Gross and microscopic changes of liver neoplasms and background hepatic structures following neoadjuvant therapy

2019 ◽  
Vol 72 (2) ◽  
pp. 112-119
Author(s):  
Anjelica Hodgson ◽  
Zuhoor Almansouri ◽  
Oyedele Adeyi ◽  
Sandra E Fischer
Keyword(s):  
Liver Transplantation ◽  
Tumour Progression ◽  
Tumour Burden ◽  
Hepatic Parenchyma ◽  
Curative Intent ◽  
Therapeutic Modalities ◽  
Hepatic Neoplasms ◽  
Ablative Techniques ◽  
Surgical Option ◽  
Secondary Tumours

Liver transplantation is a surgical option with curative intent used in the management of some cases of hepatocellular carcinoma and cholangiocarcinoma (hilar, rarely intrahepatic). A number of different therapeutic modalities including ablative techniques, arterially directed therapies, radiation and chemotherapy are used in the neoadjuvant setting prior to liver transplantation with the goals of preventing tumour progression, decreasing post-transplant recurrence and possibly downstaging patients with tumour burden beyond what is acceptable by current transplant criteria. Pathologists evaluating hepatic explants must be aware of these neoadjuvant therapies and the alterations induced by them in both tumourous and non-tumourous tissue. In this review, we discuss common neoadjuvant therapies used in in this setting, as well as the gross and microscopic changes induced by these presurgical treatments within hepatic neoplasms as well as the background hepatic parenchyma and nearby structures. Select secondary tumours involving the liver which are pretreated will also be discussed. Finally, proper reporting of these changes will be mentioned.

scholarly journals Current management of intrahepatic cholangiocarcinoma: from resection to palliative treatments

2020 ◽  
Vol 54 (3) ◽  
pp. 263-271
Author(s):  
Ilenia Bartolini ◽  
Matteo Risaliti ◽  
Laura Fortuna ◽  
Carlotta Agostini ◽  
Maria Novella Ringressi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Intrahepatic Cholangiocarcinoma ◽  
Tumour Progression ◽  
Primary Tumour ◽  
Locally Advanced ◽  
Recurrence Rates ◽  
Curative Intent ◽  
Study Protocols ◽  
Surgical Treatments ◽  
Specific Symptoms

AbstractBackgroundIntrahepatic cholangiocarcinoma (ICC) is the second most common liver primary tumour after hepatocellular carcinoma and represents 20% of all the cholangiocarcinomas. Its incidence is increasing and mortality rates are rising. Surgical resection is the only option to cure the disease, despite the high recurrence rates reported to be up to 80%. Intrahepatic recurrences may be still treated with curative intent in a small percentage of the patients. Unfortunately, due to lack of specific symptoms, most patients are diagnosed in a late stage of disease and often unsuitable for resection. Liver transplantation for ICC is still controversial. After the first published poor results, improving outcomes have been reported in highly selected cases, including locally advanced ICC treated with neoadjuvant chemotherapy, when successful in controlling tumour progression. Thus, liver transplantation should be considered a possible option within study protocols. When surgical management is not possible, palliative treatments include chemotherapy, radiotherapy and loco-regional treatments such as radiofrequency ablation, trans-arterial chemoembolization or radioembolization.ConclusionsThis update on the management of ICC focusses on surgical treatments. Known and potential prognostic factors are highlighted in order to assist in treatment selection.

Role of Sorafenib in Patients With Recurrent Hepatocellular Carcinoma After Liver Transplantation

2016 ◽  
Vol 26 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Nicola de’Angelis ◽  
Filippo Landi ◽  
Marco Nencioni ◽  
Anais Palen ◽  
Eylon Lahat ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Survival Rates ◽  
Early Recurrence ◽  
Best Supportive Care ◽  
Curative Intent ◽  
Sorafenib Group ◽  
Hepatocellular Carcinoma Recurrence ◽  
Retrospective Comparative Study ◽  
Hcc Recurrence

