Intrahepatic splenosis mimicking hepatocellular carcinoma

We present a rare clinical case of a 37-year-old man who had intrahepatic splenosis (IHS) mimics hepatocellular carcinoma on CT/MRI imaging. The patient with a history of splenectomy 14 years ago had no specific complains and the lesion was found incidentally during follow up imaging for the chronic pancreatitis. Definitive diagnosis of IHS was possible with post-operative histopathological analysis of the resected liver.

The Correlation between the CT Liver Volume and the Actual Weight of the Resected Cirrhotic Liver in Transplantation Patients

Objective: Volumetric assessment with computed tomography (CT), known as CT volumetry, is the preferred method for estimating future liver remnant. However, the data regarding the usage of CT volumetry to estimate future liver remnant of the diseased liver is still lacking. This study was designed to evaluate the correlation between the liver volume, calculated by CT, and the actual weight of the resected liver in patients who underwent orthotopic liver transplantation.Material and Methods: A total of 32 patients having underwent liver transplantation; from March 2009 to June 2015, were included. A radiologist retrospectively reviewed the pre-operative CT and performed the volume measurement. Statistical analysis was performed to determine the relationship between the estimated liver volume and the actual liver weight.Results: The estimated liver volume was significantly different among the cirrhosis of different etiology (p-value=0.001 for the total liver volume and p-value=0.003 for the functional liver volume). Compared with the total liver volume, the functional liver volume had a stronger correlation with the actual weight of the resected liver (r=0.955 vs. r=0.786). The following formula can be used to accurately estimate the expected weight of the resected liver (expected liver weight: ELW), based on the estimated functional liver volume (FLV) derived by CT volumetry: ELW=489.531+(0.618*FLV). The R-squared for this regression model was 0.914.Conclusion: CT volumetry is reliable and accurate in predicting the actual amount of the resected liver parenchyma in cirrhotic patients.

Features of Post-Resection Regeneration of Hepatocytes under the Influence of Intrahepatic Administration of Cyanocobalamin

Liver resection in most cases remains the only way to achieve an increase in life expectancy and cure of patients with large liver formations. In clinical practice, hepatoprotectors are used to improve metabolic processes of the liver, many of them include vitamin B12, the active form of which is able to stimulate reparative regeneration.The aim of the study was to identify morphological features of hepatocytes and the stroma of the resected liver during intra-organ intraoperative administration of cyanocobalamin to study the effect of vitamin B12 on the proliferative activity of hepatocytes.Material and methods. The experiment was conducted on 36 male Wistar rats. In 3 experimental groups of animals, a typical resection was performed in the volume of 70% of the initial liver mass, in the 1st experimental group, prevention of post-resection liver failure was not carried out, in the 2nd experimental group, 0.9% sodium chloride solution was injected into the preserved liver lobes after resection, in the 3rd-vitamin B12. In the animals of the 1st control group liver resection was not performed. The animals were removed from the experiment in 1, 7 and 14 days after the operation and liver material was selected for morphological examination.Results. A significant increase in the number of binuclear hepatocytes was noted in the animals of the 3rd experimental group in 14 days. When studying liver sections stained with silver impregnation after 14 days of the study, the number of reticular fibers in the animals of the 3rd experimental group was 90% higher than similar parameters in animals of the 1st control group, in the animals of the 1st and 2nd experimental groups it was less than 80%. In the immunohistochemical study, an increase in the proliferative activity of mononuclear and binuclear hepatocytes was observed in all experimental groups by the 14th day of the experiment compared with the 1st day. On the 14th day after the operation, the highest proliferation index was observed in the animals of the 3rd experimental group.Conclusion. The proposed method of intra-organ intraoperative administration of cyanocobalamin increases the proliferative activity of hepatocytes, increases the number of cells entering the mitotic cycle, and restores the structural organization of the liver, its anatomical and functional integrity.

RNA sequencing analysis reveals the competing endogenous RNAs interplay in resected liver cancer patients who received interferon-alpha therapy

Background Interferon-alpha (IFN-α) is a general therapeutic regimen to be utilized in HCC. However, regulatory mechanisms of IFN-α on competing endogenous RNAs (ceRNAs) level in HCC are rarely understood. Methods HCC patients with and without IFN-α treatment were calculated to analyze the expression profile of mRNA, lncRNA, miRNA, and circRNA by RNA sequence, and significant differential expression (DE) of these types of RNAs were screened out for the following analysis. A ceRNA regulatory network was constructed to explore effects of IFN-α intervention on HCC. Furthermore, the potential prognostic factors among these DE RNAs were identified. Results In total, 60 (0.37%) mRNAs, 23 (0.08%) circRNAs, 15 (0.11%) lncRNAs, and 23 (0.91%) miRNAs were differentially expressed in patients who received IFN-α treatment. A ceRNA regulatory network including a circRNA-miRNA-mRNA network which composed of 4 up- and 10 down-regulated circRNAs, 8 up- and 5 down-regulated miRNAs, 28 up- and 9 down-regulated mRNAs, and a lncRNA-miRNA-mRNA network which composed of 10 up- and 3 down-regulated lncRNAs, 11 up- and 5 down-regulated miRNAs, 28 up- and 10 down-regulated mRNAs was constructed. Gene enrichment and pathway analysis revealed that the ceRNA network was associated with immune-related pathway and corresponding molecular function in patients who accepted IFN-α treatment. Next, we identified 3 most relevant to IFN-α treatment to HCC among these DE RNAs, namely FAM20A,IGFBP4 and MARCH3, as the prognostic factors of HCC. Furthermore, MARCH3 expression was positively correlated with infiltrating levels of CD4 + T and CD8 + T cells, macrophages, neutrophils, and dendritic cells (DCs) in HCC. MARCH3 expression showed strong correlations with diverse immune marker sets in HCC. Conclusion Our data discovered a novel ceRNA network in HCC patients receiving IFN-α therapy, which might lay the foundation for better understand the regulatory mechanism of IFN-α treatment.

Combined liver-visceral resection for neoplastic lesions correlates with increased postoperative complications

Background: Combined liver-visceral resections (CLVRs) may impose increased risk of postoperative complications. The clinical outcome of CLVRs versus sole liver resection (SLR) has not been adequately reported from upper Egypt cancer surgery programs.Methods: Medical records of adult non-cirrhotic patients who electively underwent liver resection from February 2015 to April 2018 at Sohag University Hospital, Egypt, were retrospectively reviewed. Indications for liver resection comprised definitively malignant tumors and those with equivocal radiologic features. The severity of surgical complications, including mortality, was compared among patients who underwent CLVRs versus SLR control group with matching age, gender, number of resected liver segments, method of hepatic inflow occlusion and parenchyma transection techniques.Results: Twenty-six patients were enrolled, including 13 with CLVRs group and their 13 SLR control group. Histopathologic examination of resected specimens confirmed malignancy in 17 patients (10 in CLVR group and 7 in SLR group). Major liver resection (≥3 segments) was carried out in 14 (54%) patients, 7 per each group. The complication score was significantly higher in CLVRs (p<0.05). Similarly, the length of hospital and intensive care unit stays was significantly prolonged in CLVRs group (p<0.05). Overall, 2 patients died (8%), exclusively in the CLVRs. Elderly patients (>65 years) who underwent CLVRs exhibited increased complications compared with their matching controls.Conclusions: CLVR predisposes to increased morbidity rates and mortality. It should be carried out in carefully selected patients to avoid worse clinical outcome.