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Changing role of histopathology in the diagnosis and management of hepatocellular carcinoma

World Journal of Gastroenterology 2018年第35期24卷 4000-4013页

作者： archana rastogi Department of Pathology Institute of Liver & Biliary SciencesNew Delhi 110070 India

Hepatocellular carcinoma (HCC) is one of the most common and fatal cancer in the world. HCC frequently presents with advanced disease, has a high recurrence rate and limited treatment options, which leads to very poor prognosis. This warrants urgent improvement in the diagnosis and treatment. Liver biopsy plays very important role in the diagnosis and prognosis of HCC, but with technical advancements and progression in the field of imaging, clinical guidelines have restricted the role of biopsy to very limited situations. Biopsy also has its own problems of needle tract seeding of tumor, small risk of complications, technical and sampling errors along with interpretative errors. Despite this, tissue analysis is often required because imaging is not always specific, limited expertise and lack of advanced imaging in many centers and limitations of imaging in the diagnosis of small, mixed and other variant forms of HCC. In addition, biopsy confirmation is often required for clinical trials of new drugs and targeted therapies. Tissue biomarkers along with certain morphological features, phenotypes and immune-phenotypes that serve as important prognostic and outcome predictors and as decisive factors for therapy decisions, add to the continuing role of histopathology. Advancements in cancer biology and development of molecular classification of HCC with clinic pathological correlation, lead to discovery of HCC phenotypic surrogates of prognostic and therapeutically significant molecular signatures. Thus tissue characteristics and morphology based correlates of molecular subtypes provide invaluable information for management and prognosis. This review thus focuses on the importance of histopathology and resurgence of role of biopsy in the diagnosis, management and prognostication of HCC.

关键词： Hepatocellular carcinoma Biomarker Biopsy Histopathology Immunohistochemistry Targeted therapy Molecular Diagnosis Prognosis

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Pathomolecular characterization of HCC in non-cirrhotic livers

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Hepatoma Research 2020年第8期6卷 12-28页

作者： archana rastogi Department of Pathology Institute of Liver&Biliary SciencesNew Delhi-110070India.

Hepatocellular carcinoma(HCC)is the most common primary liver cancer and usually arises in cirrhotic ***,it is diagnosed in non-cirrhotic livers.A variety of risk factors and etiologies can trigger the development of HCC in non-fibrotic and non-cirrhotic *** most important causes are metabolic syndrome and hepatitis B virus *** pathogenetic mechanisms are direct carcinogenesis,chronic liver injury and repair cycles,and genetic/epigenetic *** has a very important role in the diagnosis of non-cirrhotic *** features of non-cirrhotic HCC are quite different from HCC originating in a cirrhotic *** characteristics are similar to a classical ***,certain histological variants show a predilection to occur in non-cirrhotic *** encompass fibrolamellar,scirrhous,steatohepatitic and mixed hepato-cholangiocarcinoma *** to the non-cirrhotic background,adenoma,metastasis and most of the other non-neoplastic and neoplastic conditions enter the differential *** studies and morpho-molecular classifications of HCC provide further understanding of the molecular pathogenesis of non-cirrhotic *** group however,has rarely been exclusively *** review offers an update of etiology,patho-molecular characteristics and differential diagnosis of HCC arising in non-cirrhotic backgrounds.

关键词： Hepatocellular carcinoma non-cirrhotic etiopathogenesis molecular genetics pathology patho-molecular differential diagnosis

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Bile Cast Nephropathy in Patients with Acute Kidney Injury Due to Hepatorenal Syndrome:A Postmortem Kidney Biopsy Study

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Journal of Clinical and Translational Hepatology 2017年第2期5卷 92-100页

作者： Suman Lata Nayak Manoj Kumar Chhagan Bihari archana rastogi Department of Nephrology Institute of Liver and Biliary Sciences New Delhi India Department of Hepatology and Liver Transplatation Institute of Liver and Biliary Sciences New Delhi India Department of Pathology Institute of Liver and Biliary Sciences New Delhi India

