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Three patients aged 79, 75, and 81 years with unresectable hepatocellular carcinoma (HCC) and undergoing maintenance hemodialysis were treated with a combination of atezolizumab and bevacizumab. The patients, respectively, received their 22nd, 2nd, and 4th treatment cycles, and one achieved long-term stable disease. No serious adverse events, including immune-related adverse events, were observed in any patient. Remarkable progress has been made in chemotherapy for cancer; however, the efficacy and safety of chemotherapy in patients undergoing hemodialysis have not been adequately elucidated. This report provides novel insights into the feasibility and outcomes of atezolizumab and bevacizumab combination therapy in patients with HCC undergoing hemodialysis, highlighting its potential as a viable treatment option with manageable side effects., (© 2024. Japanese Society of Gastroenterology.)

Background: There is increasing evidence that the presence of an ongoing systemic inflammatory response, especially a high preoperative neutrophil-to-lymphocyte ratio (NLR), is associated with a poor outcome for a variety of common solid tumors. However, few studies have investigated the clinical value of the NLR in patients undergoing gastroenterostomy for advanced pancreatic cancer., Methods: A total of 83 patients who had symptoms of gastric outlet obstruction due to advanced pancreatic cancer and underwent gastroenterostomy were analyzed. The prognostic significance of the NLR was analyzed. The relationship between the NLR value and postoperative outcome was also evaluated., Results: The median survival time was 9.4 months in patients with an NLR of <4, whereas it was 3.4 months in patients with an NLR of ≥4 (P < 0.001). The multivariate analysis revealed that an NLR of ≥4, the presence of liver metastases, daily pain, and lack of postoperative chemotherapy were significant prognostic factors. A higher NLR was associated with postoperative morbidity; 13 % of patients with an NLR of <4 and 36 % of those with an NLR of ≥4 (P = 0.012) developed morbidities. With regard to quality of life, 96 % of patients with an NLR of <4 and 36 % of patients with an NLR of ≥4 had adequate oral intake of solid food without any support with intravenous nutrition for at least 1 month after surgery (P < 0.001)., Conclusions: The preoperative NLR offers important prognostic information for patients who have gastric outlet obstruction due to advanced pancreatic adenocarcinoma.

Many advances have been made in the characterisation of primary liver tumours in humans, in particular relating to the identification and role of hepatic progenitor cells, resulting in a new classification. The aim of the present study was to investigate the presence and relative frequency of morphological types of canine primary hepatic neoplasms and to determine whether a classification similar to the human scheme can be applied to these canine neoplasms. Canine primary liver tumours (n=106) were examined histologically and with the immunohistochemical markers keratin 19, HepPar-1, epithelial membrane antigen/mucin-1, CD10, neuron-specific enolase and chromogranin-A. Eleven nodular hyperplasias and 82 tumours of hepatocellular origin were diagnosed. The latter were subdivided in hepatocellular tumours with 0-5% positivity for K19 (n=62), which were well differentiated and had no evidence of metastasis, tumours with >5% positivity for K19 (n=17), which were poorly differentiated and had intrahepatic and/or distant metastasis, and a scirrhous subgroup (n=3) with an intermediate position with regard to K19 staining and malignancy. Ten cholangiocellular tumours (nine cholangiocellular carcinomas and one cholangiolocarcinoma) were diagnosed and all had intrahepatic and/or distant metastases. Three neuroendocrine carcinomas were also diagnosed. Histopathological and immunohistochemical examination of canine primary hepatic neoplasms can differentiate hepatocellular, cholangiocellular and neuroendocrine tumours, in accordance with the most recent human classification system., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

A57 years old man with gastric cancer underwent distal gastrectomy (pT3N1M0, pStage II B). Three months after gastric resection, he was admitted to our hospital because of acute right dorsal pain. Abdominal computed tomography showed multiple liver tumors with subcapsular hemorrhage. He was diagnosed as multiple liver metastases from gastric cancer. We judged liver tumors to be unresectable and decided to start systemic chemotherapy with S-1 and cisplatin (CDDP) because he was hemodynamically stable. After 8 courses of chemotherapy, the liver tumors were markedly reduced and judged as clinical partial response. Left hepatectomy and S5, S6, S7 partial hepatectomy for liver metastasis was performed. Histopathological examination of the resected specimen revealed no cancer cell in the liver, suggesting a pathologically complete response. We consider that systemic chemotherapy is one of the effective treatments for unresectable liver metastasis with subcapsular hemorrhage from gastric metastasis.

