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Lee YJ, Lee YR, Seo CG, Goh HG, Kim TH, Yim SY, Han NY, Lee JM, Choi HS, Kim ES, Keum B, An H, Park B, Seo YS, Yim HJ, Kim JH, Yu YD, Kim DS, Jeen YT, Chun HJ, Lee HS, Kim CD, Um SH. How Should We Assign Large Infiltrative Hepatocellular Carcinomas for Staging? Cancers (Basel) 2020; 12:cancers12092589. [PMID: 32927918 PMCID: PMC7564178 DOI: 10.3390/cancers12092589] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/14/2022] Open
Abstract
Infiltrative gross morphology of hepatocellular carcinoma (HCC) is known to be associated with poor prognosis, but this is not considered for staging. A total of 774 HCC patients who underwent curative liver resection were retrospectively reviewed and the prognostic significance of infiltrative type HCC was assessed using the American Joint Committee on Cancer (AJCC) and Barcelona Clinic Liver Cancer (BCLC) staging systems. Seventy-four patients (9.6%) had infiltrative HCCs with a higher proportion of multifocal tumors, larger tumors, vessel invasion, increased tumor marker levels, and advanced T-stages than those with nodular HCC (all, p < 0.01). Infiltrative morphology was independently associated with lower overall survival (OS), but its impact was significant when the tumor size was ≥ 4 cm (p < 0.001). Under current AJCC and BCLC staging criteria, these large infiltrative HCCs were associated with significantly worse OS in early AJCC T-stages (T1b/T2, p < 0.001) and BCLC stage A/B (both, p < 0.01) but not in late AJCC (T3/T4) and BCLC C. The reassignment of this subtype to T3 and T4 increased the discriminatory ability of AJCC T-staging with lower AIC values (3090 and 3088 vs. 3109) and higher c-index (0.69 and 0.69 vs. 0.67), respectively (both, p < 0.001). Similarly, the reassignment of large infiltrative HCC to BCLC stages B and C also improved the prognostic performance. Large infiltrative HCCs should be assigned to more advanced stages in current staging systems for their prognostic impact.
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Affiliation(s)
- Yoo Jin Lee
- Department of Pathology, Korea University Medical Center, Seoul 136-701, Korea; (Y.J.L.); (E.S.K.)
| | - Yoo Ra Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Chung Gyo Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Hyun Gil Goh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Tae Hyung Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Sun Young Yim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
- Correspondence: or (S.Y.Y.); (S.H.U.); Tel.: +82-2-920-6555 (S.Y.Y); Fax: +82-2-920-6174 (S.Y.Y.)
| | - Na Yeon Han
- Department of Radiology, Korea University Medical Center, Seoul 136-701, Korea; (N.Y.H.); (B.P.)
| | - Jae Min Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Hyuk Soon Choi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Eun Sun Kim
- Department of Pathology, Korea University Medical Center, Seoul 136-701, Korea; (Y.J.L.); (E.S.K.)
| | - Bora Keum
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Hyonggin An
- Department of Biostatistics, Korea University Medical Center, Seoul 136-701, Korea;
| | - Beomjin Park
- Department of Radiology, Korea University Medical Center, Seoul 136-701, Korea; (N.Y.H.); (B.P.)
| | - Yeon Seok Seo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Hyung Joon Yim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Ji Hoon Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Young Dong Yu
- Department of Surgery, Korea University Medical Center, Seoul 136-701, Korea; (Y.D.Y.); (D.S.K.)
| | - Dong Sik Kim
- Department of Surgery, Korea University Medical Center, Seoul 136-701, Korea; (Y.D.Y.); (D.S.K.)
| | - Yoon Tae Jeen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Hoon Jai Chun
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Hong Sik Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Chang Duck Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
| | - Soon Ho Um
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Medical Center, Seoul 136-701, Korea; (Y.R.L.); (C.G.S.); (H.G.G.); (T.H.K.); (J.M.L.); (H.S.C.); (B.K.); (Y.S.S.); (H.J.Y.); (J.H.K.); (Y.T.J.); (H.J.C.); (H.S.L.); (C.D.K.)
- Correspondence: or (S.Y.Y.); (S.H.U.); Tel.: +82-2-920-6555 (S.Y.Y); Fax: +82-2-920-6174 (S.Y.Y.)
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Saraya T, Fujiwara M, Morita K, Watanabe T, Ogawa Y, Takizawa H, Light RW. Amelanotic Malignant Melanoma with Dense Pleural Thickening Mimicking Malignant Mesothelioma. Intern Med 2019; 58:969-972. [PMID: 30449771 PMCID: PMC6478975 DOI: 10.2169/internalmedicine.0867-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 51-year-old man was diagnosed with stage IIC nodular malignant melanoma (T4bN0M0) of the right upper arm. The tumor was treatment-refractory, and left-sided pleural effusion emerged 1.5 years later. Aspiration of pleural fluid revealed abundant amelanotic, atypical cells that resembled epithelial malignant mesothelioma or lung adenocarcinoma cells; these cells were positive for melanoma-associated antigen recognized by T cells (MART-1)/Melan-A, HMB-45, and S-100 on immunocytochemistry. Thoracic computed tomography (CT) revealed marked diffuse pleural thickening in the left hemithorax that mimicked malignant mesothelioma; thus, the present report describes the unique cytological and radiological findings of this case.
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Affiliation(s)
- Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | | | - Kikuko Morita
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Takayasu Watanabe
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Yukari Ogawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Hajime Takizawa
- Department of Respiratory Medicine, Kyorin University School of Medicine, Japan
| | - Richard W Light
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, USA
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