Objective:To evaluate vascular endothelial growth factor(VEGF)levels in hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization(TACE)and percutaneous ethanol injection(PEI)and its r...Objective:To evaluate vascular endothelial growth factor(VEGF)levels in hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization(TACE)and percutaneous ethanol injection(PEI)and its relation to treatment response.Methods:A total of 40 patients with unrespectable hepatocelluar carcinoma were assessed clinically.Twenty patients were suitable to be treated by TACE,while other 20patients were treated with PEI.Serum VEGF levels were measured before and 1 month after each procedure by ELISA.Response was assessed after 1 month according to Union Internationale Contre le Cancer evaluation criteria based on change in tumor size as measured by ultrasound.Results:There was no significant difference between TACE and PEI groups with regard to age,sex,tumor size,response to local therapy,or VEGF and alpha-fetoprotein before and after therapy.VEGF levels after TACE were significantly higher than before TACE[(298.1±123.6)pg/m L vs.(205.8±307.3)pg/m L;P=0.001].Also,VEGF levels were significantly higher after PEI than before PEI[(333.8±365.6)pg/m L vs.(245.3±301.8)pg/m L;P=0.000].Non-responders of both groups had significantly high VEGF levels than responder's,both before[(985.0±113.2)pg/m L vs.(117.1±75.3)pg/m L;P<0.001]and after therapy[(1 330.6±495.7)pg/m L vs.(171.0±94.7)pg/m L;P=0.000)].Conclusions:Both TACE and PEI were associated with an increase in serum VEGF in hepatocelluar carcinoma patients.Higher levels of VEGF before and after therapy were found in non-responders,suggesting that VEGF is a useful marker in predicting treatment response.展开更多
AIM： To study the expression of the inhibitor of apoptosis protein survivin in hepatocellular carcinoma （HCC）, and its correlation with clinicopathological factors, cell proliferation, recurrence and prognosis afte...AIM： To study the expression of the inhibitor of apoptosis protein survivin in hepatocellular carcinoma （HCC）, and its correlation with clinicopathological factors, cell proliferation, recurrence and prognosis after hepatectomy. METHODS： Immunohistochemical staining of survivin and Ki-67 was performed by the standard streptavidin- peroxidase technique on paraffin sections of 55 cases of HCC. RESULTS： The positive rate of survivin in HCC was 52.7% （29/55）. Significant correlation was found between survivin expression with portal vein thrombi and intrahepatic matastasistic nodes （P 〈 0.05）. The recurrent rate in survivin-positive HCC was significantly higher than that in survivin-negative HCC after hepatectomy, the 1- and 3-year survival rate in patients with survivin-positive tumors was significantly lower than that in patients with survivin-negative tumors （58.62 and 10.34% vs 76.92 and 30.77%, P 〈 0.05, log-rank test）. The proliferation index （Ki-67） in survivin-positive HCC （33.83% ± 18.90%） was significantly higher than that in survivin-negative HCC （19.60% ± 19.35%） （P 〈 0.05）. CONCLUSION： Survivin may play an important role in progression of HCC by promoting cell proliferation, and may be positively correlated with high risk of disease recurrence and poor prognosis in HCC. Its expression may serve as a prognostic factor for patients with HCC after hepatectomy.展开更多
To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） and TACE alone for hepatocellular carcinoma （HCC）, Pubmed, Cochrane Library, Web...To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） and TACE alone for hepatocellular carcinoma （HCC）, Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI） and Wanfang Datebases were searched for the randomized controlled trials （RCTs） and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were under- taken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously as- sociated with higher 1-, 2-, and 3-year overall survival rates （OR1-year=3.98, 95% CI 2.87-5.51, P〈0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P〈0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P〈0.00001） than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone （OR=13.86, 95% CI 8.04-23.89, P〈0.00001）. And there was a significant difference in local recurrence rate between two different kinds of treatment （OR=0.24, 95%CI 0.14-0.44, P〈0.00001）. Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy TACE-plus-RFA treatment was associated with a higher response rate （RR） than the TACE-alone treat- ment （OR=3.90, 95% CI=2.37-5.42, P〈0.00001）. TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease （SD） rate （OR=0.38, 95% CI=0.11-1.26, P=-0.11）. Meta-analyses showed that the combination of RFA and TACE was associated with a significantly lower progressive disease （PD） rate （OR=0.15, 95% CI=0.05M3.43, P=-0.0005）. The rate of AFP reduc- ing or returning to normal in serum in RFA plus TACE group was obviously lower than TACE alone group （OR=4.62, 95% CI 2.56-8.34, P〈0.00001）. The effect of TACE plus RFA for HCC is better than TACE mono-therapy. The combined therapy can elevate the patients＇ overall survival rate, tumor ne- crosis rate and the rate of AFP reducing or returning to normal in serum and decrease local recurrence rate, PD rate compared with TACE alone.展开更多
AIM: To investigate the capability of multidetector CT (MDCT) to diagnose HCC-associated arterioportal shunt (APS).METHODS: Two hundred and eighty-two patients with HCC received both thin-slice and enhancement MDCT sc...AIM: To investigate the capability of multidetector CT (MDCT) to diagnose HCC-associated arterioportal shunt (APS).METHODS: Two hundred and eighty-two patients with HCC received both thin-slice and enhancement MDCT scanning at early hepatic arterial phase, late hepatic arterial phase and portal venous phase, and digital subtract angiography (DSA) examination. Images were analyzed jointly by two experienced radiologists blinded to the opposite examination results, including the existence or not of APS, shunt locations, types and degrees of APS, with or without thrombosis. RESULTS: There were 56 APS associated with HCC, including 48 central, seven peripheral and one mixed, or 42 severe, seven moderate, seven mild APS. Fortyone severe, seven moderate and central APS were all revealed with MDCT and DSA. Seven mild and peripheral APS were all displayed with MDCT; only five of them displayed DSA, two faint shunt APS associated with massive HCC were missed. One mixed APS was demonstrated as severe combined with mild shunt with both MDCT and DSA.CONCLUSION: MDCT could diagnose not only DSA revealed APS, but also missed mild and peripheral APS with DSA due to faint shunt associated with massive HCC, is a simple, effective and noninvasive new technique for diagnosis of HCC-associated APS.展开更多
Chronic hepatitis B virus(HBV)infection is the key driving force of liver disease progression,resulting in the development of hepatic dysfunction,cirrhosis and hepatocellular carcinoma(HCC).The primary aim of therapy ...Chronic hepatitis B virus(HBV)infection is the key driving force of liver disease progression,resulting in the development of hepatic dysfunction,cirrhosis and hepatocellular carcinoma(HCC).The primary aim of therapy is to suppress or eliminate HBV replication to reduce the activity of hepatitis,thus reducing the risk of,or slowing the progression of,liver disease.Nucleos(t)ide analogues(Nucs)may result in rapid suppression of HBV replication with normalization of serum transaminases and restore liver function,thus increasing survival in patients with hepatic decompensation.Long-term Nuc therapy may result in histological improvement or reversal of advanced fibrosis and reduction in disease progression,including the development of HCC.The long-term benefits of a finite course of interferon(IFN)-αtherapy also include a sustained and cumulative response,as well as hepatitis B surface antigen seroclearance and reduction in the development of cirrhosis and/or HCC.Pegylated IFN and newer Nucs may achieve better long-term outcomes because of improved efficacy and a low risk of drug resistance.However,treatment outcomes are still far from satisfactory.Understanding the effects of anti-HBV treatment against HCC incidence and recurrence after hepatectomy or liver transplantation is required for further improvement of outcome.展开更多