Context: The management of hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT) is challenging, especially if it is not treatable by surgery or embolization. Objectives: The present study aims to compare the survival rates of liver transplanted patients receiving sorafenib or best supportive care (BSC) for HCC recurrence not amenable to curative intent treatments. Design: This is a retrospective comparative study on a prospectively maintained database. Participants: Liver transplanted patients with untreatable HCC recurrence receiving BSC (n = 18) until 2007 or sorafenib (n = 15) thereafter were compared. Results: No group difference was observed for demographic characteristics at the time of transplantation and at the time of HCC recurrence. On the explant pathology of the native liver, 81.2% patients were classified within the Milan criteria, and 53.1% presented with microvascular invasion. Hepatocellular carcinoma recurrence was diagnosed 17.8 months (standard deviation: 14.5) after LT, with 17 (53.1%) patients presenting with early recurrence (≤12 months). The 1-year survival from untreatable progression of HCC recurrence was 23.9% for the BSC and 60% for the sorafenib group ( P = .002). The type of treatment (sorafenib vs BSC) was the sole independent predictor of survival (hazard ratio: 2.98; 95% confidence interval: 1.09-8.1; P = .033). In the sorafenib group, 8 (53.3%) patients required dose reduction, and 2 (13.3%) patients discontinued the treatment due to intolerable side effects. Conclusion: Sorafenib improves survival and is superior to the BSC in cases of untreatable posttransplant hepatocellular carcinoma recurrence.

scholarly journals Immunoradiotherapy as an Effective Therapeutic Strategy in Lung Cancer: From Palliative Care to Curative Intent

Cancers ◽  
2020 ◽  
Vol 12 (8) ◽  
pp. 2178 ◽  
Author(s):  
Rodolfo Chicas-Sett ◽  
Juan Zafra-Martin ◽  
Ignacio Morales-Orue ◽  
Juan Castilla-Martinez ◽  
Miguel A. Berenguer-Frances ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Checkpoint Inhibitors ◽  
Locally Advanced ◽  
Progression Free Survival ◽  
Patient Characteristics ◽  
Tumor Stage ◽  
Curative Intent ◽  
Therapeutic Modalities ◽  
Improve Patient Selection ◽  
Effective Therapeutic Strategy

Lung cancer is one of the main causes of cancer-related mortality worldwide. Over the years, different therapeutic modalities have been adopted depending on tumor stage and patient characteristics, such as surgery, radiotherapy (RT), and chemotherapy. Recently, with the development of immune-checkpoint inhibitors (ICI), the treatment of metastatic and locally advanced non-small cell lung cancer (NSCLC) has experienced a revolution that has resulted in a significant improvement in overall survival with an enhanced toxicity profile. Despite this paradigm shift, most patients present some kind of resistance to ICI. In this setting, current research is shifting towards the integration of multiple therapies, with RT and ICI being one of the most promising based on the potential immunostimulatory synergy of this combination. This review gives an overview of the evolution and current state of the combination of RT and ICI and provides evidence-based data that can improve patient selection. The combination in lung cancer is a safe therapeutic approach that improves local control and progression-free survival, and it has the potential to unleash abscopal responses. Additionally, this treatment strategy seems to be able to re-sensitize select patients that have reached a state of resistance to ICI, further enabling the continuation of systemic therapy.

Liver transplantation in malignant primary hepatic neoplasms

1992 ◽  
Vol 163 (4) ◽  
pp. 395-400 ◽  
Author(s):  
Enrique Moreno González ◽  
Ramon Gámez ◽  
Ignacio García ◽  
Ignacio González-Pinto ◽  
Carmelo Loinaz ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Neoplasms

scholarly journals The Geography of Primary Hepatic Neoplasms Treatments in Canada: Changes in Latitudes and Changes in Attitudes

2017 ◽  
Vol 2017 ◽  
pp. 1-8
Author(s):  
Matthew Cwinn ◽  
Gordon Walsh ◽  
Sheikh Hasibur Rahman ◽  
Michele Molinari
Keyword(s):  
British Columbia ◽  
Hepatic Resection ◽  
Temporal Trends ◽  
Epidemiological Data ◽  
Cancer Registries ◽  
Treatment Modalities ◽  
Atlantic Canada ◽  
Therapeutic Modalities ◽  
Hepatic Neoplasms ◽  
Locoregional Therapies

Background. Studies on treatment modalities for primary hepatic neoplasms (PHN) in Canada are lacking. Our primary aim was to analyze the age-standardized incidence of hepatic resection, ablation, transplantation, and embolization for PHN between 2002 and 2013. Secondary aim was to evaluate temporal trends for these treatment modalities. Study Design. National Canadian Cancer Registries were accessed for relevant epidemiological data. Age-standardized incidence of treatment ratios (SIRs) was calculated and comparisons were performed for Atlantic Canada, Ontario, the Prairies, and British Columbia. Results. British Columbia recorded the highest SIRs for ablation (1.9; 95% CI 1.8–2.0), hepatic resection (1.2; 95% CI 1.1–1.3), and transarterial locoregional therapies (2.8; 95% CI 2.4–3.2). For hepatic resection, the lowest SIR was found in Atlantic Canada (0.7; 95% CI 0.6–0.9), while the Prairies recorded the lowest estimate for transarterial therapies (0.2; 95% CI 0.1–0.4). Liver transplantation had the highest SIR in Ontario (1.5; 95% CI 1.3–1.6) and the lowest SIR in British Columbia. No significant temporal changes in SIRs were observed for any of the treatments except for transarterial therapies. Conclusions. Treatment of PHN in Canada differs by geography. Variations might be due to differences in expertise or access to therapeutic modalities.

