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Effectiveness of radiofrequency ablation for small (less than 3.5 CM) hepatocellular carcinoma (HCC)
Sl98
Abstracts
PO.92 NEOPLASTIC PORTAL VEIN THROMBOSIS (NPVT) AS FIRST MANIFESTATION OF HEPATOCELLULAR CARCINOMA (HCC) G. Casella *,1, R. Corso 2, L. Mondazzi 1 , B. Bronzino 1, A. Somma 1, C. Monti 3, CA. Buda 4, S. Rusconi 1, A. Sartirana 1, V. Baldini 1
10spedale Desio, Desio (MI) 20spedale Niguarda, Milano 3Policlinico diMonza, Monza 4Policlinico Universitario, Messina Background and aim: Neoplastic Portal vein thrombosis (NPVn is a frequent event in advanced HCC, but it is very rare as first manifestation of the disease Material and methods: From January 1998 to September 2005, we observed 205 patients affected by HCC in Liver Cirrhosis (LC). All patients were screened for viral hepatitis markers, autoimmune and metabolic disorders including alcohol abuse. Serum alpha-feto-protein (AFP) and abdominal ultrasound were performed. Computed Tomography (CD was made only in selected case Results: 130 pts (53 f and 77 m) had a LC-HCV related (63.4%),40 pts (11 f and 29 m) a LC HBV related (19.5%),30 pts (5 f and 25 m) an alcoholic LC (14.6%), 2 (1 f and 1 m) a Primary Biliary Cirrhosis (pBC) (0.97%) and 3 m Hereditary Hemochromatosis (HH) LC (1.4%). In 3 pts (1.4%) PVTwas the first manifestation ofHCC (a female 80 y old affected by HCV, 1 male 53 y old by HBV and the other male 57 y old by Alcoholic LC). In all patients AFP was higher than 200 pg/ml and CT with contrast medium confirmed PVT. The mean survival in these 3 pts was 3.5 months (range 1 - 12 months). Only oral therapy with Megestrol 160 mg/day was administered Conclusions: NPVT is a severe condition when it is the first manifestation of HCC with a very poor prognosis
PO.93 A CASE REPORT: FIBROLAMELLAR CARCINOMA G. Amalfi *,1, M. Di Pierro 1, C. Farinato 1, G. Caravelli 1 , V. D'Angelo 1, F. Morace 1 , M. Schettino 1, G. Iannaci 2, M. Sacco 3 ,
S. Monastra 1
1u.O. Gastroenterologia, Ospedale S. Gennaro, Napoli 2Servizio di Anatomia Patologica, Ospedale Incurabili, Napoli 3U.O. Radiologia, Ospedale S. Gennaro, Napoli Background and aim: Fibrolamellar carcinoma (FC) is an uncommon malignancy seen in young adults without underlying liver disease that constituted approximately 1% of all cases of primary liver cancer. Physical signs are minimal and laboratory values are noncontributory. Material and methods: A 17 year-old man develop a central-right upper quadrant abdominal pain, dyspepsia and weight lost. There was no personal or family history of liver disease. On physical examination was appreciated an enlarged liver with increased consistency. His hemocrome, plasma proteins and alpha-fetoprotein were normal; AST was 46 (normal, 10-37 UIL), ALT was 109 (normal, 10-37 UIL), alkaline phosphatase was 405 (normal 80-130, UIL); only hepatitis B surface antibody was positive, hepatitis C antibody was negative. An abdominal US revealed an iso-hipoechoic mass in the left hepatic lobe measuring 82x85 mm and three ilar lymph nodes. The successive contrast-enhanced ultrasonography with a second generation contrast medium (Sonovue®) revealed on the liver lesion a poor enhancement in arterial phase persisting in late phase, and an intense, early enhancement of the lymph nodal structures. The contrast enhanced TC was completely agree with these findings, revealing moreover the compression on gastric little curve and duodenum by the liver mass.
Being of not univocal behaviour was suggesting a fine-needle biopsy. The patient underwent a percutaneus liver biopsy that was diagnostic of fibrolamellar carcinoma. Results: The patient underwent exploratory laparotomy and because of the tumor's extent, he was not considered for liver transplantation or resection. Palliative chemotherapy is performing for five months. Conclusions: Individual with fibrolamellar carcinoma generally has a greater survival than those with hepatocellular carcinoma. Although most patients with FC undergo curative surgery, two of the three patients had inoperable malignancies. We report an inoperable FC in a young patient.