Background and Aims:The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndrome (HRS) in decompensated cirrhosis and acute on chronic liver failure (ACLF) is *** study aimed to determine the frequency of BCN detected on postmortem renal biopsy among patients with decompensated cirrhosis and ACLF who had been admitted with acute kidney injury due to HRS (HRAAKI) and expired during that ***:One-hundred-twenty-seven postmortem renal biopsies with adequate size (>1 cm in length) were included for *** were obtained from 84 patients with decompensated cirrhosis and 43 patients with ***:BCN was detected in 57 of the total 127 (44.8%) renal biopsy *** with BCN had significantly higher levels of serum total bilirubin,total leukocyte count and model for end-stage liver disease score,as compared to those without *** was detected in 32/43 (74.4%) of the patients with ACLF,as compared to 25/84 (29.7%) of the patients with decompensated cirrhosis (p < 0.001).On multivariate analysis,direct bilirubin (OR (95% CI):1.27 (1121-1.698);p < 0.001)and presence of ACLF (OR (95% CI):2.603 (1.054-7.111);p =0.041) were found to be significant predictors of BCN on postmortem renal ***:BCN was found in 72.1% of patients with ACLF and 27.4% patients with decompensated cirrhosis who had been hospitalized with an admitting diagnosis of HRS-AKI and who expired during that hospitalization and underwent postmortem renal *** serum bilirubin and presence of ACLF were found to be significant predictors of BCN on postmortem renal biopsy.

关键词： Bile cast nephropathy Acute kidney injury Hepatorenal syndrome

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Ductal paucity and Warkany syndrome in a patient with congenital extrahepatic portocaval shunt

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World Journal of Hepatology 2014年第5期6卷 358-362页

作者： Vikrant Sood Rajeev Khanna Seema Alam Dinesh Rawat Shorav Bhatnagar archana rastogi Departments of Pediatric Hepatology Radiology and Pathology Institute of Liver and Biliary Sciences New Delhi 110070 India

An eleven-year-old clinically dysmorphic and devel-opmentally retarded male child presenting with com-plaints of 5 episodes of recurrent cholestatic jaundice since 3 years of age was evaluated. Imaging revealed features consistent with congenital extrahepatic porto-caval shunt(Abernethy type 1b), multiple regenerative liver nodules and intrahepatic biliary radical dilatation. The presence of ductal paucity and trisomy 8 were con-firmed on liver biopsy and karyotyping. The explanation for unusual and previously unreported features in the present case has been proposed.

关键词： Congenital extrahepatic portocaval shunt Ductal paucity Warkany syndrome Trisomy 8

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Rare diaphragmatic tumor mimicking liver mass

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World Journal of Gastrointestinal Surgery 2014年第2期6卷 33-37页

作者： Shalini Thapar Arvind Ahuja archana rastogi Department of Radiodiagnosis Institute of Liver and Biliary Sciences Department of Hepatopathology Institute of Liver and Biliary Sciences

Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the commonest malignant neoplasms of the diaphragm; however, only a few(less than 20) cases have been reported to date. We present the case of an extremely rare tumor of the diaphragm mimicking a liver mass. The patient, a young 28-year-old woman, presented with an 8-month-history of mildly progressive upper abdominal pain and early fullness after meals. Computed tomography scan of the abdomen revealed a mass located in the region of the left lobe of the liver with non visualized left lobe and partial vascular supply of the mass from the left hepatic artery. The tumor was also seen to draw its vascularity from bilateral internal mammary arteries. Surgical excision and hepatectomy was planned, keeping in mind the diagnosis of an atypical left hepatic mass. Laparotomy revealed a left diaphragmatic tumor growing caudally into the upper abdomen, compressing and splaying the liver along the left medial surface where the tumorwas virtually adherent to it. Successful excision of the mass and subsequent histopathological and immunochemistry examination of the specimen revealed low grade fibromyxoid sarcoma of the diaphragm. This case highlights the unusual presentation of a diaphragmatic mesenchymal tumor and how it can be mistaken as an atypical liver mass. It also emphasizes the tumoral vascular supply as an indicator of its organ of origin.

关键词： Diaphragmatic tumor Low grade Fibro-myxoid sarcoma Liver mass Atypical liver mass Com-puted tomography

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