Primary hepatic neuroendocrine carcinoma:clinical analysis of 11 cases

BACKGROUND: Primary hepatic neurocridocrine carcinoma (PHNEC) is extremely rare, and fewer than 300 cases have been reported in the English/Chinese-language literature, therefore it is difficult to make a proper diagnosis and determine a therapeutic approach. METHODS: Eleven PHNEC patients were admitted to our hospital between January 1996 and May 2008. Laboratory examination, digestive endoscopy, B-ultrasonography, CT, MRI, or PET-CT were performed on the patients for preoperative diagnosis. All patients received liver resection. Some patients received transcatheter arterial chemoembolization (TACE), percutaneous ethanol injection treatment (PEIT), or octreotide injection when a recurrence was found. The patients' clinical data were recorded and all patients were followed up. RESULTS: The patients were confirmed pathologically as having PHNEC. Their median follow-up time was 33 months (12-107 months). All patients survived, and the longest postoperative survival time was 107 months, the longest disease-free survival time was 98 months, the 1-year survival rate was 100%, and the 1-year recurrence rate was 45.5% (5/11). CONCLUSIONS: Since PHNEC is easy to confuse with hepatocellular carcinoma, careful screening of symptoms is needed to avoid misdiagnosis. Resection is the first choice of treatment for PHNEC and provides the most favorable outcomes including long-term survival. Other treatment such as TACE and PEIT can be considered as well, especially when a tumor recurs.

Risk factors for early recurrence of small hepatocellular carcinoma after curative resection

BACKGROUND: Poorer prognosis is seen in patients with hepatocellular carcinoma (HCC) after curative hepatic resection with early recurrence (<= 1 year) than in those with late recurrence (>1 year). This study aimed to identify risk factors for postoperative early recurrence of small HCC (<= 3 cm in diameter). METHODS: The study population consisted of 158 patients who underwent curative resection for small HCC between January 2002 and July 2004. Risk factors for early recurrence were analyzed. RESULTS: Thirty-three (20.8%) patients developed early recurrence after surgery. Univariate analysis showed the following significant risk factors for early recurrence in small HCC: serum alpha-fetoprotein (AFP) level >100 ng/ml, lack of tumor capsule formation, microscopic vascular invasion, high Edmonson-Steiner grades, and cytokeratin-19 (CK-19) expression (P<0.05). Multivariate stepwise logistic regression analysis showed that serum AFP level >100 ng/ml (odds ratio 2.561, 95% confidence interval 1.057 to 6.206, P=0.037) and microscopic vascular invasion (odds ratio 4.549, 95% confidence interval 1.865 to 11.097, P=0.001) were independent factors. CONCLUSIONS: Postoperative early recurrence is related to serum AFP level >100 ng/ml and microscopic vascular invasion in patients with small HCC. Adjuvant therapy and careful follow-up are required for patients with these risk factors.

Clinical features of hepatic angiomyolipoma

BACKGROUND: Hepatic angiomyolipoma (HAML) is a rare hepatic mesenchymal tumor. This study was designed to explore its clinical features. METHODS: Clinical data from 26 patients who had been pathologically confirmed with HAML and had received surgical resection at our hospital were analyzed retrospectively. RESULTS: HAML was seen more frequently in females (18/26) in this series, and most of the patients presented no significant symptoms except for one who had a spontaneous rupture hemorrhage. Serum alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were negative in all patients. Imaging presentations were diverse. Pre-operative diagnosis was made in only 3 patients. Pathological study showed that the tumor was composed of adipose tissue, smooth muscle and blood vessels in different proportions. One patient showed hepatic vessel invasion. HMB-45 immunohistochemical staining was positive in all tumors. All patients underwent surgical resection without significant complications. Except for one patient who died 14 months after operation because of recurrent disease, no tumor recurrence was observed in the remaining 25 patients during a 2-3 years follow-up. CONCLUSIONS: Pre-operative diagnosis of HAML is difficult. There are potential risks of spontaneous rupture and malignant transformation. Surgical resection is the treatment of choice for HAML.

Clinical features of solitary necrotic nodule of the liver

BACKGROUND: Solitary necrotic nodule of the liver is a rare nonmalignant lesion. The present study aimed to clarify the clinical features of the disease. METHOD: The medical records of 51 patients with histologically confirmed solitary necrotic nodule of the liver who received surgical resection at our institution were retrospectively reviewed. RESULTS: Solitary necrotic nodule of the liver was found mainly in males (68.6%, 35/51), and patients ranged in age from 5 to 69 years with a mean of 45.3. Most of the patients (72.5%) had no significant symptoms, with negative results for the serum tumor markers alpha-fetoprotein, carbohydrate antigen 19-9 and carcinoembryonic antigen. The mean diameter of the nodule was 23 mm (range 10-55 mm). Compared with ultrasonographic and computed tomography findings, the specific features of magnetic resonance imaging were more helpful for differential diagnosis of the disease. CONCLUSIONS: Solitary necrotic nodule of the liver is a rare nonmalignant lesion, showing no notable symptoms and potential complications. The pathological change of the disease is not significant over a lifetime. Conservative treatment and clinical follow-up are recommended.

Combined hepatocellular carcinoma and cholangiocarcinoma:a case report and review of the literature

BACKGROUND: combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC) is a rare histopathologic form of primary liver cancer. We report a case of cHCC-CC and review the literature. METHOD: The clinicopathological features of a 61-year-old male were retrospectively analyzed. RESULTS: Hepatocellular carcinoma (HCC) was preoperatively considered on the basis of clinical findings resembling those associated with HCC. Hepatectomy was therefore performed. Microscopically, the specimen displayed histological features of cHCC-CC. The patient has remained alive after follow-up for 3 months without evidence of recurrence and metastasis. CONCLUSION: It is difficult to make a correct preoperative diagnosis of cHCC-CC and hepatic resection is the treatment of choice.

Pivotal Roles of the Phytochrome-Interacting Factors in Cryptochrome Signaling

Light,as both energy source and informational signal,profoundlyinfluences plant growth and development during the whole lifespan from seed germination to flowering.Plant senses lightthrough multiple photoreceptors including the blue/UV-A photo-receptors cryptochromes （CRY,CRY1/2） and phototropins（PHOT,PHOT1/2）,the red/far-red photoreceptors phytochromes（PHY,phyA-E）,and the UV-B photoreceptor UVR8.In Arabidop-sis,both CRY and PHY are involved in mediating light regulationof hypocotyl elongation,cotyledon/leaf expansion,anthocyaninaccumulation,flowering,stomatal development,and light entrainment of the circadian clock.