Liver Transplant Immunology 2: Application to Liver Allograft Immunity

2018 ◽  
Author(s):  
Michael Kriss ◽  
Hugo Rosen
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Portal Blood Flow ◽  
Lymphoid Organ ◽  
Immune Functions ◽  
Transplant Recipients ◽  
Liver Allograft ◽  
Anatomic Structure ◽  
Therapeutic Modalities ◽  
Liver Transplant Recipients

The liver is a multifunctional organ responsible for complex metabolic and immune functions. Although not a classic lymphoid organ, the liver is enriched with traditional immune cells as well as parenchymal and nonparenchymal cells that play a key role in immune homeostasis. Due to its location and unique anatomic structure, the liver must finely balance immunity and tolerance to avoid undue inflammation in the setting of constant antigenic exposure from portal blood flow while maintaining appropriate immunity against pathogens. Since the first successful liver transplantation in humans in 1967 at the University of Colorado, our knowledge of hepatic immunity and tolerance, in the context of both liver disease and liver transplantation, has evolved dramatically. With these advancements, therapeutic modalities have been developed that have revolutionized the care of liver transplant recipients.  In Part 2: Application to Liver Allograft Immunity, we apply the basic principles of liver immunology and allorecognition to our current management of liver transplant recipients in the context of both immunosuppression and the holy grail of transplantation, operational tolerance. This review contains 4 figures, 3 tables, and 32 references Key Words: adaptive immunity; allograft rejection; allograft tolerance; allorecognition; antigen presenting cells; immunosuppression; innate immunity; liver transplantation; T lymphocytes

scholarly journals Peliosis Hepatis With Intrahepatic Hemorrhage: Successful Embolization of the Hepatic Artery

HPB Surgery ◽  
2000 ◽  
Vol 11 (5) ◽  
pp. 353-358 ◽  
Author(s):  
K. O'Riordan ◽  
A. Blei ◽  
R. Vogelzang ◽  
A. Nemcek ◽  
M. Abecassis
Keyword(s):  
Liver Transplantation ◽  
Hormone Replacement Therapy ◽  
Hepatic Artery ◽  
Hormone Replacement ◽  
White Female ◽  
Peliosis Hepatis ◽  
Hepatic Artery Embolization ◽  
Artery Embolization ◽  
Hepatic Parenchyma ◽  
Pharmacological Agents

Peliosis hepatis is defined as the appearance of blood filled lakes in the hepatic parenchyma. It has been associated with various pharmacological agents and infections. Treatment has been primarily symptomatic and includes discontinuation of offending medications, partial hepatectomy or occasionally liver transplantation. We report a 58 year old white female on hormone replacement therapy who developed symptomatic peliosis hepatis and underwent successful superselective hepatic artery embolization with control of bleeding.

Antitumour immune responses

2003 ◽  
Vol 5 (3) ◽  
pp. 1-22 ◽  
Author(s):  
Roshni Mitra ◽  
Sarvjeet Singh ◽  
Ashok Khar
Keyword(s):  
Immune Response ◽  
Immune System ◽  
Immune Responses ◽  
Tumour Progression ◽  
Immune Surveillance ◽  
Tumour Cells ◽  
Transformed Cells ◽  
Therapeutic Modalities ◽  
Cancerous Cells

The role of the immune system in combating tumour progression has been studied extensively. The two branches of the immune response – humoral and cell-mediated – act both independently and in concert to combat tumour progression, the success of which depends on the immunogenicity of the tumour cells. The immune system discriminates between transformed cells and normal cells by virtue of the presence of unique antigens on tumour cells. Despite this, the immune system is not always able to detect and kill cancerous cells because neoplasms have also evolved various strategies to escape immune surveillance. Attempts are being made to trigger the immune system into an early and efficient response against malignant cells, and various therapeutic modalities are being developed to enhance the strength of the immune response against tumours. This review aims to elucidate the tumouricidal role of various components of the immune system, including macrophages, lymphocytes, dendritic cells and complement.

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