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Akutsu N, Kawakami Y, Numata Y, Hirano T, Wagatsuma K, Ishigami K, Sasaki S, Nakase H. A case of hepatocellular carcinoma with long-term survival by multidisciplinary treatment for cranial and skeletal muscle metastases. Clin J Gastroenterol 2022; 15:960-967. [DOI: 10.1007/s12328-022-01669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
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KOUTSERIMPAS C, DARGARAS N, NAOUM S, ARKOUDIS NA, BAFALOUKOS D, KOUREA H, SAMONIS G. Soleus Muscle Single Metastasis from Hepatocellular Carcinoma. MAEDICA 2022; 17:714-719. [PMID: 36540597 PMCID: PMC9720651 DOI: 10.26574/maedica.2022.17.3.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Extrahepatic metastases of hepatocellular carcinoma (HCC) are associated with poor prognosis, while such lesions in skeletal muscles are extremely rare. A unique case of skeletal metastasis in the soleus muscle in a 76-year-old male patient with HCC is reported. The patient presented with a painful palpable mass in his left calf. Magnetic resonance imaging (MRI) revealed a contrast-enhancing lesion in the soleus muscle, while core needle biopsy showed metastatic lesion from the HCC. Due to the poor overall condition of the patient, no further treatment was performed, while he passed away three months later. Hepatocellular carcinoma represents an aggressive tumor, with poor prognosis, especially in cases of extra-hepatic metastases. Such lesions have a reported incidence of about 15%. Extra-hepatic metastasis to the skeletal muscles is extremely rare, with only 21 more such cases reported in the literature so far. No clear therapeutic strategies exist for such cases. Thus, it is of utmost importance to detect similar cases in early stages for a possible better prognosis and clearer understanding of the therapeutic options, including surgical and loco-regional treatments.
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Affiliation(s)
- Christos KOUTSERIMPAS
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Greece
| | - Nikolaos DARGARAS
- Department of Anesthesiology, “251” Hellenic Air Force General Hospital of Athens, Greece
| | - Symeon NAOUM
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, Greece
| | | | | | - Helen KOUREA
- Department of Pathology, University of Patras School of Medicine, Patras, Greece
| | - George SAMONIS
- First Oncology Department, Metropolitan Hospital, Neon Faliron, Athens, Greece,Department of Medicine, University of Crete, Heraklion, Greece
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Nakayama A, Arai J, Otoyama Y, Sugiura I, Nakajima Y, Kajiwara A, Ichikawa Y, Uozumi S, Shimozuma Y, Uchikoshi M, Sakaki M, Tazawa S, Shiozawa E, Yamochi T, Takimoto M, Yoshida H. Muscular Metastasis of Hepatocellular Carcinoma: Case Report and Literature Review. Intern Med 2022; 61:189-196. [PMID: 34219106 PMCID: PMC8851169 DOI: 10.2169/internalmedicine.7200-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There are few case reports of hepatocellular carcinoma (HCC) metastasis to the skeletal muscle. A 78-year-old man developed a mass in the right shoulder. Washout of contrast medium during contrast-enhanced ultrasonography (CEUS) in both the primary HCC and the metastatic site was detected. Several nodules were scattered throughout the liver on an autopsy. In addition, the moderately differentiated HCC had metastasized to the right teres major muscle. Rare muscular metastasis should be considered if a hepatic tumor is moderately or poorly differentiated HCC. Early washout during CEUS is consistent with a pathological diagnosis of moderately or poorly differentiated HCC.