PO.94 EFFECTIVENESS OF RADIOFREQUENCY ABLATION FOR SMALL (LESS THAN 3.5 CM) HEPATOCELLULAR CARCINOMA (HCC)
A. Salmi *, R. Turrini, G. Lanzani, G. Viviani, D. Giacomin, A. Zappella, A. Savio, F. Pirali
Gastroenterology Unit Pathology Department Ospedale S. Orsola, Fatebenefratelli, Italy Objective: To evaluate the therapeutic effectiveness, local recurrence, complications and long term outcome of percutaneous radiofrequency ablation for patients with single small (less than 3.5 cm in diameter) or up to 3 lesions (less than 3 cm in diameter) hepatocellular carcinoma. Methods: Radiofrequency ablation was applied to 184 nodules in 156 consecutive non-surgical patients diagnosed in a local screening program as the first-line treatment option during a 7-years interval. Percutaneous approach was avoided for greater safety in 10.2% of patients where a laparoscopic guided tecnique was chosen (preferred). Results: (1) There were no treatment-related deaths, and only 3.2% of severe complications; (2) radiofrequency ablation has induced a complete response in 83.7% of nodules and 87.1% of patients, according to Computed Tomography evaluation performed within one month (after the procedure), and the local recurrence rate at 1, 2 and 3 years was 10%,20% and 25%; (3) the overall 3-and 6-year-survival rates after treatment were 69.3% and 34.6% respectively, but the rates were higher, ... 78.3%, in Child A patients; (4) factors significantly influencing survival were liver function (P<0.03), (5) the recurrence rate at remote sites (p<0.023) and the complete response (P
PO.95 HOMOCYSTEINE LEVELS ARE NOT RELATED TO THE EXTENT OF BONE LOSS IN PATIENTS WITH INFLAMMATO RY BOWEL DISEASE
A. Papa *, S. Danese, M. Covino, A. Grillo, S. Guglielmo, I. Roberto, R. Urgesi, M. Bonizzi, L. Guidi, I. De Vitis, G. Fedeli, G. Gasbarrini, A. Gasbarrini
Department ofInternal Medicine, Catholic University, Rome Background and aim: Bone loss and subsequent osteopenia and osteoporosis are well known complications of inflammatory bowel disease (lED). Multiple risk factors, both environmental and genetic, are believed to be involved in lED-associated bone loss. Considering the high prevalence of osteoporosis in homocystinuria, abnormal homocysteine (Hcy) metabolism could contribute to the pathogenesis of bone loss in lED. Furthermore, an increased Hcy level appears to be a strong and
Abstracts
PO.92 NEOPLASTIC PORTAL VEIN THROMBOSIS (NPVT) AS FIRST MANIFESTATION OF HEPATOCELLULAR CARCINOMA (HCC) G. Casella *,1, R. Corso 2, L. Mondazzi 1 , B. Bronzino 1, A. Somma 1, C. Monti 3, CA. Buda 4, S. Rusconi 1, A. Sartirana 1, V. Baldini 1
10spedale Desio, Desio (MI) 20spedale Niguarda, Milano 3Policlinico diMonza, Monza 4Policlinico Universitario, Messina Background and aim: Neoplastic Portal vein thrombosis (NPVn is a frequent event in advanced HCC, but it is very rare as first manifestation of the disease Material and methods: From January 1998 to September 2005, we observed 205 patients affected by HCC in Liver Cirrhosis (LC). All patients were screened for viral hepatitis markers, autoimmune and metabolic disorders including alcohol abuse. Serum alpha-feto-protein (AFP) and abdominal ultrasound were performed. Computed Tomography (CD was made only in selected case Results: 130 pts (53 f and 77 m) had a LC-HCV related (63.4%),40 pts (11 f and 29 m) a LC HBV related (19.5%),30 pts (5 f and 25 m) an alcoholic LC (14.6%), 2 (1 f and 1 m) a Primary Biliary Cirrhosis (pBC) (0.97%) and 3 m Hereditary Hemochromatosis (HH) LC (1.4%). In 3 pts (1.4%) PVTwas the first manifestation ofHCC (a female 80 y old affected by HCV, 1 male 53 y old by HBV and the other male 57 y old by Alcoholic LC). In all patients AFP was higher than 200 pg/ml and CT with contrast medium confirmed PVT. The mean survival in these 3 pts was 3.5 months (range 1 - 12 months). Only oral therapy with Megestrol 160 mg/day was administered Conclusions: NPVT is a severe condition when it is the first manifestation of HCC with a very poor prognosis
PO.93 A CASE REPORT: FIBROLAMELLAR CARCINOMA G. Amalfi *,1, M. Di Pierro 1, C. Farinato 1, G. Caravelli 1 , V. D'Angelo 1, F. Morace 1 , M. Schettino 1, G. Iannaci 2, M. Sacco 3 ,
S. Monastra 1
