 months of diagnosis. HCC occurs more commonly in patients with cirrhosis associated with hepatitis B and C infections. Screening for HCC can lead to early detection of small tumours (< 5 cm) that are more amenable to surgical resection, resulting in improved survival rates. The average 5-year survival rate for those who have undergone surgical resection is 68% (range, 22-73%). Better results are obtained with the smaller tumours (< 2 cm in diameter). Patients with chronic hepatitis B and C infection especially those who are > 45 years of age, who have concomitant cirrhosis or have a family history of HCC should be examined every 3-6 months with periodic serum alpha-fetoprotein (AFP) measurements and abdominal ultrasound examinations. Abdominal ultrasound is useful in the detection of small tumours. While mass screening for HCC is not cost-effective in countries of low incidence of HCC, screening of high risk groups may be justified in countries with a high endemicity of HBV infection. Screening for HCC in Japan, Taiwan and China appears to yield better results than those in the West. Nonetheless, primary prevention with mass hepatitis B vaccination and blood donor screening for anti-HCV is expected to make a much greater impact in the control of HCC in the years to come.

Matched MeSH terms: Liver Neoplasms/diagnosis*
CAHECA: computer aided hepatocellular carcinoma therapy planning

Adeshina AM, Hashim R, Khalid NE

Interdiscip Sci, 2014 Sep;6(3):222-34.
PMID: 25205500 DOI: 10.1007/s12539-013-0204-7

Hepatocellular Carcinoma is the most common type of liver cancer having a strong relation with cirrhosis. Undoubtedly, cirrhosis may be caused by the virus infection of hepatitis B (HBV) and hepatitis C (HBC) or through alchoholism. However, even when cirrhosis has not been developed, patients with hepatitis viral infections are still at the risk of liver cancer. Apparently, among the numerous medical imaging techniques, Computed Tomography (CT) is the best in defining liver tumor borders. Unfortunately, these imaging techniques, including the CT procedures, usually rely on an appended application to reconstruct the generated 2-D slices to 3-D model. This may involve high performance computation, may be time-consuming or costly. Moreover, even with the outstanding performances of CT in defining the liver tumor boundaries, contrast between tumor tissues and the surrounding liver parenchyma is too low in CT slices. With such a close proxity in the tumor and the surrounding liver tissues, accurate characterization of liver tumor is a challenge. Previously, algorithms were developed to reveal abnormalities in brain's MRI datasets and CT abdominal pelvic, however, introducing a framework that could accurately characterize liver tumor and its surrounding tissues in CT datasets would go a long way in contributing to medical diagnosis and therapy planning of Hepatocellular Carcinoma. This paper proposes an Hepatocellular Carcinoma framework by extending the functionalities of SurLens Visualization System with an automatic liver tumor localization technique using Compute Unified Device Architecture (CUDA). The study was evaluated with liver CT datasets from the Imaging Science and Information Systems (ISIS) Center, the Georgetown University Medical Center. Significantly, visualization of liver CT datasets and the localization of the entangled tumor was achieved without prior datasets segmentation. Interestingly, the framework achieved remarkably good processing speed at a reasonably cheaper cost with an immediate reconstruction of the datasets and mapping of the tumor tissues within the surrounding liver parenchyma.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Fulltext Computer-linked image analysis of nuclear area: is there a use in diagnosis and grading of hepatocellular carcinoma?

Cheah PL, Looi LM

Malays J Pathol, 2007 Jun;29(1):37-40.
PMID: 19105327 MyJurnal

Hepatocellular carcinoma (HCC) ranks as the fifth most common cancer with an increasing frequency worldwide. "Nuclear atypia", one of the critical features in histological diagnosis of malignancy and grading of the tumour, is generally ascertained through eyeballing. A study was conducted at the Department of Pathology, University of Malaya Medical Centre to assess whether nuclear area, (surrogate measure for nuclear size) and standard deviation (surrogate measure for nuclear pleomorphism) when objectively measured via computer-linked image analysis differs between (1) benign and malignant liver cells and (2) different grades of HCC. A 4-microm thick H&E stained section of 52 histologically re-confirmed HCC with 36 having benign, non-dysplastic surrounding liver were analysed using the Leica Q550 CW system. 10 consecutive non-overlapping, non-mitotic and non-apoptotic nuclei of HCC and surrounding benign hepatocytes respectively were manually traced at 400x magnification on the computer monitor and the nuclear area for the particular cell computed in arbitrary units by the Leica QWIN software. A total of 360 benign hepatocytic nuclei, 240 low grade HCC and 280 high grade HCC nuclei were traced. The mean nuclear area of the benign hepatocytes (37.3) was significantly smaller (p < 0.05) than that of both low grade (65.2) and high grade HCC (80.0). In addition, the mean nuclear area of high grade HCC was significantly larger (p < 0.05) than the low grade HCC. SD of the nuclear areas was lowest in benign hepatocytes (9.3), intermediate in low grade HCC (25.0) and highest in high grade HCC (25.6). These findings indicate that computer-linked nuclear measurement may be a useful adjunct in differentiating benign from malignant hepatocytes, in particular in small biopsies of well-differentiated tumours, and in predicting survival after surgical resection and transplant.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Caecal tumour with hepatic metastases?

