【 Abstract 】 Objective To observe the effect of disruption of hypoxia inducible factor-1 α (HIF-1 α ) pathway by small hairpin RNA (shRNA) on chemosensitivity of human hepatocellular carcinoma (HCC) cells and to reveal the correlative mechanisms. Methods Plasmid of pshRNA-HIF-1α was transfected into HepG2 cells by lipofectamine. HepG2/pshRNA-HIF-1α (HepG2/pshRNA) cell lines were obtained by selection of HepG2 cells in G418. Meanwhile, plasmid of empty vector (pHK) was transfected as a control (HepG2/pHK). The mRNA and protein expression levels of HIF-1α and mdr1 were investigated by RT-PCR and Western blot respectively. Using CoCl2 to simulate the hypoxia condition, growth inhibition and apoptosis rates of HepG2 cells under different dosages of chemotherapeutic agents (adriamycin) were measured by MTT assay and flow cytometry (FCM) ． ResultsCompared with HepG2/pHK cells, the mRNA and protein expression levels of HIF-1αand mdr1 were obviously down-regulated in HepG2/pshRNA cells. At the same time, the proliferation inhibition and apoptosis rates were evidently increased after transfection with pshRNA-HIF-1α(P＜0.05)，which decreased the expression of HIF-1αto 82.18% at mRNA level and 75.51% at protein level. There was no significant effect of transfection pHK (Pgt;0.05). Conclusion These data demonstrates that HIF-1α interference by shRNA increased the sensitivity of HCC chemotherapy and the reversal of multidrug resistance, which may be done by down-regulating the transcription of mdr1 and the translation of P-gp. Blocking HIF-1αin HCC cells may offer an new avenue for gene therapy．
Objective To approach the indications， techniques features， and efficacy of laparoscopic hepatectomy for liver tumor. Methods The clinical data and follow-up results of 61 patients who received laparoscopic hepatectomy at our institute from January， 2007 to December， 2012 were retrospectively analyzed. Results Of the 61 patients， 16 cases were with primary liver cancer， 1 case with liver adenocarcinoma， 2 cases with metastatic liver cancer， 31 cases with hepatic hemangioma， and 11 cases with other benign liver diseases （including hepatocellular adenoma， focal nodular hyperplasia， hepatic cysts， and mucinous cystadenoma）. The average tumor diameter was 5.6 cm （2-15 cm）. The surgical approaches includes laparoscopic hepatic left lateral lobectomy （42 cases）， right posterior lobectomy （2 cases）， hepatectomy of segmentⅥ （3 cases）， hepatectomy of segmentsⅦ/Ⅷ， Ⅳa， and caudate lobe （one respectively）. Non-anntomic and wedge resection were performed on 11 patients. The mean operating time， blood loss， postoperative hospital stay， and postoperative complication rate were （124±65） min （50-200min）， （251±145） mL （50-1 000mL），（7.3±3.6） d （4-11d）， and 16.3% （10/61）， respectively. In 19 cases with malignant liver lesions， 15 cases were followed up mean for 26 months （1-48 months）. One of them died in 1 year after operation for multiple organ dysfunction， others were survival. Conclusions Experienced laparoscopic surgery doctors selected appropriate cases， used proper blood inflow oclussion and liver resction methods， and cared for tumor-free principle， the laparoscopic hepatectomy for malignant and benign tumors of liver could be safe and effective to carry out.
ObjectiveTo summarize the application status and progress of indocyanine green fluorescence imaging in laparoscopic anatomic liver resection , and to analyze its advantages, limitations, and prospects.MethodThe literatures about indocyanine green fluorescence imaging in laparoscopic anatomic liver resection were reviewed.ResultsIndocyanine green fluorescence imaging had been preliminarily used in the operation of liver tumors and had shown its unique value in the anatomical liver resection, providing a new way to reduce the recurrence of liver cancer, improve the therapeutic effect, and prolong the survival time of patients.ConclusionsThe clinical application of indocyanine green fluorescence imaging in anatomic liver resection is still at the stage of development and popularization. Although it has unique advantages and development potential, it needs to be further improved in the aspects of tissue penetration, specificity, and staining success rate.
In order to solve the pathological grading of hepatocellular carcinomas (HCC) which depends on biopsy or surgical pathology invasively, a quantitative analysis method based on radiomics signature was proposed for pathological grading of HCC in non-contrast magnetic resonance imaging (MRI) images. The MRI images were integrated to predict clinical outcomes using 328 radiomics features, quantifying tumour image intensity, shape and text, which are extracted from lesion by manual segmentation. Least absolute shrinkage and selection operator (LASSO) were used to select the most-predictive radiomics features for the pathological grading. A radiomics signature, a clinical model, and a combined model were built. The association between the radiomics signature and HCC grading was explored. This quantitative analysis method was validated in 170 consecutive patients (training dataset: n = 125; validation dataset, n = 45), and cross-validation with receiver operating characteristic (ROC) analysis was performed and the area under the ROC curve (AUC) was employed as the prediction metric. Through the proposed method, AUC was 0.909 in training dataset and 0.800 in validation dataset, respectively. Overall, the prediction performances by radiomics features showed statistically significant correlations with pathological grading. The results showed that radiomics signature was developed to be a significant predictor for HCC pathological grading, which may serve as a noninvasive complementary tool for clinical doctors in determining the prognosis and therapeutic strategy for HCC.
Malignant peritoneal mesothelioma is a very rare serous malignant tumor, which often manifests as multiple soft tissue masses in peritoneum and omentum, most of which are accompanied by ascites. In this study, a case of peritoneal malignant mesothelioma confirmed by pathological examination was presented. The case was rarely confined to the perihepatic peritoneum and grew into the liver. Without ascites, it was easy to be confused with intrahepatic lesions. Through case analysis, on the one hand, the MRI manifestations of malignant peritoneal mesothelioma are displayed. On the other hand, the main points of differentiation between extrahepatic and intrahepatic origin lesions are discussed, so as to improve the understanding and differential diagnosis ability of this disease.
