Primary combined hepatocellular-cholangiocellular sarcoma:An unusual case

Primary liver carcinosarcoma is rare. Here we report an unusual case of liver carcinosarcoma containing combined hepatocellular cholangiocarcinoma. A mass in the right liver lobe of a 45-year-old man was accidentally discovered by ultrasonic inspection and computed tomography(CT) scan. Surgical resection was performed following a diagnosis of primary liver cancer. Micropathologically, both carcinomatous and sarcomatous elements were present, and diagnosis of liver carcinosarcoma was confirmed. The carcinomatous element consisted of hepatocellular carcinoma and foci of cholangiocellular carcinoma. The sarcomatous element was composed of spindle cells and bizarre cells,as well as foci of osteosarcoma and chondrosarcoma.Hepatocellular carcinoma cells diffusely expressed both hepatocyte specific markers cytokeratin(CK)8/18 and cholangiocyte specific markers CK19, and sarcoma cells were positive for vimentin. Interestingly,both carcinomatous and sarcomatous cells expressed epithelial membrane antigen. CD117-positive ductular reactions and small undifferentiated cells were observed.A liver progenitor cell origin of the liver carcinosarcoma was proposed.

Clinical Value of Trans-parenchymal Compressing Suture to Decrease the Cutting Surface Related Complications after Non-anatomical Liver Resection

Non-anatomical liver resection with appropriate resection margin is regarded as a potential curative treatment for selected major hepatic carcinoma due to preserving maximal normal liver,especially in cirrhotic patients.But occurrence of cutting surface related complications becomes a main challenge.From June 2010 to June 2016,448 patients with major hepatic carcinoma received non-anatomical liver resection in our liver surgery center.After excluding 66 cases that were incongruent with the purpose of study,235 patients undergoing transparenchymal compressing suture(TCS)to“not good”cutting surface were allocated as study group;147 patients with exposed surface(ES)were matched as control group.The characteristics of postoperative drainage,postoperative hepatic and renal functions,hospital days,and outcomes were collected retrospectively.We further compared cutting surface related complications under different levels of liver cirrhosis between the two groups.Compared with ES group,patients in TCS group had a decreased incidence of cutting surface related complications(14.3%vs.6.8%,P=0.011)and a decreased probability of interventions for cutting surface related complications(8.2%vs.3.4%,P=0.042).TCS application was much more effective to prevent cutting surface related complications in patients with moderate and severe cirrhosis(5.4%vs.15.8%,P=0.003).Postoperative hepatic and renal function,hospita 1 days and mortality did not differ between the two groups.In conclusion,TCS decreases the probability of cutting surface related complications and postoperative interventions for related complications,especially in patients with moderate and severe cirrhosis.

Diagnosis and Treatment of Cholangiocarcinoma: A Consensus from Surgical Specialists of China

Cholangiocarcinoma refers to malignant tumors that develop in epithelial lining of biliary system, and it is divided into two categories according to tumor location, intrahepatic cholangiocarcinoma （ICC） and extrahepatic cholangiocarcinoma （ECC）. ICC occurs from the epithelial cells of the intrahepatic bile duct, its branches and interlobular biliary tree; and ECC is divided into hilar cholangiocarcinoma and distal cholangiocarcinoma by the circumscription at the confluence of cystic duct and the common hepatic duct.

A combined pre- and intra-operative nomogram in evaluation of degrees of liver cirrhosis predicts post-hepatectomy liver failure: a multicenter prospective study

Background:Adequate evaluation of degrees of liver cirrhosis is essential in surgical treatment of hepatocellular carcinoma(HCC)patients.The impact of the degrees of cirrhosis on prediction of post-hepatectomy liver failure(PHLF)remains poorly defined.This study aimed to construct and validate a combined pre-and intra-operative nomogram based on the degrees of cirrhosis in predicting PHLF in HCC patients using prospective multi-center’s data.Methods:Consecutive HCC patients who underwent hepatectomy between May 18,2019 and Dec 19,2020 were enrolled at five tertiary hospitals.Preoperative cirrhotic severity scoring(CSS)and intra-operative direct liver stiffness measurement(DSM)were performed to correlate with the Laennec histopathological grading system.The performances of the pre-operative nomogram and combined pre-and intra-operative nomogram in predicting PHLF were compared with conventional predictive models of PHLF.Results:For 327 patients in this study,histopathological studies showed the rates of HCC patients with no,mild,moderate,and severe cirrhosis were 41.9%,29.1%,22.9%,and 6.1%,respectively.Either CSS or DSM was closely correlated with histopathological stages of cirrhosis.Thirty-three(10.1%)patients developed PHLF.The 30-and 90-day mortality rates were 0.9%.Multivariate regression analysis showed four pre-operative variables[HBV-DNA level,ICG-R15,prothrombin time(PT),and CSS],and one intra-operative variable(DSM)to be independent risk factors of PHLF.The pre-operative nomogram was constructed based on these four pre-operative variables together with total bilirubin.The combined pre-and intra-operative nomogram was constructed by adding the intra-operative DSM.The pre-operative nomogram was better than the conventional models in predicting PHLF.The prediction was further improved with the combined pre-and intra-operative nomogram.Conclusions:The combined pre-and intra-operative nomogram further improved prediction of PHLF when compared with the pre-operative nomogram.