Macrotrabecular-Massive Hepatocellular Carcinoma: Light and Shadow in Current Knowledge

Sessa, Anna; Mulé, Sebastien; Brustia, Raffaele; Regnault, Hélène; Pregliasco, Athena Galletto; Rhaiem, Rami; Leroy, Vincent; Sommacale, Danièle; Luciani, Alain; Caldéraro, Julien; Amaddeo, Giuliana

doi:10.2147/jhc.s364703

Cited by 12 publications

(3 citation statements)

References 56 publications

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“…Although some previous studies have focused on the clinical and radiological features of MTM-HCC, there is no consensus on the best biomarker for predicting MTM-HCC. Our study showed that MTM-HCC patients presented with large tumour sizes and high AFP loads, which were consistent with previous findings[ 17 - 20 ]. Interestingly, this study found that the age of patients with MTM-HCC was lower than that of the patients with nMTM-HCC.…”

Section: Discussionsupporting

confidence: 93%

Preoperative prediction of macrotrabecular-massive hepatocellular carcinoma through dynamic contrast-enhanced magnetic resonance imaging-based radiomics

Zhang¹,

He²,

Liu³

et al. 2023

World J Gastroenterol

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BACKGROUND Macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) is closely related to aggressive phenotype, gene mutation, carcinogenic pathway, and immunohistochemical markers and is a strong independent predictor of early recurrence and poor prognosis. With the development of imaging technology, successful applications of contrast-enhanced magnetic resonance imaging (MRI) have been reported in identifying the MTM-HCC subtype. Radiomics, as an objective and beneficial method for tumour evaluation, is used to convert medical images into high-throughput quantification features that greatly push the development of precision medicine. AIM To establish and verify a nomogram for preoperatively identifying MTM-HCC by comparing different machine learning algorithms. METHODS This retrospective study enrolled 232 (training set, 162; test set, 70) hepatocellular carcinoma patients from April 2018 to September 2021. A total of 3111 radiomics features were extracted from dynamic contrast-enhanced MRI, followed by dimension reduction of these features. Logistic regression (LR), K-nearest neighbour (KNN), Bayes, Tree, and support vector machine (SVM) algorithms were used to select the best radiomics signature. We used the relative standard deviation (RSD) and bootstrap methods to quantify the stability of these five algorithms. The algorithm with the lowest RSD represented the best stability, and it was used to construct the best radiomics model. Multivariable logistic analysis was used to select the useful clinical and radiological features, and different predictive models were established. Finally, the predictive performances of the different models were assessed by evaluating the area under the curve (AUC). RESULTS The RSD values based on LR, KNN, Bayes, Tree, and SVM were 3.8%, 8.6%, 4.3%, 17.7%, and 17.4%, respectively. Therefore, the LR machine learning algorithm was selected to construct the best radiomics signature, which performed well with AUCs of 0.766 and 0.739 in the training and test sets, respectively. In the multivariable analysis, age [odds ratio (OR) = 0.956, P = 0.034], alpha-fetoprotein (OR = 10.066, P < 0.001), tumour size (OR = 3.316, P = 0.002), tumour-to-liver apparent diffusion coefficient (ADC) ratio (OR = 0.156, P = 0.037), and radiomics score (OR = 2.923, P < 0.001) were independent predictors of MTM-HCC. Among the different models, the predictive performances of the clinical-radiomics model and radiological-radiomics model were significantly improved compared to those of the clinical model (AUCs: 0.888 vs 0.836, P = 0.046) and radiological model (AUCs: 0.796 vs 0.688, P = 0.012), respectively, in the training set, highlighting the improved predictive ...

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Section: Discussionsupporting

confidence: 93%

Preoperative prediction of macrotrabecular-massive hepatocellular carcinoma through dynamic contrast-enhanced magnetic resonance imaging-based radiomics

Zhang¹,

He²,

Liu³

et al. 2023

World J Gastroenterol

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“…Как и многие другие авторы, мы столкнулись с мимикрией этого варианта под ГЦК из-за характерных особенностей визуализации: гиперваскулярности, быстрого накопления контрастного препарата в артериальную фазу и сниженной плотности по отношению к сохранной паренхиме печени в отсроченную фазу контрастирования [3,13]. В связи с наличием в данном случае множественного поражения в виде «дочерних» опухолей, необходимо было исключить массивный тип ГЦК, который в литературе характеризуют наличием крупных фокусов поражения с возможным образованием сателлитных узлов (обычно без признаков цирроза) в окружающей паренхиме печени [14]. О возможности доброкачественного характера образования в нашем случае позволили думать признаки, так же описываемые рядом авторов: отсутствие быстрого вымывания (wash-out) контрастного препарата, характерного для ГЦК, наличие липоматозных участков, отсутствие накопления контрастного вещества капсулой [1,3,10,15].…”

Section: Discussionunclassified

The Difficulties of Diagnosis Giant Angiomyolipoma of the Liver: Clinical Case and Literature Review

