Hepatocellular carcinoma. Hepatocellular carcinoma (HCC) is a primary malignancy of the hepatocyte , derived from well-differentiated hepatocytes , generally leading to death within 6-20 months.
(1) the use of chemical tumor initiators and promoters in animal models
(2) studies of growth factors and their signaling pathways
(3) transgenic mouse models overexpressing cytokines, growth factors or oncogenes
(4) studies of immune-mediated mechanisms of hepatocellularinjury
(5) analysis of the molecular genetic changes that occur in HCCs, including studies of chromosomal allelic imbalance, comparative genomic hybridization, restriction landmark genomic scanning and gene expression analysis using cDNAmicroarrays
(6) studies of the molecular consequences of HBV integration and the interaction of the protein products of HBV and HCV with host cell processes
the diffuse infiltrating cancers further worsen hepatic function, resulting in:
Hepatic carcinoma, primary. Dilated collateral superficial abdominal veins in a 67-year-old man with cirrhosis, hepatocellular carcinoma (HCC), and portal vein occlusion.
- less common than the presentation of hepatic decompensation
- the pain is usually acute, limited in time (less than 24 hours) and assumed to be biliary colic
64-year-old woman with hepatocellular carcinoma. Celiac arteriogram shows standard hepatic artery anatomy.
Hepatic carcinoma, primary. Unusual location of a bone metastasis from hepatocellular carcinoma (HCC).
CLIP scoring system: Score of 0-2 is assigned for each of the 4 features listed below; cumulative score ranging from 0-6 is the CLIP score.
- Estimated survival based on CLIP score: Patients with a total CLIP score of 0 have an estimated survival of 31 months; those with score of 1, about 27 months; score of 2, 13 months; score of 3, 8 months; and scores 4-6, approximately 2 months.
Laboratory findings include:
Laboratory findings depend on the cause of jaundice.
1. Is the elevated bilirubin conjugated or unconjugated? In general, most jaundiced patients will not have isolated unconjugatedhyperbilirubinemia.
2. If the hyperbilirubinemia is unconjugated, is it caused by increased production, decreased uptake, or impaired conjugation?
3. If the hyperbilirubinemia is conjugated, is the problem intrahepatic or extrahepatic?
4. Is the process acute or chronic?
84 year-old man presented with jaundice and epigastric pain. Several biliary calculi are shown within the dilated distal common bile duct on this abdominal ultrasound.
Images in 52-year-old woman with jaundice, abdominal pai, and weight loss due to unresectable pancreatic cancer. (a) Transverse contrast-enhanced CT image shows hypoattenuating mass in the head of the pancreas (∗) abutting splenic vein (arrow). (b-d) Curved planar reformations (cpr) show mass adjacent to and deforming superior mesenteric vein (black arrows), inferior mesenteric vein (imv) (arrowheads), and splenic vein (white arrows).
A twenty six year old male patient presented to the surgical emergency with history of high-grade fever and right hypochondrial pain of one week duration. The patient was icteric and had a tender hepatomegaly.
MRI coronal section (T2W MRI) shows linear serpinginous shadows within the fluid filled cyst in the right upper lobe, suggestive of collapsed membranes (arrow). The dilated left main hepatic duct can be seen.
MRC scan the cyst can be seen to communicate with the common hepatic duct. The membranes can be seen entering the biliary duct
Hydatid serology was found to be positive.
Biliaryscintigraphy with technetium (a HIDA scan) is an excellent test to decide whether common bile duct and cystic ducts are patent. This involves the administration of an isotope which concentrates within the gallbladder, and flows into the duodenum and biliary tree allowing visualization.
89-year-old male patient presented with epigastric pain, low grade fever and vomiting. Lab showed anormal liver function including jaundice. ERCP revealed stress ulcers with bleeding, suppurativecholangitis and CBD stone.
50-year-old woman with jaundice. Percutaneoustranshepaticcholangiogramshows large type 1 bile duct cyst of extrahepatic bile duct containing contrast material (arrows). Slightly distended left and right hepatic ducts are noted (open arrows). Percutaneous needle (Perc), gallbladder (GB), and duodenum (D) are noted.