LA CONSULTA SEMANAL

 

MAYO 2001

 

 

CONSULTA

Tumores hepáticos

BMJ 2001 Feb 24;322(7284):477-80 [Texto completo]
ABC of diseases of liver, pancreas, and biliary system.
Beckingham IJ, Krige JE
Department of Surgery, Queen's Medical Centre, Nottingham, UK. Ian.Beckingham@nottingham.ac.uk
Publication Types:
  Review
  Review, tutorial


Clin Radiol 2001 Feb;56(2):138-45
Pre-operative detection of malignant hepatic tumours: value of combined helical CT during arterial portography and biphasic CT during hepatic arteriography.
Matsuo M, Kanematsu M, Inaba Y, Matsueda K, Yamagami T, Kondo H, Arai Y, Hoshi H
Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan.
AIMS: The purpose of our study was to evaluate the observer performance with  combined helical CT during arterial portography (CTAP) and biphasic CT hepatic arteriography (CTHA) in the pre-operative detection of malignant hepatic tumours. METHODS: Computed tomography images obtained in 41 patients with suspected hepatic tumours were retrospectively reviewed. In a blind fashion, three off-site, independent radiologists reviewed CTAP and early-phase CTHA combined for the first review, then late-phase CTHA was added for the second review. Statistical analysis was conducted on lesion-by-lesion and segment-by-segment bases; a total of 328 liver segments including 65 segments with 74 malignant hepatic tumours ranging in size from 5 to 100 mm (mean, 21.4 mm) were analysed. RESULTS: Sensitivity for detection of liver segments harbouring tumours of CTAP and biphasic CTHA combined (82%) was identical to that of CTAP and early-phase CTHA combined (82%). Specificity of CTAP and biphasic CTHA combined (93%) was greater than that of CTAP and early-phase CTHA combined (90%, P < 0.005). The mean confidence level for the 74 tumours significantly increased by adding late-phase CTHA (P < 0.0005). The mean confidence level for 100-142 benign perfusion abnormalities detected with CTAP and early-phase CTHA combined significantly decreased by adding late-phase CTHA (P < 0.0005). CONCLUSION: By combining late-phase CTHA with CTAP and early-phase CTHA information, the specificity for the detection of malignant hepatic tumours rises significantly, allowing more accurate preoperative tumour detection. Copyright 2001 The Royal College of Radiologists.
Publication Types:
  Evaluation studies


Clin Liver Dis 2001 Feb;5(1):87-107, vi
Epidemiology of hepatocellular carcinoma.
el-Serag HB
Sections of Gastroenterology and Health Services Research, Houston VA Medical Center, and Baylor College of Medicine, Houston, Texas, USA. hasheme@bcm.tmc.edu
The epidemiology of hepatocellular carcinoma (HCC) is characterized by marked differences between genders, ethnic groups, and geographic regions. These variations are explained by the nature, frequency, and time of acquisition of the major risk factors for cirrhosis--namely hepatitis B virus, hepatitis C virus (HCV), and alcoholic cirrhosis. The incidence and mortality of HCC has been rising in the US over the last two decades and is progressively affecting younger persons. The evidence indicates that HCV infection is responsible for the current trends.
Publication Types:
  Review
  Review, tutorial


Clin Liver Dis 2001 Feb;5(1):69-85
Pathogenesis of hepatocellular carcinoma.
Macdonald GA
Queensland Institute of Medical Research and the Department of Medicine, University of Queensland, Brisbane, Queensland, Australia.
The pathogenesis of HCC is poorly understood at present. There is insufficient understanding to propose a robust general model of hepatic carcinogenesis, partly because pathogenic host and environmental factors show significant regional variation, making such generalization difficult. Figure 4 is a model based on data presented in this article. Multiple risk factors for HCC have been identified, including cirrhosis, male gender, increasing patient age, toxins, chronic viral hepatitis, and other specific liver diseases. The understanding of how the individual risk factors result in genetic changes is rudimentary, and there is even less understanding about interactions between risk factors. Future studies should acknowledge the geographic origin of the HCCs studied and consider the effects of cirrhosis, gender, and age. A more rigorous approach to these factors may help explicate the interaction with specific liver diseases so that a comprehensive model of hepatic carcinogenesis can be developed.
Publication Types:
  Review
  Review, tutorial


