Regression of recurrent granulosa cell tumor liver metastases following selective internal radiation therapy

Granulosa cell tumor(GCT)is the most common sex cordstromal tumor,comprising 5%of all ovarian malignancies[1].The disease course is indolent,and the majority of cases present at stage 1.However,metastases may develop with potential sites being peritoneum,lung,brain,liver and bone[2].Due to the rarity of the disease,published evidence for management of granulosa cell tumor liver metastases(GCTLM)is limited.Surgical resection is the optimal treatment in instances where there is a high chance of achieving complete resection[3].With regards to unresectable GCTLM there is a paucity of evidence to guide treatment strategy.

Pigmented well-differentiated hepatocellular neoplasm with β-catenin mutation

ABSTRACT： According to the most recent WHO classification of hepatocellular adenomas, a small percentage of inflammatory hepatocellular adenomas presents with mutation in the β-catenin gene and are at higher risk of malignant transformation. It has been recognized that adenoma-like hepatocellular neoplasms with focal atypia, or in unusual clinical context present with similar cytogenetic and immunohistochemistry characteristics to well-differentiated hepatocellular carcino- mas.

Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation

AIM To determine the impact of Charlson comorbidity index(CCI) on waiting list(WL) and post liver retransplantation(LRT) survival.METHODS Comparative study of all adult patients assessed for primary liver transplant(PLT)(n = 1090) and patients assessed for LRT(n = 150), 2000-2007 at our centre. Demographic, clinical and laboratory variables were recorded. RESULTS Median age for all patients was 53 years and 66% were men. Median model for end stage liver disease(MELD) score was 15. Median follow-up was 7- years. For retransplant patients, 84(56%) had ≥ 1 comorbidity. The most common comorbidity was renal impairment in 66(44.3%). WL mortality was higher in patients with ≥ 1 comorbidity(76% vs 53%, P = 0.044). CCI(OR = 2.688, 95%CI: 1.222-5.912, P = 0.014) was independently associated with WL mortality. Patients with MELD score ≥ 18 had inferior WL survival(LogRank 6.469, P = 0.011). On multivariate analysis,CCI(OR = 2.823, 95%CI: 1.563-5101, P = 0.001), MELD score ≥ 18(OR 2.506, 95%CI: 1.044-6.018, P = 0.04), and requirement for organ support prior to LRT(P < 0.05) were associated with reduced post-LRT survival. Donor/graft parameters were not associated with survival(P = NS). Post-LRT mortality progressively increased according to the number of transplanted grafts(Log-Rank 18.455, P < 0.001). Post-LRT patient survival at 1-, 3- and 5-years were significantly inferior to those of PLT at 88% vs 73%, P < 0.001, 81% vs 71%, P = 0.018 and 69% vs 55%, P = 0.006, respectively. CONCLUSION Comorbidity increases WL and post-LRT mortality. Patients with MELD ≥ 18 have increased WL mortality. Patients with comorbidity or MELD ≥ 18 may benefit from earlier LRT. LRT for ≥ 3 grafts may not represent appropriate use of donated grafts.