Primary carcinoma of the liver: a study of 100 cases among 48,900 necropsies.

The pathologic findings of 232 consecutive cases of hepatocellular carcinoma (HCC) autopsied during the past ten years at Kurume, Japan, were analyzed from the point of view of global epidemiology, in relation to clinical feature, and in regard to incidence, age, sex, etiologic factors, size of liver, changes in noncancer parenchyma, gross type of tumor, extrahepatic metastases, intravascular and intraductal growths, cancer cell histology, hepatitis B surface antigen (HBsAg) in hepatocytes and cancer cells, liver cell dysplasia, and frequency and clinicopathologic characteristics of minute HCC. Furthermore, postmortem hepatic arteriography and portography were done in 152 livers for comparison with gross anatomy and celiac angiograms. It was found that: (1) epidemiologically, HCC in Japan is distinct from that in the West that it is frequently encapsulated, livers are generally small because of frequent and advanced cirrhosis and small cancer, minute HCC, is not uncommon at autopsy, cirrhosis most commonly associated is the one with thin stroma and medium size nodules, and micronodular cirrhosis is very rare despite frequent alcohol abuse; (2) HCC is increasing in incidence; (3) HBsAg is frequently found in parenchyma; (4) liver cell dysplasia is indirectly related to HBsAg with no evidence for premalignancy; (5) the lung is the most frequent site of metastasis but peritoneal dissemination is unusual; (6) intraportal tumor growth is very common and the hepatic vein is less frequently affected; (7) growth in the major bile duct is frequently associated with intraportal growth and clinically presents as obstructive jaundice; and (8) tumor is supplied solely by arteries and celiac arteriograms are closely correlated with gross pathologic findings.

Pathology of hepatocellular carcinoma in Japan. 232 Consecutive cases autopsied in ten years.

Publisher Summary This chapter focuses on the physiology of primary carcinoma of the liver. In primary liver cancer, there is little doubt that long periods of time may intervene between the initiation of irreversible liver damage and the first manifestations of malignancy. Subjective symptoms often appear for the first time only after the liver tumor has attained sizeable dimensions or have produced catastrophic intraperitoneal hemorrhage through erosion of a blood vessel, or even only after extra-hepatic metastases have already become widely disseminated. The salient features, therefore, which emerge from the consideration of the etiological factors presented in the chapter, are that environmental factors (including cirrhotigenic and carcinogenic agents) may be responsible for precancerous and cancerous states of the liver and that in man these probably act on a favorably prepared soil, the nature of which is determined largely on a nutritional basis.

Primary carcinoma of the liver.

The clinical features of 57 autopsied cases of intrahepatic bile duct carcinoma including 28 cases of the peripheral type (cholangiocarcinoma in the narrow sense) and 29 cases of the hilar type are described in comparison with those of hepatocellular carcinoma, with a review of the literature on the clinicopathological aspects of intrahepatic bile duct carcinoma. As compared with hepatocellular carcinoma, the average age of the patients was older; the male predominance was not obvious, chronic parenchymal liver disease was infrequent in the past history, association of primary cirrhosis was seldom, cholestatic features were frequently the early signs and more pronounced during the course, the liver was enlarged to a lesser extent, ascites was less common, signs of portal hypertension were absent or minimal, and extrahepatic metastases were less frequent. In many respects, the hilar type resembled extrahepatic bile duct carcinoma, and the peripheral type was somewhat between it and hepatocellular carcinoma. Although the overall survival was not much different from that for hepatocellular carcinoma, early diagnosis is emphasized; this would make surgical management possible. Differential diagnosis from hepatocellular carcinoma may be possible in the majority with direct cholangiography, liver scan, celiac angiography, determination of alpha-fetoprotein and hepatitis B antigen, and blood chemistry such as SGOT, SLDH, serum bilirubin and alkaline phosphatase. Illustrative cases are given including one patient with a hilar carcinoma who survived for more than 2 years after transhepatic biliary drainage.

Clinical aspects of intrahepatic bile duct carcinoma including hilar carcinoma: a study of 57 autopsy-proven cases.

Primary liver carcinoma. autopsy study of 60 cases.

PRIMARY carcinoma of the liver is a rare disease. In 1926 Counseller and McIndoe 1 reported 5 instances of this condition in 5.976 necropsies at the Mayo Clinic, and shortly thereafter they reported another. 2 Since that time, 25 additional cases of primary malignant growth of the liver have been discovered at necropsy at the Mayo Clinic. The present study is concerned with these 31 cases. Rokitansky 3 is credited with being one of the earliest investigators to insist that a primary malignant hepatic neoplasm could occur. In 1876 Kelsh and Kiener 4 reported 2 cases of primary carcinoma of the liver and found only 1 other case in the literature. In 1881 Sabourin 5 added HISTORIC SURVEY 4 more cases. In 1888 Hanot and Gilbert 6 classified the tumors into three macroscopic groups: (1) cancer nodulaire , (2) cancer massif and (3) cancer avec cirrhose . They also suggested the microscopic

PRIMARY CARCINOMA OF THE LIVER: A Study of Thirty-One Cases

Advances in the field of nutrition in the past have been of interest only to a limited few. Since the recent national emergency, however, advances in this field have become of great importance to every one. The potential necessity of limitation of buying power makes it now important that every one be acquainted with what and how much food constitutes a well balanced diet. A national campaign to inform the public in this direction already has begun. Studies of vitamins and other essential nutrient substances during the past year have been most actively conducted. The general recognition and acceptance of the conception that deficiency of vitamins usually is multiple rather than single is encouraging. The close relation between the liver and metabolism of vitamins again has been emphasized, and important advances in this direction have been accomplished. VITAMIN A Chemical and Physiologic Properties. —During 1941 there has been an unusually

Robert M. Hoyne

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PRIMARY CARCINOMA OF THE LIVER: A Study of Thirty-One Cases

Diseases of nutrition: review of certain recent contributions