Rajendra S, Kutty K

Gut, 2005 Feb;54(2):178, 200.
PMID: 15647173
Matched MeSH terms: Liver Neoplasms/diagnosis
Combined cytological and histological diagnosis of hepatocellular carcinoma in ultrasonically guided fine needle biopsy specimens

Zainol H, Sumithran E

Histopathology, 1993 Jun;22(6):581-6.
PMID: 7689070

This study evaluates the usefulness of a combined cytological and histological approach to the diagnosis of hepatocellular carcinoma (HCC) when applied to fine needle biopsy specimens obtained under ultrasonic guidance. The material, aspirated from 51 focal liver lesions, was handled in such a way that there was sufficient material for both cytological and histological (cell block) assessment. Of the 29 cases of HCC studied, a confident cytological diagnosis was made in 23 (79%). In the remaining six cases, the cytological features were considered to be suspicious but not diagnostic of HCC. Examination of cell blocks in the six cases enabled a confident diagnosis of HCC to be made in all cases. This was due to the supplementary visual information provided by the histological features, particularly the pattern of arrangement of the tumour cells.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Diffuse hepatic haemangiomatosis: A case report and review of literature

Rao R, Naidu J, Muhammad Nawawi KN, Wong ZQ, Ngiu CS, Mohammed F, et al.

Med J Malaysia, 2018 12;73(6):436-438.
PMID: 30647226

Hepatic haemangioma is a solitary liver lesion and prevalent among the female patients. We report a case of diffuse hepatic haemangiomatosis in a 62-year-old man, who was referred for an incidental finding of multiple liver nodules. History and physical examinations were unremarkable. Computed tomography and magnetic resonance imaging of the liver were performed and showed multiple haemangiomatosis. In view of the rarity of this condition in men, a liver biopsy was done and confirmed haemangiomas. Available published literature on diffuse hepatic haemangiomatosis was reviewed.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Silica nanoparticle assists determining liver cancer gene sequence on interdigitated electrode surface

Song F, Yang Y, Gopinath SCB

Biotechnol Appl Biochem, 2021 Jun;68(3):683-689.
PMID: 32628799 DOI: 10.1002/bab.1980

A high-performance interdigitated electrode (IDE) biosensing surface was reported here by utilizing self-assembled silica nanoparticle (SiNP). The modified surface was used to evaluate the complementation of hairpin forming region from Mitoxantrone resistance gene 7 (MXR7; liver cancer-related short gene). The conjugated SiNPs on 3-aminopropyl triethoxysilane functionalization were captured with probe sequence on IDE biosensing surface. The physical and chemically modified surface was used to quantify MXR7 and an increment in the current response upon complementation was noticed. Limit of target DNA detection was calculated (1-10 fM) and this label-free detection is at the comparable level to the fluorescent-based sensing. A linear regression was calculated [y = 0.243x - 0.0773; R² = 0.9336] and the sensitivity was 1 fM on the linear range of 1 fM to 10 pM. With the strong attachment of capture DNA on IDE through SiNP, the surface clearly discriminates the specificity (complementary) versus nonspecificity (complete-, single-, and triple-mismatched sequences). This detection strategy helps to determine liver cancer progression and the similar strategy can be followed for other gene sequence complementation.