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Affiliation(s)
- Akihiro Nakayama
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Jun Arai
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Yumi Otoyama
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Ikuya Sugiura
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Yoko Nakajima
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Atsushi Kajiwara
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Yuki Ichikawa
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Shojiro Uozumi
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Yuu Shimozuma
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Manabu Uchikoshi
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Masashi Sakaki
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
| | - Sakiko Tazawa
- Division of Pathology, Department of Medicine, Showa University School of Medicine, Japan
| | - Eisuke Shiozawa
- Division of Pathology, Department of Medicine, Showa University School of Medicine, Japan
| | - Toshiko Yamochi
- Division of Pathology, Department of Medicine, Showa University School of Medicine, Japan
| | - Masafumi Takimoto
- Division of Pathology, Department of Medicine, Showa University School of Medicine, Japan
| | - Hitoshi Yoshida
- Department of Medicine, Division of Gastroenterology, Showa University School of Medicine, Japan
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Karbownik A, Stanisławiak-Rudowicz J, Stachowiak A, Romański M, Grześkowiak E, Szałek E. The Influence of Paracetamol on the Penetration of Sorafenib and Sorafenib N-Oxide Through the Blood-Brain Barrier in Rats. Eur J Drug Metab Pharmacokinet 2020; 45:801-808. [PMID: 32776310 PMCID: PMC7677279 DOI: 10.1007/s13318-020-00639-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Objective Sorafenib is an oral, multikinase inhibitor with established single-agent activity in several tumor types. Sorafenib was moderately transported by P-glycoprotein (P-gp) and more efficiently by breast cancer resistance protein. The constitutive androstane receptor (CAR) is a ligand-activated transcription factor involved in P-gp regulation in the brain microvasculature. Paracetamol is a CAR activator. The purpose of this study was to investigate the effect of paracetamol on the brain uptake of sorafenib and sorafenib N-oxide. Methods The rats were assigned to two groups—rats receiving oral paracetamol 100 mg/kg and sorafenib 100 mg/kg (n = 42, ISR+PA) and rats receiving oral vehicle and sorafenib 100 mg/kg (n = 42, IISR). The sorafenib and sorafenib N-oxide concentrations in blood plasma and brain tissue were determined by a high-performance liquid chromatography method with ultraviolet detection. Brain-to-plasma partition coefficient (Kp) was calculated as a ratio of the area under the curve from zero to 24 h (AUC) in the brain and plasma. A drug targeting index (DTI) was estimated as the group ISR+PAKp to group IISRKp ratio. Results Pharmacokinetic analysis revealed increased brain exposure to sorafenib and sorafenib N-oxide after co-administration of paracetamol. The brain maximum concentration (Cmax) and the AUC of the parent drug in the ISR+PA group compared with the IISR group were greater by 49.5 and 77.8%, respectively, and the same parameters for the metabolite were higher by 51.4 and 50.9%. However, the Kp values of sorafenib and sorafenib N-oxide did not differ significantly between the two animal groups and the DTI values were close to 1. Conclusion Paracetamol increases exposure to sorafenib and sorafenib N-oxide in the brain, likely due to increased exposure in plasma.
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Affiliation(s)
- Agnieszka Karbownik
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 14 Św. Marii Magdaleny Str., 61-861, Poznan, Poland.