Clin Liver Dis 2001 Feb;5(1):259-81, viii-ix
Hepatic tumors in children.
Stocker JT
Department of Pathology, F. Edward Hebert School of Medicine, Uniformed Services, University of the Health Sciences, Bethesda, Maryland, USA.
Although they account for only 1% to 4% of solid tumors in children, hepatic tumors and pseudotumors offer a diagnostic challenge to the clinician seeing only an occasional case. Metastatic lesions such as neuroblastoma, Wilms' tumor, and lymphoma are the most common neoplasm seen in the liver, but 10 distinct primary tumors and pseudotumors of the liver occur with some regularity, and a few others may be seen rarely, including leiomyosarcoma, rhabdoid tumor, and endodermal sinus tumor. Five of these neoplasms--hepatoblastoma, infantile hemangio-endothelioma, mesenchymal hamartoma, undifferentiated embryonal sarcoma, and embryonal rhabdomyosarcoma of the biliary tree--occur only in children and are the major focus of the article.
Publication Types:
  Review
  Review, tutorial


Clin Liver Dis 2001 Feb;5(1):219-57, viii
Mesenchymal tumors of the liver.
Mani H, Van Thiel DH
Department of Pathology, Indian Navy Health Service, Asvini, Colaba, Mumbai, India.
Primary angiosarcoma of the liver accounts for up to 2% of all primary liver tumors and is the second most common primary malignant neoplasm of the liver. Approximately 10 to 20 new cases are diagnosed every year in the United States and the prevalence varies from 0.14 to 0.25 per million. In an autopsy series from Chicago, one hepatic angiosarcoma was noted for every 30 cases of hepatocellular carcinoma.
Publication Types:
  Review
  Review, tutorial


Can J Gastroenterol 2000 Sep;14(8):703-9
Epidemiology of hepatocellular carcinoma.
Yu MC, Yuan JM, Govindarajan S, Ross RK
Department of Preventive Medicine, University of Southern California/Norris Comprehensive Cancer Center, Keck School of Medicine, Los Angeles 90089-9176, USA. mimiyu@hsc.usc.edu
Although rare in Canada and the United States, hepatocellular carcinoma (HCC) ranks as the eighth most common cancer in the world. High-risk regions are East and Southeast Asia, and sub-Saharan Africa. Independent of race and geography, rates in men are at least two to three times those in women; this sex ratio is more pronounced in high-risk regions. Rates of HCC in the United States have increased by 70% over the past two decades. Registry data in Canada and Western Europe show similar trends. In contrast, the incidence of HCC in Singapore and Shanghai, China, both high-risk regions, has declined steadily over the past two decades. Among white and black Americans, there is an inverse relationship between social class status and HCC incidence. Chronic infection by the hepatitis B virus (HBV) is by far the most important risk factor for HCC in humans. It is estimated that 80% of HCC worldwide is etiologically associated with HBV. In the United States, although the infection rate in the general population is low, HBV is estimated to account for one in four cases of HCC among non-Asians. Chronic infection by the hepatitis C virus is another important risk factor for HCC in the United States; however, this virus is believed to play a relatively minor role in the development of HCC in Africa and Asia. Dietary aflatoxin exposure is an important codeterminant of HCC risk in Africa and parts of Asia. In Canada and the United States, excessive alcohol intake, cigarette smoking and oral contraceptive use in women also are risk factors for HCC.
Publication Types:
  Review
  Review, multicase


Magn Reson Imaging Clin N Am 2000 Nov;8(4):757-68
MR imaging of hepatocellular carcinoma.
Onaya H, Itai Y
Department of Radiology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
MR imaging is useful in the diagnosis and early detection of HCC. Characteristic findings for overt HCC, a pseudocapsule and an intratumoral mosaic pattern, are better demonstrated on MR imaging than by other imaging modalities such as ultrasound and CT scanning. Signal intensity on T2-weighted images is useful in evaluating the grade of malignancy of hepatocytic nodular lesions. Hyperintensity on T1-weighted MR imaging is almost always seen in precancerous hepatocellular lesions and in about one third of overt HCC tumors, whereas other hepatic tumors show hypointensity on T1-weighted MR imaging. In evaluating tumor vascularity, gadolinium-enhanced dynamic MR imaging is an essential and powerful tool.
Publication Types:
  Review
  Review, tutorial