ObjectiveTo summarize clinicopathologic and immunophenotypic features of hepatic epithelioid angiomyolipoma (HEAML) and to explore its diagnostic and differential diagnostic methods.MethodThe clinical and imaging manifestations, pathological morphology and immunohistochemical features of 5 patients with HEAML from August 2011 to December 2017 in this hospital were retrospectively analyzed.ResultsThere were 2 males and 3 females in the 5 patients with HEAML, aged 38–64 years with an average age of 50 years. There were 2 cases of the left lobe tumors and 3 cases of the right lobe tumors. Three cases were diagnosed as the hepatocellular carcinoma and the other two cases were diagnosed as the hepatic hamartoma and (or) hemangioma by the preoperative imaging examination. The diameter of tumors ranged from 1.5 cm to 7.0 cm, with an average of 3.6 cm. Microscopically, the tumors were composed of more epithelioid smooth muscle cells, parenchyma vessels and a small amount of fat. The immunohistochemical results showed that the melan-A, HMB45, and SMA were positive, while the HepPar-1, AE1/AE3, EMA, CD117, Dog-1, CD10, CgA, Syn, and Desmin were negative. The Ki-67 proliferation index was 2%–10%. The patients were all alive without the tumor recurrence after following up for 2–76 months with an average of 31.4 months.ConclusionsHEAML is a rare primary mesenchymal tumor of liver, which should be misdiagnosed for other benign or malignant tumors for influencing clinical treatment. Diagnosis and differential diagnosis can be made by histopathology and immunohistochemical staining.
ObjectiveTo investigate the imaging characteristics of gallium-68 labeled fibroblast activation protein inhibitor (68Ga-FAPI)-positron emission tomography/magnetic resonance (PET/MR) imaging in patients with liver fibrosis or liver tumor. MethodsThirteen patients with suspected liver tumor who underwent 68Ga-FAPI-PET/MR examination from May 2020 to April 2021 were retrospectively analyzed. Maximum standard uptake value (SUVmax) was investigated. All patients underwent liver surgery or biopsy. Scheuer scoring system was used to evaluate the liver fibrosis. The imaging characteristics of liver fibrosis or liver tumor were analyzed. ResultsThe liver fibrosis was confirmed in 6 patients, including 1 case of S2, 2 cases of S3, and 3 cases of S4. Among them, 4 patients had increased uptake of 68Ga-FAPI, with patchy or diffuse abnormal concentration of liver, and the SUVmax was 7.9±3.1. The liver imaging of the other 2 patients with liver fibrosis showed no obvious radioactive concentration. In addition, 2 patients were diagnosed with hepatocellular carcinoma, its SUVmax was 7.2 and 6.1; 1 patient was diagnosed with hepatobiliary duct carcinoma and its SUVmax was 13.8. Moreover, increased uptake of 68Ga-FAPI was observed in 4 patients with metastatic liver cancer, with SUVmax of 6.7±2.7. ConclusionBoth liver fibrosis and liver tumor are suitable for 68Ga-FAPI-PET/MR examination, which have different imaging characteristics.
【Abstract】Objective To investigate the CT imaging features of metastatic hepatic adenocarcinomas from the digestive tract by using multidetectorrow helical CT (MDCT) with pathological correlation. Methods CT and clinical data of 36 patients with pathologically proven metastatic hepatic adenocarcinomas from the digestive tract were retrospectively reviewed. The primary tumors included 10 cases of gastric cancer, 1 duodenal cancer, 18 colonic carcinoma, 7 rectal cancer. All patients underwent MDCT plain scan and contrastenhanced dualphase scanning of upper or whole abdomen. The appearances of hepatic metastatic lesions on MDCT images at various enhancement phases were carefully observed. Results On plain CT scan 32 cases （88.9%） presented multiple nodules of low density at different sizes, 3 cases （8.3%） showed a single low-density nodule, and 1 case presented with a cystic mass. On contrast-enhanced scan, 4 cases (11.1%) showed faintly enhanced rim around the nodules on arterial phase; on portal venous phase 29 cases (80.6%) presented slight ringlike enhancement at the periphery of the nodule while the nodule core was markedly hypodense with intermediate soft tissue density area in between, giving rise to the typical appearance of “bull’seye” sign. Three cases (8.3%) showed no enhancement on either phase images. Conclusion The ring-like enhancement and the appearance of “bull’s-eye” on portal venous phase was characteristic CT features of metastatic hepatic adenocarcinoma from digestive tract.
Objective To investigate the application progress of mixed reality (MR) technology in hepatobiliary and pancreatic fields. Method The relevant literatures on the application of MR technology of the hepatobiliary and pancreatic field in recent years at home and abroad were reviewed. Results MR technology had been widely used in the hepatobiliary and pancreatic field, including preoperative diagnosis and evaluation, surgical plan formulation, doctor-patient communication, intraoperative navigation precision surgery, teaching practice and many other aspects, which had the advantages of shortening the operation time, reducing the difficulty of surgery and improving the success rate of surgery. To some extent, it had promoted the innovation of clinical diagnosis and treatment in the field of liver, gallbladder and pancreas. Conclusions The application and development of MR related techniques are of great significance to the operation and teaching in the hepatobiliary and pancreatic field. With the development and progress of MR technology and modern medicine, MR technology will give full play to its advantages in intelligent real-time navigation hepatobiliary and pancreatic surgery system and promote the further development of hepatobiliary and pancreatic surgery.