• Clinical Endoscopy
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• 제56권2호
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• pp.143-154
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• 2023

Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

• 한국임상수의학회지
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• 제23권4권
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• pp.388-392
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• 2006

80두의 가토 간에 $1{\sim}2mm^3$ 크기의 VX2 종양세포를 직접 주입하여 단일간암모델을 만들고, 종양이식 후1주, 2주, 3주째에 CT촬영을 실시하여 생성된 종양의 크기와 조영 양상을 관찰하고 조직병리학적검사로 종양의 진위 여부를 확인하였다. 80두 중 66두(82.5%)에서 단일 종양이 만들어졌다. 나머지 12두 중 1두에서 간외종앙의 생성, 그리고 다른 1두에서 육아종성 종괴가 관찰되었으며, 4두는 폐사하였다. 나머지 8두에서는 종양이 생성되지 않았다. 조영 CT에서 관찰된 종양의 크기는 1주, 2주 그리고 3주째에 각각 $7.4{\times}6.3,\;14.2{\times}10.8,\;16.2{\times}12.6cm$로 측정되었다. 모양은 둥글거나 타원형이었으며, 동맥기에서 중앙에 저감쇠와 변연에 조영증강을 보였으며, 문맥기에는 저감쇠를 나타내었다. 종양조직의 이식은 균질한 단일종양모델을 만드는데 매우 유용하고 적합한 방법이며, 조영 CT 촬영술은 간종양 진단 및 다양한 치료방법 적용 후 추적검사에 매우 유용하게 활용될 것으로 판단된다.

• Neonatal Medicine
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• 제15권2호
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• pp.183-189
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• 2008

신생아의 선천성 거대 간내 혈관내피종을 복부 단층 촬영과 $^{99m}Tc$-RBC 간스캔을 통해 진단하고, 대증요법과 함께 IFN$\alpha$를 11개월간 단독으로 피하 투여하여 크기 감소를 유도한 후 남은 병변의 완전한 수술적 제거와 조직학적 확진을 시행하였음을 보고하는 바이다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권1호
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• pp.315-319
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• 2015

Background: Surgical resection of spontaneously ruptured hepatocellular carcinoma (HCC) after successful transarterial embolization (TAE) remains controversial. The aim of this study was to investigate its efficacy in a series of cases. Materials and Methods: We retrospectively examined ruptured HCC cases from Jan 2000 to Dec 2008; all of these 126 cases received TAE as the initial therapy. Subsequently, 74 cases received staged surgical resection, and the remaining 52 cases underwent repeated TACE. The baseline demographic data, tumor characteristics, and long term survival were recorded and compared. Results: The demographic and baseline characteristics were comparable between the hepatic resection and TACE groups; furthermore, no significant difference in the tumor characteristics was detected between the two groups. The differences in in-hospital, 30-day and 90-day mortality between the two groups were not significant (P>0.05). However, the 1-, 3-, and 5-year overall survival rates were 85.1%, 63.5%, and 37.8%, respectively, in the hepatic resection group, which were significantly higher than those in the TACE group (69.2%, 46.2%, and 17.3%, respectively, P=0.004). Univariate and multivariate analyses indicated that these patients benefitted from hepatic resection compared with TACE with respect to long-term outcomes. Conclusions: Staged hepatic resection after TAE is an effective treatment that results in superior long-term survival to repeated TACE.

• BMB Reports
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• 제48권3호
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• pp.127-128
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• 2015

Tumor metastasis involves circulating and tumor-initiating capacities of metastatic cancer cells. Hepatic TM4SF5 promotes EMT for malignant growth and migration. Hepatocellular carcinoma (HCC) biomarkers remain unexplored for metastatic potential throughout metastasis. Here, novel TM4SF5/CD44 interaction-mediated self-renewal and circulating tumor cell (CTC) capacities were mechanistically explored. TM4SF5-dependent sphere growth was correlated with $CD133^+$, $CD24^-$, ALDH activity, and a physical association between CD44 and TM4SF5. The TM4SF5/CD44 interaction activated c-Src/STAT3/ Twist1/ B mi1 signaling for spheroid formation, while disturbing the interaction, expression, or activity of any component in this signaling pathway inhibited spheroid formation. In serial xenografts of less than 5,000 cells/injection, TM4SF5-positive tumors exhibited locally-increased CD44 expression, suggesting tumor cell differentiation. TM4SF5-positive cells were identified circulating in blood 4 to 6 weeks after orthotopic liver-injection. Anti-TM4SF reagents blocked their metastasis to distal intestinal organs. Altogether, our results provide evidence that TM4SF5 promotes self-renewal and CTC properties supported by $CD133^+/TM4SF5^+/CD44^+^{(TM4SF5-bound)}/ALDH^+/CD24^-$ markers during HCC metastasis.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8823-8828
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• 2014

Objective: To explore the most appropriate treatment for patients with hepatocellular cancer (HCC) >10 cm by using the Barcelona Clinic Liver Cancer (BCLC) classification. Materials and Methods: A total of 124 HCC patients undergoing surgery were selected. Disease-free survival (DFS), overall survival (OS) and prognostic factors were respectively assessed. Results: This study showed that the cumulative 1-, 3-, 5-year survival rates were 79.7%, 59.8% and 41.6% in BCLC-A patients, 76.2%, 9.5% and 0% in BCLC-B patients and 44.9%, 0% and 0% in BCLC-C patients, respectively. The 1-, 3-, 5-year DFS rates were 49%, 24.5% and 9.1% in BCLC-A patients, 7.5%, 0% and 0% in BCLC-B patients, respectively. No BCLC-C patients survived 1 year after surgery. Multivariate analysis indicated that hepatitis B surface antigen (HBsAg), vascular invasion, intra-hepatic metastasis, curative resection, tumor rupture and pathologic differentiation were independent prognostic factors. Conclusions: Surgery is effective and safe for patients with HCC >10 cm with sufficient hepatic reserve.