| | - Joanna Stanisławiak-Rudowicz
- Department of Gynecological Oncology, University Hospital of Lord's Transfiguration, 82/84 Szamarzewskiego Str., 60-569, Poznan, Poland
| | - Anna Stachowiak
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 14 Św. Marii Magdaleny Str., 61-861, Poznan, Poland
| | - Michał Romański
- Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, 6 Święcickiego Str., 60-781, Poznan, Poland
| | - Edmund Grześkowiak
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 14 Św. Marii Magdaleny Str., 61-861, Poznan, Poland
| | - Edyta Szałek
- Department of Clinical Pharmacy and Biopharmacy, Poznan University of Medical Sciences, 14 Św. Marii Magdaleny Str., 61-861, Poznan, Poland
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Lee CH, Chang CJ, Lin YJ, Yen CL, Shen CH, Cheng YT, Lin CC, Hsieh SY. Nomogram predicting extrahepatic metastasis of hepatocellular carcinoma based on commonly available clinical data. JGH OPEN 2018; 3:38-45. [PMID: 30834339 PMCID: PMC6386739 DOI: 10.1002/jgh3.12102] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 09/15/2018] [Accepted: 09/29/2018] [Indexed: 12/13/2022]
Abstract
Background and Aim Extrahepatic metastasis (EHM) of hepatocellular carcinoma (HCC) leads to a worse prognosis. We aimed to develop a nomogram based on noninvasive pretreatment clinical data to predict EHM of HCC sooner. Methods Three cohorts containing 1820, 479, and 988 HCC patients were enrolled from three hospitals in different regions in Taiwan and served as the training and validation cohorts. Pretreatment clinical data were analyzed by Cox regression modeling for independent risk factors of EHM. Results Platelet count ≥ 200 × 103/μL, serum alfa-fetoprotein ≥ 100 ng/dL, tumor size ≥ 3 cm, tumor number > 1, and macrovascular invasion were independent risk factors for EHM and were used to develop a nomogram. This nomogram had concordance indices of 0.733 (95% confidence interval [CI]: 0.688-0.778) and 0.739 (95% CI: 0.692-0.787) for the prediction of EHM during a 5-year follow-up duration in the training and validation cohorts, respectively. A nomogram score > 61 implied a high risk of EHM (hazard ratio [HR] = 3.83; 95% CI: 2.77-5.31, P < 0.001). Conclusion We have developed a nomogram that could accurately predict EHM of HCC and be readily available for formulating individualized treatment for all individual HCC patients to improve therapeutic efficacy.
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Affiliation(s)
- Chern-Horng Lee
- Division of General Internal Medicine and Geriatrics Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Chee-Jen Chang
- Graduate Institute of Clinical Medical Sciences Clinical Informatics and Medical Statistics Research Center Taoyuan Taiwan
| | - Yu-Jr Lin
- Graduate Institute of Clinical Medical Sciences Clinical Informatics and Medical Statistics Research Center Taoyuan Taiwan
| | - Cho-Li Yen
- Department of Gastroenterology and Hepatology Keelung Chang Gung Memorial Hospital Keelung Taiwan
| | - Chien-Heng Shen
- Department of Gastroenterology and Hepatology Chiayi Chang Gung Memorial Hospital Chiayi Taiwan
| | - Ya-Ting Cheng
- Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital Taoyuan Taiwan
| | - Sen-Yung Hsieh
- Department of Gastroenterology and Hepatology Chang Gung Memorial Hospital Taoyuan Taiwan.,Graduate Institute of Clinical Medical Sciences Clinical Informatics and Medical Statistics Research Center Taoyuan Taiwan.,College of Medicine Chang Gung University Taoyuan Taiwan
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Takahashi K, Putchakayala KG, Safwan M, Kim DY. Extrahepatic metastasis of hepatocellular carcinoma to the paravertebral muscle: A case report. World J Hepatol 2017; 9:973-978. [PMID: 28839518 PMCID: PMC5550763 DOI: 10.4254/wjh.v9.i22.973] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/29/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
Identification of extrahepatic metastases (EHM) of hepatocellular carcinoma (HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle tissue is extremely rare. We describe a unique case of HCC metastasizing to the paravertebral muscle. A 55-year-old man with a history of hepatitis B cirrhosis underwent partial liver resection with complete removal of HCC. Three months later, a computed tomography (CT) scan showed intrahepatic recurrence. The tumors were treated with yttrium-90 microspheres, trans-catheter arterial chemoembolization, and sorafenib. Six months later, a CT scan showed an enhancing lesion of the left paravertebral muscle that on biopsy were consistent with metastatic HCC. The tumor was treated with stereotactic hypo-fractionated image-guided radiation therapy (SHFRT). A follow-up scan 3 mo post-radiotherapy revealed a stable appearance of the paravertebral muscle metastasis. Because of the progression in the intrahepatic tumors, the patient was treated with capecitabine, which was changed to dasatinib 6 mo later. The patient passed away three years after the primary surgical resection. Management of EHM poses an extreme challenge. This is the first case of HCC with EHM to the paravertebral muscle in which stability of disease was achieved using SHFRT. This case highlights the importance of early detection of hepatitis B viral infection and initiation of anti-viral therapy to decrease recurrence of HCC and prevent EHM.