Background: Studies have previously indicated that surgical outcomes are poorer for obese patients. To date, few reports concerning the effect of obesity on patient outcomes following a hepatectomy for hepatocellular carcinoma (HCC) have been published. The present study, therefore, sought to determine the impact of patients' body mass index (BMI, kg/m(2)) on short- and long-term surgical outcomes and to identify potential prognostic factors for HCC following a hepatectomy., Methods: Patient data was retrospectively collected from 181 consecutive patients between September 2002 and August 2007 who had undergone hepatectomy for HCC with curative intent. Patients were assigned to three groups according to their BMI (low <18.5, standard 18.5-25, and high >25), and the clinical and pathological data, surgical outcome, and long-term survival were analyzed and compared between the three groups., Results: The overall survival rate of the low BMI group was notably below that of the standard group. Surgical outcomes were not significantly different between the three groups. Multivariate analysis revealed that a low BMI (<18.5) is a predictor of unfavorable prognosis., Conclusions: The present study suggests that a low BMI is a significant prognostic factor for low overall survival when performing a hepatectomy for HCC.

Little information is available on the relationship between computed tomography (CT) imaging findings and the pathologic diagnosis of canine hepatic tumors. Our purpose was to clarify the characteristic features of CT findings in liver tumors in dogs. Data from 33 dogs with either a hepatocellular carcinoma, n = 14, hepatocellular adenoma, n = 14, or nodular hyperplasia, n = 5 were summarized from medical records. CT features for each histologic diagnosis were characterized and analyzed statistically. Common findings in hepatocellular carcinoma included central (79%, P = 0.0030) and marginal enhancement (93%, P = 0.00043) in the arterial phase, cyst-like lesions (93%), capsule formation (93%), and hypoattenuation in the portal (86%), and equilibrium phases (93%). Hepatic adenoma was characterized by a characteristic diffuse enhancement pattern during the arterial phase (57%, P = 0.013), which was also found in nodular hyperplasia (60%), but never in hepatocellular carcinoma. Nodular hyperplasia was less likely to have a capsule structure (20%, P = 0.0087). Mass size was significantly smaller in nodular hyperplasia than in hepatocellular carcinoma and hepatic adenoma (P = 0.0033 and 0.038, respectively). Hyperattenuation in the arterial and the portal phase i.e. contrast retention, was more frequent in hepatic adenoma than in the other groups (P = 0.037 and 0.037, respectively). Nodular hyperplasia was more frequently isoattenuating in the equilibrium phase (P = 0.043)., (© 2012 Veterinary Radiology & Ultrasound.)

We report a case of hepatocellular adenoma, focusing on the findings of liver-specific contrast agent-enhanced magnetic resonance imaging (MRI) and ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET). The patient was a 37-year-old woman, referred to us after contrast-enhanced computed tomography showed a homogeneous, poorly enhanced liver tumor, 2.8 cm in diameter. Magnetic resonance imaging showed a liver mass with significant fatty change. The tumor increased in size to 3.3 cm over 9 months of follow-up. Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI revealed spotty enhancement in the hypointense tumor in the hepatobiliary phase. Subsequent FDG-PET showed increased uptake of FDG (maximum standardized uptake value 5.0), which suggested the possibility of malignancy. The patient underwent partial hepatectomy, and histological examination of the resected specimen revealed a tumor composed of hepatocyte-like cells with minimal cellular atypia and significant diffuse fatty change. Based on these findings, we diagnosed hepatocellular adenoma.