Summary: To comparatively investigate ultrastructural characteristics and expressions of AFP (alpha-fetoprotein) and Tn (Thomsen-Friedenreich-related antigen) protein in AFP negative (AFP-) and AFP positive (AFP+) pri...Summary: To comparatively investigate ultrastructural characteristics and expressions of AFP (alpha-fetoprotein) and Tn (Thomsen-Friedenreich-related antigen) protein in AFP negative (AFP-) and AFP positive (AFP+) primary hepatocellular carcinoma. Fourty-three cases of AFP-and AFP+ hepatocellular carcinoma (HCC) tissues and five cases of normal liver tissues were divided into three groups: control group (normal liver tissue, n=5); AFP+ HCC group (the serum AFP level was higher than 10 ng/ml, n = 22); AFP-HCC group (the serum AFP level was lower than 10 ng/ml, n=21). The ultrastructural morphology was studied by transmission electron microscopy, the expressions of AFP and Tn protein were detected by immunohistochemistry and cell image analysis. 1. The immunohistochemical study showed that (1) the expression intensity and positive rate of Tn protein in AFP-HCC group were markedly higher than that in AFP+ HCC group (P<~0.01); (2) The expression intensity of AFP in AFP-HCC group was lower than that in AFP+ HCC group (P<0.01). 2. The transmission electron microscopy demonstrated that some AFP-HCC cells linked closely with each other, others dispersed loosely just as cultured cells, the remarkable morphologic features in AFP-HCC cells were simple organelles, but they were abundant in the free polyribosomes. In AFP+ HCC group, all the HCC cells linked closely together and were rich organelles in their cytoplasm, especially the rough endoplasmic reticula. In addition, mitochondria and Golgi complex were obviously observed. (1) The AFP and Tn protein had discrepancy distribution in AFP-and AFP+ HCC tissues, Tn protein may be one of the early diagnostic indicators in AFP-HCC; (2) The synthetic locations of the AFP and Tn protein were different in hepatocarcinoma cells by ultrastructural observation.展开更多
Hepatocellular carcinoma （HCC） is a so highly invasive tumor that metastasizes hematogenously and lymphogenously to distant site. Frequent sites are lung, regional lymph node, bone, and adrenal gland. But metastasis...Hepatocellular carcinoma （HCC） is a so highly invasive tumor that metastasizes hematogenously and lymphogenously to distant site. Frequent sites are lung, regional lymph node, bone, and adrenal gland. But metastasis to the gastrointestinal （GI） tract is rare, and most common site is stomach. Metastasis to the small intestine is extremely rare. Moreover, metastatic HCC of the small bowel causing intussusception has not been reported until now. Here, we report a case of metastasis of HCC to the small bowel manifested by intussusception.展开更多
Hepatocellular carcinoma （HCC） metastasizes to the mandible is infrequently seen. Solitary bony metastasis to the mandible is rarer. The intractable bleeding caused by rupture of the metastatic HCC is challenging to...Hepatocellular carcinoma （HCC） metastasizes to the mandible is infrequently seen. Solitary bony metastasis to the mandible is rarer. The intractable bleeding caused by rupture of the metastatic HCC is challenging to clinicians. We present a case of a 74-year-old woman with HCC under control without progression for 3 years. Left facial swelling and episodes of bleeding developed recently and biopsy revealed a metastatic HCC. Computer tomography showed a large tumor in parapharyngeal space with evident mandibular ramus destruction. Bleeding occurred from the metastatic tumor but could not be controlled by electrocauterization, SurgicelTM, tissue glue, and bone wax and angiographic embolization. Palliative radiotherapy （2400 cGy in 6 fractions） was tried and the intractable bleeding was successfully stopped after the radiotherapy. Because of the hypervascular and osteolytic nature of the solitary mandibular metastatic lesion, the bleeding was troublesome. Radiotherapy provided successful control of intractable bleeding from the metastatic tumor.展开更多