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Gai JQ, Sheng X, Qin JM, Sun K, Zhao W, Ni L. The effect and mechanism of bufalin on regulating hepatocellular carcinoma cell invasion and metastasis via Wnt/β-catenin signaling pathway. Int J Oncol 2015; 48:338-48. [PMID: 26648168 DOI: 10.3892/ijo.2015.3250] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/11/2015] [Indexed: 01/30/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a highly malignant tumor with an extremely poor prognosis. Our preliminary study indicated that bufalin could restrain the proliferation of human hepatoma BEL-7402 cells in a time- and dose-dependent manner. In the present study, the colony formation assay, the Transwell invasion assay, the western blot analysis and the immunofluorescence method were respectively used to investigate the effect and mechanism of bufalin against HCC cell invasion and metastasis. We found that: i) bufalin had significant inhibitory effect on the cell proliferation of BEL-7402 cells; ii) bufalin markedly inhibited the migration and invasion of BEL-7402 cells; iii) bufalin could suppress the phosphorylation of GSK-3β Ser9 site in BEL-7402 cells, decrease the expression of β-catenin, cyclin D1, metalloproteinases-7 (MMP-7) and cyclooxygenase-2 (COX-2) in the cytoplasm, and increase the expression of E-cadherin and β-catenin on the cell membrane; and iv) the expression of α-fetoprotein significantly decreased and the expression of albumin increased in BEL-7402 cells after bufalin was used. Our results indicate that: i) bufalin can regulate the expression of associated factors in Wnt/β-catenin signaling pathway of BEL-7402 cells through suppressing the phosphorylation of GSK-3β Ser9 site; ii) bufalin can strengthen intercellular E-cadherin/β-catenin complex to control epithelial-mesenchymal transition; and iii) bufalin can reverse the malignant phenotype and promote the differentiation and maturation by regulating the AFP and ALB expression in BEL-7402 cells. These are very important mechanisms of bufalin on the inhibition of the invasion and metastasis of HCC cells.
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Affiliation(s)
- Ji Qin Gai
- Department of General Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Xia Sheng
- Department of Pathology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Jian Min Qin
- Department of General Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Kang Sun
- Department of General Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Wei Zhao
- Department of General Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
| | - Lei Ni
- Department of General Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, P.R. China
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Vallianou N, Gounari P, Skourtis A, Vourlakou C. Cervical mass as the presenting manifestation of hepatocellular carcinoma. Hippokratia 2014; 18:285-287. [PMID: 25694768 PMCID: PMC4309154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Hepatocellular carcinoma is one of the most common cancers in the world due to its association with chronic hepatitis infections. Amongst the most usual metastasis of hepatocellular carcinoma are the lymph nodes, the lungs and the bones. Soft tissue metastases are extremely rare. CASE PRESENTATION Herein, we report the case of a 73-years-old male patient who presented with cervical and upper extremities muscle pain along with paresthesias and a palpable mass on the cervical region. CONCLUSION This unusual clinical manifestation along with the above-described rare presentations of hepatocellular carcinoma must be taken into account, especially among patients with chronic hepatitis infections. Hippokratia 2014; 18 (3): 285-287.
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Affiliation(s)
- Ng Vallianou
- Evangelismos General Hospital, Department of Internal Medicine, Athens, Greece
| | - P Gounari
- Evangelismos General Hospital, Department of Internal Medicine, Athens, Greece
| | - A Skourtis
- Evangelismos General Hospital, Department of Internal Medicine, Athens, Greece
| | - C Vourlakou
- Evangelismos General Hospital, Department of Internal Medicine, Athens, Greece
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