Matched MeSH terms: Liver Neoplasms/diagnosis
Primary carcinoma of liver

Islam N, Hasan M, Ali SM

Med J Malaysia, 1977 Jun;31(4):322-5.
PMID: 927240
Matched MeSH terms: Liver Neoplasms/diagnosis*
Solid pseudopapillary neoplasm of the pancreas with liver metastasis initially misinterpreted as benign haemorrhagic cyst

Jung MJ, Kim HK, Choi SY, Kim SG, Jin SY

Malays J Pathol, 2017 Dec;39(3):327-330.
PMID: 29279599

Solid pseudopapillary neoplasm (SPN) of the pancreas is considered a low-malignant neoplasm with a good prognosis. However, 5% to 15% of patients with SPNs develop metastatic disease, most commonly in the liver. Metastatic hepatic malignancies that show pseudocystic features are rare. Here we describe the case of a middle-aged female with a cystic liver metastasis from SPN. To the best of our knowledge, SPN with a single cystic liver metastasis has not been described, although these tumours frequently undergo haemorrhagic-cystic degeneration. Thus, in these patients the marked cystic change could be misinterpreted as a benign lesion.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Fulltext Robot-assisted radiofrequency ablation of primary and secondary liver tumours: early experience

Abdullah BJ, Yeong CH, Goh KL, Yoong BK, Ho GF, Yim CC, et al.

Eur Radiol, 2014 Jan;24(1):79-85.
PMID: 23928933 DOI: 10.1007/s00330-013-2979-7

OBJECTIVE: Computed tomography (CT)-compatible robots, both commercial and research-based, have been developed with the intention of increasing the accuracy of needle placement and potentially improving the outcomes of therapies in addition to reducing clinical staff and patient exposure to radiation during CT fluoroscopy. In the case of highly inaccessible lesions that require multiple plane angulations, robotically assisted needles may improve biopsy access and targeted drug delivery therapy by avoidance of the straight line path of normal linear needles.
METHODS: We report our preliminary experience of performing radiofrequency ablation of the liver using a robotic-assisted CT guidance system on 11 patients (17 lesions).
RESULTS/CONCLUSION: Robotic-assisted planning and needle placement appears to have high accuracy, is technically easier than the non-robotic-assisted procedure, and involves a significantly lower radiation dose to both patient and support staff.
KEY POINTS: • An early experience of robotic-assisted radiofrequency ablation is reported • Robotic-assisted RFA improves accuracy of hepatic lesion targeting • Robotic-assisted RFA makes the procedure technically easier with significant lower radiation dose.

Matched MeSH terms: Liver Neoplasms/diagnosis
The value of liver function tests in hepatocellular carcinoma

Lopez JB, Balasegaram M, Thambyrajah V, Timor J

Malays J Pathol, 1996 Dec;18(2):95-9.
PMID: 10879229

This study was undertaken to see if liver function tests (LFT) served a worthwhile purpose in the investigation of hepatocellular carcinoma (HCC). Sera from 80 HCC, 76 benign liver disease (BLD) and 152 healthy adult (HA) subjects were assayed for alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), aspartate aminotransferase (AST), alanine aminotransferase and lactate dehydrogenase, bilirubin and albumin. Cut-off values were determined from the HA. ALP, GGT, AST and albumin were abnormal in about 90% of the HCC. With the exception of bilirubin, the LFT were abnormal more frequently in HCC than in chronic hepatitis and cirrhosis, the conditions which preceed it. Raised ALP in the presence of normal bilirubin was more often a feature of HCC than BLD although this relationship was not statistically significant. It seems unlikely that LFT serve a useful function in HCC.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Fulltext Glypican-3 is useful but not superior to Hep Par 1 in differentiating hepatocellular carcinoma from other liver tumours

Pour AM, Masir N, Rose IM

Malays J Pathol, 2016 Dec;38(3):229-233.
PMID: 28028292 MyJurnal

To assess the diagnostic utility of glypican-3 (GPC-3) in comparison to Hep Par 1 in the diagnosis of liver tumours, a cross-sectional study involving 66 resected liver tumours were tested for the protein expression of these markers by immunohistochemistry using monoclonal antibodies. Of the 66 cases, 26 (39.4%) were hepatocellular carcinoma (HCC), 4 (6.1%) were intrahepatic cholangiocarcinoma and 36 (54.5%) were metastatic tumours. Hep Par 1 and GPC-3 expressions in HCC were 24/26 (92.3%) and 19/26 (73.1%) respectively. In contrast, of non-HCC cases, only 2/40 cases (5.0%) expressed Hep Par 1, including a metastatic colorectal adenocarcinoma and a metastatic gastric adenocarcinoma. GPC-3 was expressed in 3/40 cases (7.5%), i.e. a metastatic adenocarcinoma of unknown origin, a metastatic gastric adenocarcinoma and an intrahepatic cholangiocarcinoma. The sensitivity and specificity for Hep Par 1 were 92.3% and 95% respectively while that of GPC-3 was 73.1% and 92.5% respectively. GPC-3 is a useful marker in the diagnosis of HCC. However it is not superior to Hep Par 1 in its sensitivity and specificity. We recommend that it is utilized together with Hep Par 1 as a panel in the diagnosis of HCC.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Cullen and Grey Turner signs in abdominal pain

Chuah YY, Lee YY

Med J Aust, 2021 03;214(4):164.
PMID: 33458825 DOI: 10.5694/mja2.50924
Matched MeSH terms: Liver Neoplasms/diagnosis*
Fulltext Metabolic perturbations prior to hepatocellular carcinoma diagnosis: Findings from a prospective observational cohort study

Stepien M, Keski-Rahkonen P, Kiss A, Robinot N, Duarte-Salles T, Murphy N, et al.