Sorafenib,a multikinase inhibitor,is the first and only drug,which improves significantly the overall survival in patients with advanced hepatocellular carcinoma(HCC).However,many patients experience diverse side effe...Sorafenib,a multikinase inhibitor,is the first and only drug,which improves significantly the overall survival in patients with advanced hepatocellular carcinoma(HCC).However,many patients experience diverse side effects,some of them severe and unexpected.To date,acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib.Here,we report the case of a 43-yearold woman with hepatitis C virus-related advanced HCC.She received sorafenib,and later complained ofa sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense.Laboratory examination showed mild elevation of transaminases,biliary enzymes,bilirubin,inflammation markers,and a marked peripheral eosinophilia.Abdominal computed tomography(CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris.Consequently,sorafenib treatment was stopped immediately,and steroid-pulse therapy was performed.Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings,eosinophilia,and liver functions.In summary,we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.展开更多
文摘Objective:To evaluate vascular endothelial growth factor(VEGF)levels in hepatocellular carcinoma patients before and after transcatheter arterial chemoembolization(TACE)and percutaneous ethanol injection(PEI)and its relation to treatment response.Methods:A total of 40 patients with unrespectable hepatocelluar carcinoma were assessed clinically.Twenty patients were suitable to be treated by TACE,while other 20patients were treated with PEI.Serum VEGF levels were measured before and 1 month after each procedure by ELISA.Response was assessed after 1 month according to Union Internationale Contre le Cancer evaluation criteria based on change in tumor size as measured by ultrasound.Results:There was no significant difference between TACE and PEI groups with regard to age,sex,tumor size,response to local therapy,or VEGF and alpha-fetoprotein before and after therapy.VEGF levels after TACE were significantly higher than before TACE[(298.1±123.6)pg/m L vs.(205.8±307.3)pg/m L;P=0.001].Also,VEGF levels were significantly higher after PEI than before PEI[(333.8±365.6)pg/m L vs.(245.3±301.8)pg/m L;P=0.000].Non-responders of both groups had significantly high VEGF levels than responder's,both before[(985.0±113.2)pg/m L vs.(117.1±75.3)pg/m L;P<0.001]and after therapy[(1 330.6±495.7)pg/m L vs.(171.0±94.7)pg/m L;P=0.000)].Conclusions:Both TACE and PEI were associated with an increase in serum VEGF in hepatocelluar carcinoma patients.Higher levels of VEGF before and after therapy were found in non-responders,suggesting that VEGF is a useful marker in predicting treatment response.
文摘AIM： To study the expression of the inhibitor of apoptosis protein survivin in hepatocellular carcinoma （HCC）, and its correlation with clinicopathological factors, cell proliferation, recurrence and prognosis after hepatectomy. METHODS： Immunohistochemical staining of survivin and Ki-67 was performed by the standard streptavidin- peroxidase technique on paraffin sections of 55 cases of HCC. RESULTS： The positive rate of survivin in HCC was 52.7% （29/55）. Significant correlation was found between survivin expression with portal vein thrombi and intrahepatic matastasistic nodes （P 〈 0.05）. The recurrent rate in survivin-positive HCC was significantly higher than that in survivin-negative HCC after hepatectomy, the 1- and 3-year survival rate in patients with survivin-positive tumors was significantly lower than that in patients with survivin-negative tumors （58.62 and 10.34% vs 76.92 and 30.77%, P 〈 0.05, log-rank test）. The proliferation index （Ki-67） in survivin-positive HCC （33.83% ± 18.90%） was significantly higher than that in survivin-negative HCC （19.60% ± 19.35%） （P 〈 0.05）. CONCLUSION： Survivin may play an important role in progression of HCC by promoting cell proliferation, and may be positively correlated with high risk of disease recurrence and poor prognosis in HCC. Its expression may serve as a prognostic factor for patients with HCC after hepatectomy.