• Nuclear Medicine and Molecular Imaging
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• 제42권3호
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• pp.246-248
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• 2008

A hepatic angiomyolipoma is a rare benign tumor mainly composed of blood vessels, smooth muscle cells and fat cells in varying proportion. Hepatic angiomyolipoma is often misdiagnosed as a hepatocellular carcinoma in preoperative imaging work-up. To date, there has been little published data describing PET findings of hepatic angiomyolipoma. We report one case of hepatic angiomyolipoma that showed a high acetate and relatively low FDG uptake on PET images.

• Asian Pacific Journal of Cancer Prevention
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• 제13권3호
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• pp.1015-1018
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• 2012

Objective: To improve the diagnosis of primary gallbladder carcinoma (GBC) with/without hepatic metastases by analyzing our experience of different GBC treatment in our patients. Methods: A retrospective study was carried out to analyze the clinical data of the 139 patients with GBC who underwent hepatic resection in our unit from January 2003 to December 2007. Patients were divided into two groups according to whether they demonstrated hepatic invasion. Tumor presentation, surgical modes, and prognosis of each patient were retrospectively reviewed. Kaplan-Meier curves and log-rank tests were employed to compare the survival rates of those patients undergoing different surgical procedures. Results: Of the 139 patients, 46 were men and 93 were women with the male to female ratio of 1:2.0. Their ages were ranged from 35 to 86 years with a mean age of $62.8{\pm}10.4$ years. There were 73 patients complicated with hepatic invasion (group A), and no hepatic invasion occurred in the other 66 patients (group B). Compared with the group B, the patients with hepatic invasion suffered lower differentiation of tumor (p=0.000), more advanced Nevin staging (p=0.008) and poorer prognosis (p=0.013). Radical resection were more frequently performed in group B (75.76%) than in group A (45.20%) with better outcomes (p=0.000). Conclusion: GBC patients complicated with hepatic invasion had poorer prognosis than those without invasion in long-term follow-ups. Radical resection might result in a satisfied prognosis in patients without hepatic invasion, but appears less favorable than palliative resection in those who were complicated with hepatic invasion.

• Advances in pediatric surgery
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• 제9권1호
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• pp.12-18
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• 2003

The purpose of this study is to evaluate children who underwent hepatic resection for primary malignant hepatic tumor in the period from January 1994 to December 2001. A total of 8 patients, seven with hepatoblastoma (HB) and one with hepatocellular carcinoma (HCC), were studied. One HCC was resectable at the initial diagnosis, but five cases of unresectable HB received two cycles of transarterial chemoembolization (TACE) before operation. One patient with an unresectable HB with bone marrow metastasis was operated after one cycle of TACE and one cycle of systemic chemotherapy based on CCG-823F protocol. Another unresectable HB patient received systemic chemotherapy instead of TACE before operation. Postoperative chemotherapy was administered to all of the patients after complete surgical resection on CCG-823F protocol. All 6 patients who underwent TACE and neoadjuvant chemotherapy showed marked reduction in tumor volume and a clear outline of the lesion. Major complication was not noticed. Mean alpha-fetoprotein (${\alpha}$-FP) level at diagnosis, after neoadjuvant chemotherapy and after postoperative chemotherapy was 9,818 (42-35,350), 664, and 10.1 ng/mL, respectively. Half life of the ${\alpha}$-FP after complete resection was 5.1 days (3.0-8.7 days). Median follow up period was 57.1 months (10-97 months) and all the patients are alive with NED. In conclusion, preoperative chemotherapy, especially TACE, is effective, safe, and useful to treat initially unresectable hepatoblastoma, and serial level of the serum ${\alpha}$-FP is a useful tumor marker for diagnosis and monitoring therapeutic responses.

• 한국임상수의학회지
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• 제16권1호
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• pp.108-117
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• 1999

Hepatic tumorigenesis was induced by ad libitum feeding of diethylnitrosamine (DEN) only. We could also observe hepatic tumor induction in 100% of DEN treated rats without any other cocarcinogen. The liver specific enzyme activities (AST, ALT, ALP, ${\gamma}$-GTP) were significantly increased (P<0.05) in all treated groups compared to control and induced apoptosis groups. In histopathological analysis, the altered foci, hyperplastic nodules, neoplastic nodules, adenomas and carcinomas were observed in liver tumors induced by administration of DEN in rats. Lipopolysaccharide-induced apoptosis in D-galactosamine sensitized mice was investigated in hepatocytes in vivo. Typical morphological changes of apoptosis were detectable in liver 12 hr and 24 hr after the injection of Lipopolysaccharide (5 $\mu\textrm{g}$) and D-galactosamine (20 mg) to mice. It was suggested that organ specific enzyme activities and morphological findings might be very useful for understanding the role of hepatic tumorigenesis including the apoptotic cell death.