Int J Cancer, 2021 Feb 01;148(3):609-625.
PMID: 32734650 DOI: 10.1002/ijc.33236

Hepatocellular carcinoma (HCC) development entails changes in liver metabolism. Current knowledge on metabolic perturbations in HCC is derived mostly from case-control designs, with sparse information from prospective cohorts. Our objective was to apply comprehensive metabolite profiling to detect metabolites whose serum concentrations are associated with HCC development, using biological samples from within the prospective European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (>520 000 participants), where we identified 129 HCC cases matched 1:1 to controls. We conducted high-resolution untargeted liquid chromatography-mass spectrometry-based metabolomics on serum samples collected at recruitment prior to cancer diagnosis. Multivariable conditional logistic regression was applied controlling for dietary habits, alcohol consumption, smoking, body size, hepatitis infection and liver dysfunction. Corrections for multiple comparisons were applied. Of 9206 molecular features detected, 220 discriminated HCC cases from controls. Detailed feature annotation revealed 92 metabolites associated with HCC risk, of which 14 were unambiguously identified using pure reference standards. Positive HCC-risk associations were observed for N1-acetylspermidine, isatin, p-hydroxyphenyllactic acid, tyrosine, sphingosine, l,l-cyclo(leucylprolyl), glycochenodeoxycholic acid, glycocholic acid and 7-methylguanine. Inverse risk associations were observed for retinol, dehydroepiandrosterone sulfate, glycerophosphocholine, γ-carboxyethyl hydroxychroman and creatine. Discernible differences for these metabolites were observed between cases and controls up to 10 years prior to diagnosis. Our observations highlight the diversity of metabolic perturbations involved in HCC development and replicate previous observations (metabolism of bile acids, amino acids and phospholipids) made in Asian and Scandinavian populations. These findings emphasize the role of metabolic pathways associated with steroid metabolism and immunity and specific dietary and environmental exposures in HCC development.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Expression of interleukin-18, interferon-gamma and interleukin-10 in hepatocellular carcinoma

Chia CS, Ban K, Ithnin H, Singh H, Krishnan R, Mokhtar S, et al.

Immunol Lett, 2002 Dec 03;84(3):163-72.
PMID: 12413732

This is the first report on the detection of IL-18, IFN-gamma and IL-10 proteins in hepatocelllular carcinoma. In the apparently normal surrounding tissue, 13 out of 17 paired specimens showed positive immunoreactivity to IL-18 (76.5%) compared with six out of 17 in the tumour portion (35.3% of specimens). Thus, a significantly higher number of IL-18 positive specimens was found in the hepatocytes of apparently normal surrounding tissue compared with the tumour (P=0.018). In contrast, the number of specimens with positive immunoreactivity to the antibody against the Th1 cytokine, IFN-gamma expression in the hepatocytes was lower. Only one specimen from the apparently normal surrounding tissue (one out of 17; 5.9%) and three other specimens from the tumour portion (three out of 17; 17.6%) had positive immunoreactivity. Similarly, the expression of the Th2 cytokine, IL-10 in normal (four out of 17; 23.5%) and tumour portions (five out of 17; 29.4%) was also low. Thus, there did not appear to be predominant Th2 immune response as denoted by IL-10 expression. Using the Spearman correlation rank test, a significant correlation between IL-18 expression in the apparently normal surrounding tissue and high alpha-foetoprotein (AFP) levels of >350 IU/l. No correlation between IL-18 expression in the tumour portion and clinicopathological factors was found. There was also no correlation found between IL-18 and the other cytokines, namely, IFN-gamma and IL-10 expression These new findings provide additional information on the type of cytokines expressed in the tumour microenvironment and give a further insight into the role of cytokines in the pathogenesis of cancer which is critical for the development of effective immunotherapeutic approaches for cancer therapy in the future.