文摘To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） and TACE alone for hepatocellular carcinoma （HCC）, Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI） and Wanfang Datebases were searched for the randomized controlled trials （RCTs） and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were under- taken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously as- sociated with higher 1-, 2-, and 3-year overall survival rates （OR1-year=3.98, 95% CI 2.87-5.51, P〈0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P〈0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P〈0.00001） than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone （OR=13.86, 95% CI 8.04-23.89, P〈0.00001）. And there was a significant difference in local recurrence rate between two different kinds of treatment （OR=0.24, 95%CI 0.14-0.44, P〈0.00001）. Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy TACE-plus-RFA treatment was associated with a higher response rate （RR） than the TACE-alone treat- ment （OR=3.90, 95% CI=2.37-5.42, P〈0.00001）. TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease （SD） rate （OR=0.38, 95% CI=0.11-1.26, P=-0.11）. Meta-analyses showed that the combination of RFA and TACE was associated with a significantly lower progressive disease （PD） rate （OR=0.15, 95% CI=0.05M3.43, P=-0.0005）. The rate of AFP reduc- ing or returning to normal in serum in RFA plus TACE group was obviously lower than TACE alone group （OR=4.62, 95% CI 2.56-8.34, P〈0.00001）. The effect of TACE plus RFA for HCC is better than TACE mono-therapy. The combined therapy can elevate the patients＇ overall survival rate, tumor ne- crosis rate and the rate of AFP reducing or returning to normal in serum and decrease local recurrence rate, PD rate compared with TACE alone.
文摘AIM: To investigate the capability of multidetector CT (MDCT) to diagnose HCC-associated arterioportal shunt (APS).METHODS: Two hundred and eighty-two patients with HCC received both thin-slice and enhancement MDCT scanning at early hepatic arterial phase, late hepatic arterial phase and portal venous phase, and digital subtract angiography (DSA) examination. Images were analyzed jointly by two experienced radiologists blinded to the opposite examination results, including the existence or not of APS, shunt locations, types and degrees of APS, with or without thrombosis. RESULTS: There were 56 APS associated with HCC, including 48 central, seven peripheral and one mixed, or 42 severe, seven moderate, seven mild APS. Fortyone severe, seven moderate and central APS were all revealed with MDCT and DSA. Seven mild and peripheral APS were all displayed with MDCT; only five of them displayed DSA, two faint shunt APS associated with massive HCC were missed. One mixed APS was demonstrated as severe combined with mild shunt with both MDCT and DSA.CONCLUSION: MDCT could diagnose not only DSA revealed APS, but also missed mild and peripheral APS with DSA due to faint shunt associated with massive HCC, is a simple, effective and noninvasive new technique for diagnosis of HCC-associated APS.
文摘Chronic hepatitis B virus(HBV)infection is the key driving force of liver disease progression,resulting in the development of hepatic dysfunction,cirrhosis and hepatocellular carcinoma(HCC).The primary aim of therapy is to suppress or eliminate HBV replication to reduce the activity of hepatitis,thus reducing the risk of,or slowing the progression of,liver disease.Nucleos(t)ide analogues(Nucs)may result in rapid suppression of HBV replication with normalization of serum transaminases and restore liver function,thus increasing survival in patients with hepatic decompensation.Long-term Nuc therapy may result in histological improvement or reversal of advanced fibrosis and reduction in disease progression,including the development of HCC.The long-term benefits of a finite course of interferon(IFN)-αtherapy also include a sustained and cumulative response,as well as hepatitis B surface antigen seroclearance and reduction in the development of cirrhosis and/or HCC.Pegylated IFN and newer Nucs may achieve better long-term outcomes because of improved efficacy and a low risk of drug resistance.However,treatment outcomes are still far from satisfactory.Understanding the effects of anti-HBV treatment against HCC incidence and recurrence after hepatectomy or liver transplantation is required for further improvement of outcome.