1u.O. Gastroenterologia, Ospedale S. Gennaro, Napoli 2Servizio di Anatomia Patologica, Ospedale Incurabili, Napoli 3U.O. Radiologia, Ospedale S. Gennaro, Napoli Background and aim: Fibrolamellar carcinoma (FC) is an uncommon malignancy seen in young adults without underlying liver disease that constituted approximately 1% of all cases of primary liver cancer. Physical signs are minimal and laboratory values are noncontributory. Material and methods: A 17 year-old man develop a central-right upper quadrant abdominal pain, dyspepsia and weight lost. There was no personal or family history of liver disease. On physical examination was appreciated an enlarged liver with increased consistency. His hemocrome, plasma proteins and alpha-fetoprotein were normal; AST was 46 (normal, 10-37 UIL), ALT was 109 (normal, 10-37 UIL), alkaline phosphatase was 405 (normal 80-130, UIL); only hepatitis B surface antibody was positive, hepatitis C antibody was negative. An abdominal US revealed an iso-hipoechoic mass in the left hepatic lobe measuring 82x85 mm and three ilar lymph nodes. The successive contrast-enhanced ultrasonography with a second generation contrast medium (Sonovue®) revealed on the liver lesion a poor enhancement in arterial phase persisting in late phase, and an intense, early enhancement of the lymph nodal structures. The contrast enhanced TC was completely agree with these findings, revealing moreover the compression on gastric little curve and duodenum by the liver mass.
Being of not univocal behaviour was suggesting a fine-needle biopsy. The patient underwent a percutaneus liver biopsy that was diagnostic of fibrolamellar carcinoma. Results: The patient underwent exploratory laparotomy and because of the tumor's extent, he was not considered for liver transplantation or resection. Palliative chemotherapy is performing for five months. Conclusions: Individual with fibrolamellar carcinoma generally has a greater survival than those with hepatocellular carcinoma. Although most patients with FC undergo curative surgery, two of the three patients had inoperable malignancies. We report an inoperable FC in a young patient.
PO.94 EFFECTIVENESS OF RADIOFREQUENCY ABLATION FOR SMALL (LESS THAN 3.5 CM) HEPATOCELLULAR CARCINOMA (HCC)
A. Salmi *, R. Turrini, G. Lanzani, G. Viviani, D. Giacomin, A. Zappella, A. Savio, F. Pirali
Gastroenterology Unit Pathology Department Ospedale S. Orsola, Fatebenefratelli, Italy Objective: To evaluate the therapeutic effectiveness, local recurrence, complications and long term outcome of percutaneous radiofrequency ablation for patients with single small (less than 3.5 cm in diameter) or up to 3 lesions (less than 3 cm in diameter) hepatocellular carcinoma. Methods: Radiofrequency ablation was applied to 184 nodules in 156 consecutive non-surgical patients diagnosed in a local screening program as the first-line treatment option during a 7-years interval. Percutaneous approach was avoided for greater safety in 10.2% of patients where a laparoscopic guided tecnique was chosen (preferred). Results: (1) There were no treatment-related deaths, and only 3.2% of severe complications; (2) radiofrequency ablation has induced a complete response in 83.7% of nodules and 87.1% of patients, according to Computed Tomography evaluation performed within one month (after the procedure), and the local recurrence rate at 1, 2 and 3 years was 10%,20% and 25%; (3) the overall 3-and 6-year-survival rates after treatment were 69.3% and 34.6% respectively, but the rates were higher, ... 78.3%, in Child A patients; (4) factors significantly influencing survival were liver function (P<0.03), (5) the recurrence rate at remote sites (p<0.023) and the complete response (P
PO.95 HOMOCYSTEINE LEVELS ARE NOT RELATED TO THE EXTENT OF BONE LOSS IN PATIENTS WITH INFLAMMATO RY BOWEL DISEASE
A. Papa *, S. Danese, M. Covino, A. Grillo, S. Guglielmo, I. Roberto, R. Urgesi, M. Bonizzi, L. Guidi, I. De Vitis, G. Fedeli, G. Gasbarrini, A. Gasbarrini
Department ofInternal Medicine, Catholic University, Rome Background and aim: Bone loss and subsequent osteopenia and osteoporosis are well known complications of inflammatory bowel disease (lED). Multiple risk factors, both environmental and genetic, are believed to be involved in lED-associated bone loss. Considering the high prevalence of osteoporosis in homocystinuria, abnormal homocysteine (Hcy) metabolism could contribute to the pathogenesis of bone loss in lED. Furthermore, an increased Hcy level appears to be a strong and