A large database of 1773 HCC patients in Turkey was examined. 41.9% had alpha-fetoprotein (AFP) levels <20 IU/ml and an additional 16.123% had values between 20-100 IU/ml. This 58% of the cohort (<100 IU/ml AFP levels) was examined in detail. 66% of patients with small (<5 cm) HCCs had low AFP, compared to 49% of patients with larger (>5 cm) HCCs. The mean diameter (MTD) of larger MTD, low AFP tumors was 8.4cm. Therefore, factors other than AFP must contribute to HCC tumor growth. Larger tumors in low AFP patients had both higher platelet levels and increased PVT percent. Linear regression analysis for both MTD and multifocality showed that platelet numbers and presence of PVT were significant variables; whereas for PVT, significant variables were albumin, alkaline phosphatase and MTD. Comparisons between patients with AFP levels <20, 20-<100, 100-<1000 and >1000 IU/ml showed the most significant tumor finding was an increase in PVT percent between each group, and to a lesser extent, MTD. Thus, low-or normal-AFP HCCs constitute the majority of patients and have slightly lower MTD and much lower PVT percent than HCCs associated with elevated blood AFP levels. New, non-AFP markers are thus needed, especially for small HCCs

Aims The purpose of the study was to compare the pharmacokinetic parameters of rifabutin obtained in a group of patients without wasting syndrome (NWS) with those obtained in a group with wasting syndrome (WS). Methods A single dose of 300 mg rifabutin was administered in the fasting state to the patients in both study groups and blood samples were scheduled to be collected at the following times: 0 (predose), 0.5, 1, 2, 3, 4, 6, 8, 24, 48, 72 and 96 h following administration. Data were analysed using noncompartmental methods. The pharmacokinetic parameters of rifabutin in patients with and without wasting syndrome were compared using the Mann–Whitney U‐test. ResultsCmax was 0.34±0.14 mg l−1 in NWS patients and 0.55±0.16 mg l−1 (P=0.01) in patients with WS. tmax was 4.2±1.5 and 3.3±2.3 h (P=0.17) in NWS and WS patients, respectively. The AUCs were similar in the two study groups. V/F was 2905±1646 l in NWS patients and 1701±492 l (P=0.07) for the WS group. These differences are less pronounced following normalization of V/F to patients body weight (43.7±20.1 vs 35.4±10.3 l kg−1 ). t1/2,λz tended to be shorter in patients with WS (31.4±12.9 vs 46.0±23.5 h, P=0.12). Conclusions Our study suggests that the pharmacokinetics of rifabutin in patients with wasting syndrome are not altered to a degree that is clinically important.

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Cutaneous metastases of internal malignancies are very rare in children. In this group, neuroblastoma, leukaemia and lymphoma are the most common malignancies that may develop metastases or neoplastic infiltrates to the skin. Carcinomas have infrequently been reported in children, and cutaneous metastases from carcinoma in this group have not been described. A 10-year-old girl presented with an erythematous plaque on the left hemithorax. Histopathological findings revealed grouped signet-ring cells within the lumina of lymphatic vessels in the dermis. Immunohistochemical examination confirmed the epithelial origin of the tumour. Despite an exhaustive search, the primary site could not be determined. This exceptional observation is, to the best of our knowledge, the first report of cutaneous metastasis from occult carcinoma in a child.

C-reactive protein (CRP) is a blood marker for inflammation and is an independent prognostic factor for many human cancers. Combined with albumin levels, it forms the basis of the Glasgow Index for cancer prognosis. We reviewed the literature on CRP and HCC and also evaluated blood CRP levels and combination CRP plus albumin levels in a large HCC cohort. In order to understand the prognostic significance of CRP, we retrospectively examined a large HCC cohort and examined the relationship of CRP levels to tumor parameters. We report, that CRP alone and CRP plus albumin combined as well, significantly correlated with parameters of HCC aggressiveness, such as maximum tumor dimension (MTD), portal vein thrombosis (PVT) and blood alpha-fetoprotein (AFP) levels, both as individual parameters and all parameters together (Aggressiveness Index). This extends current thinking, to suggest a possible explanation for the usefulness of blood CRP levels in HCC prognostication.