文摘Summary: To comparatively investigate ultrastructural characteristics and expressions of AFP (alpha-fetoprotein) and Tn (Thomsen-Friedenreich-related antigen) protein in AFP negative (AFP-) and AFP positive (AFP+) primary hepatocellular carcinoma. Fourty-three cases of AFP-and AFP+ hepatocellular carcinoma (HCC) tissues and five cases of normal liver tissues were divided into three groups: control group (normal liver tissue, n=5); AFP+ HCC group (the serum AFP level was higher than 10 ng/ml, n = 22); AFP-HCC group (the serum AFP level was lower than 10 ng/ml, n=21). The ultrastructural morphology was studied by transmission electron microscopy, the expressions of AFP and Tn protein were detected by immunohistochemistry and cell image analysis. 1. The immunohistochemical study showed that (1) the expression intensity and positive rate of Tn protein in AFP-HCC group were markedly higher than that in AFP+ HCC group (P<~0.01); (2) The expression intensity of AFP in AFP-HCC group was lower than that in AFP+ HCC group (P<0.01). 2. The transmission electron microscopy demonstrated that some AFP-HCC cells linked closely with each other, others dispersed loosely just as cultured cells, the remarkable morphologic features in AFP-HCC cells were simple organelles, but they were abundant in the free polyribosomes. In AFP+ HCC group, all the HCC cells linked closely together and were rich organelles in their cytoplasm, especially the rough endoplasmic reticula. In addition, mitochondria and Golgi complex were obviously observed. (1) The AFP and Tn protein had discrepancy distribution in AFP-and AFP+ HCC tissues, Tn protein may be one of the early diagnostic indicators in AFP-HCC; (2) The synthetic locations of the AFP and Tn protein were different in hepatocarcinoma cells by ultrastructural observation.
文摘Hepatocellular carcinoma （HCC） is a so highly invasive tumor that metastasizes hematogenously and lymphogenously to distant site. Frequent sites are lung, regional lymph node, bone, and adrenal gland. But metastasis to the gastrointestinal （GI） tract is rare, and most common site is stomach. Metastasis to the small intestine is extremely rare. Moreover, metastatic HCC of the small bowel causing intussusception has not been reported until now. Here, we report a case of metastasis of HCC to the small bowel manifested by intussusception.
文摘Hepatocellular carcinoma （HCC） metastasizes to the mandible is infrequently seen. Solitary bony metastasis to the mandible is rarer. The intractable bleeding caused by rupture of the metastatic HCC is challenging to clinicians. We present a case of a 74-year-old woman with HCC under control without progression for 3 years. Left facial swelling and episodes of bleeding developed recently and biopsy revealed a metastatic HCC. Computer tomography showed a large tumor in parapharyngeal space with evident mandibular ramus destruction. Bleeding occurred from the metastatic tumor but could not be controlled by electrocauterization, SurgicelTM, tissue glue, and bone wax and angiographic embolization. Palliative radiotherapy （2400 cGy in 6 fractions） was tried and the intractable bleeding was successfully stopped after the radiotherapy. Because of the hypervascular and osteolytic nature of the solitary mandibular metastatic lesion, the bleeding was troublesome. Radiotherapy provided successful control of intractable bleeding from the metastatic tumor.
文摘Sorafenib,a multikinase inhibitor,is the first and only drug,which improves significantly the overall survival in patients with advanced hepatocellular carcinoma(HCC).However,many patients experience diverse side effects,some of them severe and unexpected.To date,acute acalculous cholecystitis has not been documented in association with a HCC patient treated with sorafenib.Here,we report the case of a 43-yearold woman with hepatitis C virus-related advanced HCC.She received sorafenib,and later complained ofa sudden onset of severe right hypocondrial pain with rebound tenderness and muscle defense.Laboratory examination showed mild elevation of transaminases,biliary enzymes,bilirubin,inflammation markers,and a marked peripheral eosinophilia.Abdominal computed tomography(CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or debris.Consequently,sorafenib treatment was stopped immediately,and steroid-pulse therapy was performed.Steroid therapy drastically improved all clinical manifestations along with normalization of CT findings,eosinophilia,and liver functions.In summary,we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.
