Poorly Differentiated Hepatocellular Carcinoma in a Low-risk Patient with an Otherwise Normal Liver

We herein report a 48-year-old healthy woman who visited our hospital to investigate a 25-mm space-occupying lesion in the liver. The tumor was irregularly shaped and exhibited heterogeneous enhancement on dynamic computed tomography (CT). Whole-body positron emission tomography-CT showed an abnormal fluorodeoxyglucose uptake in the liver tumor, with a maximum standardized uptake value of 12.82. During the ensuing three months, the tumor grew rapidly and the serum alpha-fetoprotein levels also rose; partial hepatectomy was therefore performed. Microscopic findings revealed a moderately-to-poorly differentiated hepatocellular carcinoma in the normal liver.

Deep sequencing and comprehensive expression analysis identifies several molecules potentially related to human poorly differentiated hepatocellular carcinoma

Hepatocellular carcinoma (HCC) that is graded histologically as poorly differentiated has a high recurrence, metastasis and poor prognosis. We sought to determine the regulatory mechanisms of HCC tumorigenesis and to identify molecules closely related to poorly differentiated HCC. High‐throughput sequencing was used to construct microRNA (miRNA) and mRNA expression profiles for poorly differentiated HCC tissues and adjacent tissues. Network analysis was carried out to study miRNA–target interactions. Integrating the miRNA and mRNA data of HCC with four tumor grades from The Cancer Genome Atlas (TCGA) portal enabled the identification of potential closely related molecules for early diagnosis of poorly differentiated HCC. Electronic validation of RNA‐seq data and survival analysis was also performed. In total, 1051 differentially expressed genes and 165 differentially expressed miRNAs were identified between HCC tumor and paired non‐tumorous tissue. Based on 3718 miRNA–target interactions, we established an miRNA–target interaction network; the target genes were mainly involved in bile acid biosynthesis and bile secretion. Integrating expression data of HCC from TCGA indicated that two proteins, TM4SF1 and ANXA2, are convincing indicators for initial diagnosis of poorly differentiated HCC. According to the survival analysis, three proteins, ANXA2, C8orf33 and IGF2BP3, were identified as being associated with the survival time of HCC patients. Moreover, we suggest that hsa‐miR‐1180 may be an effective biomarker for poorly differentiated HCC. Three molecules, TM4SF1, ANXA2 and C8orf33, are potential biomarkers for distinguishing poorly differentiated from well‐differentiated HCC.

Comparative study of percutaneous radiofrequency ablation and hepatic resection for small, poorly differentiated hepatocellular carcinomas

AIM

Histologically, poorly differentiated hepatocellular carcinomas (HCC) are considered highly malignant. Here, we aimed to evaluate the relative efficacy and safety of hepatic resection or radiofrequency ablation (RFA) for treating this malignancy.

METHODS

Between April 2004 and May 2011, we enrolled 48 patients who had poorly differentiated HCC that had been diagnosed postoperatively by pathological assessment. All the tumors had a maximum diameter of 3 cm and all patients had three or less tumors. Fifteen of these patients underwent hepatic resection (HR group) and 33 patients underwent RFA (RF group). The patient background, tumor characteristics, overall survival rate and recurrence-free survival rate were assessed in both groups.

RESULTS

The mean maximum tumor diameter was 2.5 and 2.0 cm in the HR and RF groups, respectively. The prothrombin activity level was 94% and 86% in the HR and RF groups, respectively. The 1-, 3- and 5-year cumulative survival rates were 89.1%, 68.7% and 68.7%, respectively, in the HR group, and 59.2%, 40.9% and 32.7%, respectively, in the RF group. The 1-, 3- and 5-year recurrence-free survival rates were 85.1%, 64.8% and 48.6%, respectively, in the HR group, and 29.0%, 7.2% and 7.2%, respectively, in the RF group. There was a significant difference between these groups (P < 0.05).

CONCLUSION

As hepatic resection has greater efficacy than RFA in the treatment of poorly differentiated HCC, even in cases with a small tumor size, we recommend its use for this malignancy.

A case of poorly differentiated hepatocellular carcinoma with intriguing ultrasonography findings

A 60-year-old female was referred to the Toho University Omori Medical Center due to ultrasonography findings revealing a notable hepatic mass. The 44×32 mm isoechoic mass had a high-echo band along the margin in the liver. Contrast-enhanced ultrasonography (CEUS) with Sonazoid detected an enhancement pattern extending from the outer periphery to the inside of the mass in the vascular phase and a pattern similar to that of surrounding hepatic tissue in the post-vascular phase. High-flow hepatic hemangioma was suspected due to the hyperechoic rim-like high-echo band, the oval shape and the CEUS findings. However, computed tomography revealed a hypervascular hepatocellular carcinoma (HCC) pattern and the patient underwent surgery. Histopathological findings revealed poorly differentiated HCC. As poorly and moderately differentiated HCC types are conventionally classified as 'hypervascular HCC', few detailed ultrasonography (US) studies of poorly differentiated HCC are available. US characteristics of hypervascular HCC include the presence of a halo (hypoechoic band) around the lesion and reduced signal intensity in the post-vascular phase of CEUS. US in the patient revealed a mass with a hyperechoic band and a signal intensity in the post-vascular phase of CEUS that was almost identical to that of the surrounding liver parenchyma. These findings suggest poorly differentiated HCC and indicate that further research on hypervascular HCC is required.