Magn Reson Imaging Clin N Am 2000 Nov;8(4):741-56
MR imaging in the evaluation of hepatic metastases.
Imam K, Bluemke DA
Russel H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. khursheed_imam@hotmail.com
Optimal detection of focal hepatic lesions in patients with metastases can alter patient management and result in significant cost savings by reducing the number of unnecessary laparotomies for unresectable disease. Liver-specific MR imaging contrast agents (reticuloendothelial and hepatobiliary agents) offer greater lesion-to-liver contrast than the conventional extracellular fluid space MR imaging contrast agents (gadolinium chelates), which have a nonspecific distribution. For the detection of hepatic metastases, although the work of Seneterre et al suggests that the accuracy of ferumoxide-enhanced MR imaging is equivalent to that of CTAP, other studies find CTAP to be superior. Comparisons of reticuloendothelial agents and hepatobiliary agents for imaging liver metastases are lacking in the literature. Further studies comparing MR imaging enhanced with liver-specific contrast agents to CTAP are needed to determine if hepatic MR imaging can replace CTAP for the preoperative evaluation of hepatic metastases. For the characterization of focal liver lesions, MnDPDP and ferumoxides have been added to the small list of FDA-approved contrast agents, and both can help to increase diagnostic specificity. Two of the hepatobiliary agents which are not yet approved, Gd-BOPTA and Gd-EOB-DTPA, have the potential of characterizing liver lesions during dynamic contrast enhancement (similar to Gd-DTPA) and during the hepatocyte phase (similar to MnDPDP), and may increase the detection of focal liver lesions.
Publication Types:
  Review
  Review, tutorial


Endoscopy 2000 Nov;32(11):884-9
Laparoscopy, minimally invasive surgery, and percutaneous treatment of hepatic tumors.
Adamsen S
Bispebjerg Hospital, Copenhagen, Denmark. sven.adamsen@dadlnet.dk
Publication Types:
  Review
  Review, tutorial


Ann Oncol 2000;11 Suppl 3:153-9
Pancreatic and hepatobiliary cancers: adjuvant therapy and management of inoperable disease.
Glimelius B
Department of Oncology, Radiology and Clinical Immunology, University Hospital, Uppsala, Sweden.
Publication Types:
  Review
  Review, tutorial


J Hepatol 2000 Oct;33(4):667-72
Radiofrequency ablation in the treatment of hepatocellular carcinoma--a clinical viewpoint.
Grasso A, Watkinson AF, Tibballs JM, Burroughs AK
Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital, London, UK.
Publication Types:
  Review
  Review, tutorial


Surgery 2000 Oct;128(4):686-93
Hepatic resection: effective treatment for primary and secondary tumors.
Buell JF, Rosen S, Yoshida A, Labow D, Limsrichamrern S, Cronin DC, Bruce DS, Wen M, Michelassi F, Millis JM, Posner MC
Department of Surgery, and Health Studies, University of Chicago, Pritzker School of Medicine, Chicago, Ill. 60637, USA.
BACKGROUND: Hepatic resection is an accepted therapeutic modality for isolated colorectal metastases (CRM) and primary hepatobiliary cancers (PC). Controversy continues regarding the safety, efficacy, and appropriateness of resection for noncolorectal metastases (NCM). METHODS: A retrospective review of 167 resections in 160 patients was performed to evaluate the impact of demographics and perioperative data on survival and recurrence. Statistical analyses were performed by Student t test, analysis of variance, and Kaplan-Meier survival estimates. RESULTS: Resections were performed for CRM, 110 of 167 (66%), NCM, 31 of 167 (19%), and PC, 26 of 167 (15%). The interval from primary to metastases was significantly longer in the NCM group than the CRM group (34.7+/-45.1 vs. 18.7+/-23.7 months; P<.01). Mean number of lesions was not different between groups; however, NCM were larger than CRM (5.9+/-4.5 vs 4.5+/-2.9 cm; P<.05). Operative complications were significantly greater for PC (54%) versus CRM and NCM (21% and 19%, respectively; P<.01), although length of stay was similar between groups. Perioperative mortality was 2%. Actuarial survival at 1 year, 3 years, and 5 years was CRM 91%, 54%, and 40%, PC 75%, 60%, and 38%, and NCM 68%, 36%, and not available, respectively (CRM vs. NCM; P<.01 at 3 years). CONCLUSIONS: Hepatic resection for primary and secondary malignancy can be performed with minimal morbidity and mortality. Resection of NCM is associated with a lower overall survival compared with CRM and PC. The disease-free interval from resection of the primary to metastasectomy is prolonged and hepatic recurrence infrequent after resection in the NCM group. These results suggest that tumor biology is a critical determinant of outcome after hepatic resection of primary and secondary hepatic tumors.