Matched MeSH terms: Liver Neoplasms/diagnosis
Fulltext Combined assessment of TGF-beta-1 and alpha-fetoprotein values improves specificity in the diagnosis of hepatocellular carcinoma and other chronic liver diseases in Malaysia

Yasmin Anum MY, Looi ML, Nor Aini AH, Merican I, Wahidah A, Mohd Radzi AH, et al.

Med J Malaysia, 2009 Sep;64(3):223-7.
PMID: 20527273 MyJurnal

Transforming growth factor beta-1 (TGF-beta-1) is a multifunctional cytokine involved in the regulation of growth and differentiation of both normal and transformed cells. The main aim of this study was to determine whether TGF-beta-1 or alpha fetoprotein (AFP) or the combination of the two is a better indicator for hepatocellularcarcinoma (HCC). Serum TGF-beta-1 and AFP were measured by ELISA in 40 healthy subjects, 23 patients with hepatocellular carcinoma (HCC), 70 patients with hepatitis B, 26 patients with hepatitis C and 16 patients with liver cirrhosis (LC). Patients with liver diseases showed significantly higher serum TGF-beta-1 values (> 3 fold) compared to control subjects. As for serum AFP, significant elevation was only observed for HCC cases. Serum TGF-beta-1 exhibited higher percent sensitivity compared to serum AFP in all liver diseases. Combination of serum TGF-beta-1 and AFP increased specificities in all cases studied. In conclusion, serum TGF-beta-1 is a more sensitive marker for HCC when compared to serum AFP and its specificity is increased when combined with serum AFP.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Fulltext The utility of hepatocyte paraffin 1 antibody in the immunohistological distinction of hepatocellular carcinoma from cholangiocarcinoma and metastatic carcinoma

Shiran MS, Isa MR, Mohd Sidik S, Rampal L, Hairuszah I, Sabariah AR

Malays J Pathol, 2006 Dec;28(2):87-92.
PMID: 18376797 MyJurnal

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and its diagnosis on routine stains is usually straightforward, except in some cases where there may be difficulty in distinguishing HCCs from metastatic carcinomas (MC) and cholangiocarcinomas (CC). Hepatocyte Paraffin 1 antibody (Hep Par 1) is a new monoclonal antibody which reacts with normal and neoplastic hepatocytes, and this study aims to determine its specificity and sensitivity in distinguishing hepatocellular carcinoma (HCC) from cholangiocarcinoma (CC) and metastatic carcinomas (MC). Hep Par 1 antibody was applied to 28 cases of HCC, 22 cases of MC from varying sites and 8 CCs, and produced a strong, diffuse, granular, cytoplasmic staining of all benign hepatocytes. 23 out of 28 cases of HCC showed heterogeneously positive staining for Hep Par 1 irrespective of their degree of differentiation, while 2 out of 8 cases of cholangiocarcinoma were positive for Hep Par 1, and all 22 cases of metastatic carcinoma were negative. The sensitivity and specificity of Hep Par 1 for HCC was 82.1% and 93.3% respectively; whereby the antibody was noted to show occasional false positivity in cases of cholangiocarcinoma and non-neoplastic bowel mucosa, while its variable staining in HCC produced false negative results in some small biopsies. Thus, Hep Par 1 should be used in a panel with other antibodies to obtain useful information in distinguishing HCC from CC and MC.

Matched MeSH terms: Liver Neoplasms/diagnosis*
Malignant transformation of mesenchymal hamartoma of the liver: case report and review of the literature

Ramanujam TM, Ramesh JC, Goh DW, Wong KT, Ariffin WA, Kumar G, et al.

J Pediatr Surg, 1999 Nov;34(11):1684-6.
PMID: 10591570

Here the first case in the literature of both mesenchymal hamartoma and malignant mesenchymoma occurring in a 6-year-old male child, at different times and at different sites in the liver, and also the possible malignant transformation of a mesenchymal hamartoma is reported. The tumor developed from a lesion in the right lobe that was overlooked initially during a left lateral segmentectomy at 18 months of age for a mesenchymal hamartoma. Malignant mesenchymoma is a rare and aggressive tumor. The origin of this tumor is not well understood. There has been no direct support to the hypothesis that malignant mesenchymoma may be the malignant counterpart of mesenchymal hamartoma. The authors provide clinical and histopathologic evidence in our case that suggests the possibility of malignant mesenchymoma arising from a mesenchymal hamartoma. This case emphasizes the need for complete removal of mesenchymal hamartoma and the need for long-term follow-up to detect multifocal lesion or malignant transformation.

Matched MeSH terms: Liver Neoplasms/diagnosis

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