Contrast-enhanced ultrasound using Sonazoid, a novel contrast medium with a liver-specific Kupffer phase, was evaluated in canine focal liver lesions Twenty-five dogs with a liver mass were given intravenous Sonazoid, and the enhancement pattern in the arterial, portal, and parenchymal phase was characterized. An enhancement defect in the lesion in the parenchymal phase was observed in all malignant lesions, whereas only one of nine benign lesions had a filling defect. The diagnostic value of the presence of a filling defect for malignancy was statistically significant (100% sensitivity, 88.9% specificity, 94.1% positive predictive value, 100% negative predictive value), and was equal to that of hypoenhancement in the portal or delayed phase. The defect pattern (clear or irregular defect) was dependent (P < 0.05) on the types of malignancy (i.e., hepatocellular carcinoma and other types of malignancies). In the arterial phase, five of the six hepatocellular carcinomas had hypervascularity, whereas no other lesion was characterized by hypervascularity. In some dogs, additional lesions that could not be observed with conventional B-mode ultrasonography were detected in the parenchymal phase. The enhancement pattern of Sonazoid, especially in the parenchymal phase, has potential as a diagnostic tool for canine focal liver lesions.

Hepatocellular adenoma (HA) is a benign liver tumor most frequently occurring in young women using oral contraceptives. We report a rare case of HA in a 27-year-old male patient with familial adenomatous polyposis (FAP). The patient underwent a total colectomy and ileo-rectal anastomosis for FAP in 2003. A preoperative computed tomography scan of the abdomen disclosed a tumor in the left-lobe of the liver, 5.8 cm in diameter. Pathologic examination of a needle biopsy disclosed HA, but he had never used anabolic steroids or other known inducers of HA. The size of the liver mass gradually increased to 8.5 cm during a follow-up period of 38 months, and a left hepatectomy was performed in 2006. Pathology of the resected specimen confirmed the diagnosis of HA. Although FAP is known to be complicated with neoplasia in various extracolonic organs, only five reported cases of HA have developed in patients with FAP, including this case. This is the first report of HA to develop in a male FAP patient.

A 70-year old Japanese man with hepatitis B infection developed a 4.8-cm liver tumor in the right lobe. Computed tomographic findings suggested hepatocellular carcinoma or combined hepatocellular and cholangiocarcinoma. After right hepatectomy, the cut surface of the resected specimen showed a whitish tumor with indistinct borders. Microscopically, the tumor consisted of pleomorphic, eosinophilic cells forming thickened trabeculae, suggesting hepatocellular carcinoma, and also tumor cells forming glandular structures, suggesting adenocarcinoma. Cells comprising both the trabeculae and the glands were immunoreactive for cytokeratin (CK) 19. In some gland-forming cells, varying immunoreactivity for CK7 and carcinoembryonic antigen (CEA) was observed. In the cytoplasm of cells in the thickened trabeculae, hepatocyte paraffin (HepPar) 1 and alpha-fetoprotein (AFP) were focally reactive. Some of these tumor cells were also reactive for CK19. Accordingly, we concluded that this tumor was a combined hepatocellular and cholangiocarcinoma whose cells had undergone divergent differentiation into hepatocytes and biliary epithelium. Because the tumor expressed markers of both phenotypes, it may have originated from cells intermediate between hepatocytes and biliary epithelium. A few reported cases have shown similar histologic features.

We report a hepatocellular carcinoma that appeared to undergo spontaneous regression twice. On June 5, 1995, two hepatocellular carcinomas were detected by ultrasonography in a 72-year-old woman. On July 1, 1995, the tumor in the lateral segment had increased in size from 2.0 cm to 3.2 cm in 27 days, and the level of alpha-fetoprotein (AFP) had increased from 743 to 1300 ng/ml. On September 22, 1995, one tumor appeared as a typical hypervascular lesion on contrast-enhanced computed tomography. It was 3.9 cm in size and located in the posterior segment. The other was a 3.9-cm cystic mass located in the lateral segment. The tumor in the posterior segment was treated with an emulsion of epirubicin and lipiodol administered via the posterior branch of the right hepatic artery and percutaneous ethanol injection. The tumor in the lateral segment was kept under observation because it was avascular, had regressed to 2.0 cm in size, and the patient's AFP level had decreased to 237 ng/ml by December 5, 1995. By February 21, 1996, the AFP level had increased again to 105,340 ng/ml, and by March 22, 1996, the latter tumor had increased in size to 3.8 cm. However, it later regressed again to 1.6 cm, and the AFP level decreased spontaneously to 7 ng/ml. From the changes in the contrast-enhanced computed tomographic images, and the level of AFP, we cannot rule out the possibility that the spontaneous regression might have been caused by the tumor's rapid growth.