Surg Clin North Am 2000 Aug;80(4):1203-11
Laparoscopic management of benign liver disease.
Katkhouda N, Mavor E
Department of Surgery, University of Southern California School of Medicine, USA. nkatkhouda@surgery.usc.edu
Minimally invasive techniques may be used for treating a variety of benign hepatic lesions in selected patients. The size of the lesions is less important than the anatomic location in anterolateral regions. Laparoscopic unroofing of solitary liver cysts is the surgery of choice for this indication. The laparoscopic management of patients with PLD should be reserved for patients with a few, large, anteriorly located, symptomatic cysts. Active hydatid cysts present technical difficulties because of their complex biliovascular connections and the inherent nature of the parasite. The authors' results do not support the widespread use of laparoscopy in these cases. Uncomplicated benign liver tumors located in the left lobe or in the anterior segments of the right lobe can be resected safely using a four-hand technique. Open surgery is the treatment of choice when primary tumors are malignant, located posteriorly, or in proximity to major hepatic vasculature. Laparoscopic resection of liver metastases with a safety margin of 1 cm, when the total number is less than four, is not unreasonable and can be offered to patients without evidence of extrahepatic disease.
Publication Types:
  Review
  Review, tutorial


Surg Clin North Am 2000 Aug;80(4):1111-26
Role of laparoscopy in the staging of malignant disease.
Pratt BL, Greene FL
Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA.
Although diagnostic laparoscopy has been used by surgeons and gastroenterologists since the early 1900s, today's surgical oncologists have been relatively slow to embrace this technology. Together with the fervor and benefits afforded by laparoscopic therapeutic interventions in the management of patients with benign disease and the diagnostic usefulness in blunt trauma and abdominal pain, awareness has been rekindled regarding the advantages of laparoscopy for the staging of abdominal malignancy. As surgeons begin to realize that extirpative procedures are doomed to failure in curing patients with diffuse abdominal metastases disclosed on laparoscopic assessment, palliative measures, such as stent placement, ablative procedures, balloon dilatation, intraluminal high-dose radiation, and laser techniques will be used commonly by surgical endoscopists and gastroenterologists. Similarly, it is hoped that the use of systemic chemotherapy will achieve better specificity in cell destruction in patients identified laparoscopically to have uncontained disease in the abdominal cavity. The sensitivity of sonography combined with laparoscopy has been shown to approach that of celiotomy in the evaluation of solid organs, thereby avoiding unnecessary laparotomy and its associated morbidities. Using sonography as a complement to laparoscopy will extend the usefulness of both techniques. The application of laparoscopy and the advent of miniaturized laparoscopic instrumentation (Fig. 7), both diagnostic and therapeutic, in the management of patients with abdominal malignancy will be limited only by the creativity and expertise of physicians and instrument makers.
Publication Types:
  Review
  Review, tutorial


Gastroenterol Clin Biol 2000 May;24(5 Pt 2):B92-4
[Screening for hepatocellular carcinoma in cirrhotic patients].
[Article in French]
Beaugrand M
Service d'Hepato-Gastroenterologie, Hopital Jean Verdier, 93143 Bondy Cedex.
Publication Types:
  Review
  Review, tutorial