Arablinskii,

Myasnyankina,

Sedova

et al. 2024

jour

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Purpose: To report a clinical case demonstrating difficulties of diagnosis and successful surgical treatment of myomatous type of angiomyolipoma of the liver without simultaneous damage to the kidneys.Material and methods: A female patient, 49 years old, was admitted to the hospital in August 2023, had no specific complaints, an abdominal ultrasound revealed extraperitoneal extraorgan mass in the epigastrium and mesogastrium and masses in the right lobe of liver, most likely hemangioma. The contrast-enhanced MSCT was performed on admission. Patient was rehospitalized for a surgery in September. During the operation the tumor was removed and sent for histological examination, a further immunohistochemical study was also carried out.Results: According to the results of MSCT in S3, S4, S5 of the liver oval-shaped mass (198×104×177 mm) with heterogeneous density and solid, cystic and fat features was found. Three hypovascular hypodense inclusions sizes up to 11 mm was also identified in S7/8. There was no pathologic formation in the kidneys. The liver tumor was surgically removed, the resected material was directed to a scheduled histological examination. To confirm the diagnosis an IHC analysis was also done and it revealed the expression of melanocytic (HBM-45) and smooth muscle (SMA) markers.Discussion: In this case we encountered very sparsely described in the world literature localization of angiomyolipoma — isolated hepatic one (without kidney damage). Like other authors we encountered the similarity of muomatous tumor type to the HCC and adenoma of the liver due to the characteristic features of visualization: hypervascularity, early contrast enhancement into an arterial phase and reduced density relative to the preserved parenchyma of the liver into a delayed phase of contrast.Conclusion: This case demonstrates the difficulty of diagnosing the myomatous type of AML simulating the HCC. As one of the most informative methods of diagnosis, we single out MSCT, which allowed us to think about the possibility of a benign nature of the tumor. In our case the main features excluding HCC were the absence of rapid “washout” of contrast drug, the presence of lipomatous areas and no accumulation of contrast agent by the capsule.

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“…A large number of studies have been conducted to identify the high-risk factors affecting early postoperative recurrence of HCC, such as tumor size, tumor number, tumor differentiation, MVI, AFP level and Protein Induced by Vitamin K Absence or Antagonist II (PIVKA-II) level [6,18,19]. However, there are few reports on the effect of the MTM-HCC HCC pathological type on early postoperative recurrence of HCC [8,9,14,15,20], and the predictive value of the histological type has not received much attention from the general public. MTM-HCC is more aggressive than other types of HCC, showing more vascular invasion (including large vessels and microvessels), low differentiation and high proliferation, and it is an independent risk factor for early recurrence and total recurrence [8,9].…”

Section: Discussionmentioning

confidence: 99%

Macrotrabecular-massive subtype-based nomogram to predict early recurrence of hepatocellular carcinoma after surgery

Yang¹,

Mao²,

Fang³

et al. 2023

European Journal of Gastroenterology &Amp; Hepatology

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Objectives To analyze the predictive factors on early postoperative recurrence of hepatocellular carcinoma (HCC) and to establish a new nomogram to predict early postoperative recurrence of HCC. Methods A retrospective analysis of 383 patients who had undergone curative resection between February 2012 and September 2020 in our center was performed. The Kaplan–Meier method was used for survival curve analysis. Univariate and multivariate Cox regression were performed to identify independent risk factors associated with early recurrence, and a nomogram for predicting early recurrence of HCC was established. Results A total of 152/383 patients developed recurrence after surgery, of which 83 had recurrence within 1 year. Multivariate Cox regression analysis showed that preoperative alpha-fetoprotein level ≥400 ng/ml (P = 0.001), tumor diameter ≥5 cm (P = 0.009) and MVI (P = 0.007 and macrotrabecular-massive HCC (P = 0.003) were independent risk factors for early postoperative recurrence of HCC. The macrotrabecular-massive-based nomogram obtained a good C-index (0.74) for predicting early recurrence of HCC, and the area under the curve for predicting early recurrence was 0.767, which was better than the single American Joint Committee on Cancer T stage and Barcelona Clinic Liver Cancer stage. Conclusions The nomogram based on macrotrabecular-massive HCC can effectively predict early postoperative recurrence of HCC.

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Macrotrabecular-Massive Hepatocellular Carcinoma: Light and Shadow in Current Knowledge

Cited by 12 publications

References 56 publications

Preoperative prediction of macrotrabecular-massive hepatocellular carcinoma through dynamic contrast-enhanced magnetic resonance imaging-based radiomics

Preoperative prediction of macrotrabecular-massive hepatocellular carcinoma through dynamic contrast-enhanced magnetic resonance imaging-based radiomics

The Difficulties of Diagnosis Giant Angiomyolipoma of the Liver: Clinical Case and Literature Review

Macrotrabecular-massive subtype-based nomogram to predict early recurrence of hepatocellular carcinoma after surgery

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