Med Clin (Barc) 2000 Apr 8;114(13):506-10
[Current status of the treatment of hepatic metastases of colorectal carcinoma].
[Article in Spanish]
Cubillo A, de Castro J, Feliu J, Gonzalez Baron M
Servicio de Oncologia Medica, Hospital La Paz, Universidad Autonoma de Madrid.
Publication Types:
  Review
  Review, tutorial


Postgrad Med 2000 May 1;107(5):117-24 [Texto completo]
Hepatocellular carcinoma. A concise guide to its status and management.
Ulmer SC
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, USA. Sculmer@yahoo.com
Although common worldwide, hepatocellular carcinoma is relatively rare in the United States. However, for unknown reasons, the incidence is rising. Multiple causes exist, but chronic viral hepatitis in the setting of cirrhosis is probably the most common. Despite limitations, AFP measurement and multiple-phase abdominal CT are the most sensitive tests for diagnosis. Surgical resection and liver transplantation are at present the only treatment options that offer potential for long-term survival or cure in limited-stage hepatocellular carcinoma. Otherwise, the prognosis is poor, and 1-year survival is rare. Future efforts should focus on improving detection of early-stage disease and improving preventive measures to reduce viral hepatitis infection, transmission, and progression.
Publication Types:
  Review
  Review, tutorial


Surg Clin North Am 2000 Apr;80(2):603-32
Hepatic malignancies.
Tsao JI, DeSanctis J, Rossi RL, Oberfield RA
Department of Surgery, Tufts University School of Medicine, Burlington, Massachusetts, USA.
The battle against malignancies of the liver is far from over, although tremendous strides have been made in the past decade, such as improved diagnostic capabilities, safe surgical resection, availability of safe nonsurgical ablative modalities, multimodality therapy, and aggressive approach to recurrent disease. Even after the best attempts at curative treatment, recurrence of primary and secondary malignancies of the liver continues to be the cause of demise for more than 70% of treated patients. The battle continues in the laboratories, where investigations are focused on delineating the pathophysiology of cancer on the molecular and genetic levels and mapping the patterns of cancer emergence and spread. The new millennium holds promise for formulating therapies that may improve disease-free survival for patients with malignancies of the liver.
Publication Types:
  Review
  Review, tutorial


Surg Clin North Am 2000 Apr;80(2):495-503
Role of videoscopic-assisted techniques in staging malignant diseases.
Buyske J
Department of Surgery, University of Pennsylvania Medical School, Philadelphia, USA.
Preoperative radiographic studies fail to uncover a significant number of patients with unresectable malignancies. Small peritoneal studs of tumor, lymph node involvement, and small liver metastases are common causes of understaging by imaging studies. Videoscopic staging offers a higher degree of accuracy among these patients, with minimal complications and a shorter recovery time than with exploratory laparotomy. The addition of laparoscopic sonography and peritoneal lavage may further increase sensitivity to unresectable disease. Staging videoscopy has been applied to hepatobiliary and gastrointestinal malignancies, pleural and pulmonary tumors, and gynecologic malignancies. The author believes that videoscopic staging will become increasingly common as it is further studied and the best applications are delineated.
Publication Types:
  Review
  Review, tutorial


Postgrad Med J 2000 Jan;76(891):4-11
Hepatocellular carcinoma.
Badvie S
The Guy's, King's College & St Thomas' Medical School, London, UK.
Primary hepatocellular carcinoma is one of the 10 most common tumours, and the most common primary liver malignancy, in the world. In the majority of cases, it occurs against a background of hepatitis B or C viral infection and/or liver cirrhosis, and is associated with a dismal prognosis of a few months. Current treatments in routine clinical practice are surgical resection and liver transplantation, but these therapies are applicable to only a small proportion of patients and prolongation of survival is restricted. Other treatment options include intra-arterial chemotherapy, transcatheter arterial chemoembolisation, percutaneous ethanol injection, cryotherapy, thermotherapy, proton therapy, or a wide range of their possible combinations. The current lack of definitive data, however, limits the use of these therapies. Another option is gene therapy, which although in its infancy at the present time, may have a significant role to play in the future management of hepatocellular carcinoma.
Publication Types:
  Review
  Review, tutorial


N Engl J Med 1997 Jun 26;336(26):1889-94
Imaging of the hepatobiliary tract.
Saini S
Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA.
Publication Types:
  Review
  Review, tutorial

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