Journal of Hepatology
Intra-tumoral tertiary lymphoid structures are associated with a low risk of early recurrence of hepatocellular carcinoma.
Calderaro J, Petitprez F, Becht
E, et al. Journal of Hepatology 2019;70:58–65.
https://www.ncbi.nlm.nih.gov/pubmed/30213589
In most cancers explored,
tertiary lymphoid structures (TLS) supply a vital microenvironment for
generating anti-tumor immune responses, and are linked with enhanced clinical
outcomes in most cancers, but its role in HCC is not well defined. In this retrospective pathological study of a
series of 273 patients with HCC treated with surgical resection, intratumoral
TLSs were found to be associated with a low risk of early relapse after
surgical resection, suggesting that they reflect the existence of in situ
effective anti-tumor immunity. The
pathological results were further validated by gene expression profiling using
public data set (LCI cohort). Learn more
of the details of the study in the January 2019 issue.
American Journal of Clinical Pathology
Unexpectedly High Prevalence of Cystoisospora belli Infection in Acalculous Gallbladders of Immunocompetent Patients.
Noor M, Katzman PJ, Huber AR, et
al. American Journal of Clinical Pathology 2019; 151: 100–107.
https://www.ncbi.nlm.nih.gov/pubmed/30285068
This study is a retrospective
review of cholecystectomy specimens (n = 401) removed for various indications,
and a prospective cohort of cholecystectomy specimens (n = 22) entirely
submitted for histologic evaluation to determine the prevalence of C.
belli. C belli was identified in 39/401
(9.7%) of the retrospective cohort, and 6/22 (27.3%) of the entirely submitted
specimens. There was no correlations of
presence of C belli with age, sex, clinical indication, and abnormalities of
preoperative laboratory values. The
authors conclude that C belli resides in a latent state in the gallbladder and
may be best considered a commensal organism.
Evaluation of Peritumoral Fibrosis in Metastatic Colorectal Adenocarcinoma
to the Liver Using Digital Image Analysis.
Waters KM, Cottrell TR, Besharati
S, et al. American Journal of Clinical Pathology 2019, 151:226–230.
https://www.ncbi.nlm.nih.gov/pubmed/30339201
This study addresses the effect
of peritumoral fibrosis to the assessment of native liver fibrosis in 25 cases
of metastatic colonic adenocarcinoma to liver by digital image analysis. The authors found that there was a 3.9 fold
(range 0.9-18.6) median increase in fibrosis in the first 0.5 mm of peritumoral
liver compared to distant liver. Fibrosis levels returned to baseline at median
2.5 mm (interquartile range 1.5-5.0 mm) from tumor. The authors conclude that fibrosis is
markedly increased in peritumoral liver. Fibrosis levels returned to baseline
by 5 mm from tumor in approximately 75% of cases. Pathologists should be
cautious of fibrosis in mass-directed liver biopsies without at least 5 mm of
liver tissue distal to the mass.
American Journal of Gastroenterology
Diagnosis and Management of Primary Biliary Cholangitis.
Younossi ZM, Bernstein D,
Shiffman ML, et al. Am J Gastroenterol. 2019; 114 (1):48-63.
https://www.ncbi.nlm.nih.gov/pubmed/30429590
This paper provides a good
general review of PBC. With reference to
liver biopsy, it supports the current
consensus that the diagnosis of PBC does
not require liver biopsy and that the diagnosis is based on clinical and
laboratory tests. It is, however, indicated when the diagnosis of PBC is
uncertain or where another superimposed diagnosis (most commonly non-alcoholic
fatty liver disease) is suspected. It is essential if an overlap syndrome is
suspected because of clinical and laboratory features of AIH.
Hepatology
Clinical Manifestations and Outcomes of Patients with Sarcomatoid Hepatocellular Carcinoma
Liao SH, Su TH, Jeng YM, et al.
Hepatology 69(1): 209-221.
https://www.ncbi.nlm.nih.gov/pubmed/30014620
This study examines 40 cases of
sarcomatoid HCC and compares them to 160 cases of non-sarcomatoid HCC. The
sarcomatoid group had significantly shorter median recurrence-free and overall
survival. Sarcomatoid histology was an independent factor for all-cause
mortality and tumor recurrence, and was associated with atypical imaging
patterns.
Hepatocellular Carcinoma as a Complication of Vascular Disease of the
Liver After Fontan Procedure
Mazzarelli C, Cannon MD, Hudson
Mark, et al. Hepatology 69(2): 911-913.
https://www.ncbi.nlm.nih.gov/pubmed/30055116
The authors report 3 cases of HCC
occurring in patients 17-18 years after Fontan procedure as children. None of
the patients had features of advanced liver disease. They suggest further
studies are needed on this rare, late complication of Fontan procedure.
Antiprogrammed Cell Death-1 Immunotherapy-Related Secondary Sclerosing
Cholangitis
Ogawa K, Kamimura K, Terai S.
Hepatology 69(2): 914-916.
https://www.ncbi.nlm.nih.gov/pubmed/30033637
The authors report a case of
secondary sclerosing cholangitis due to PD-1 immunotherapy with pembrolizumab.
The case adds to the list of immune-mediated adverse events that can occur in
the setting of immunotherapy.
Histopathology
Histology of portal vascular changes associated with idiopathic non-cirrhotic portal hypertension: nomenclature and definition.
Guido M, Alves VAF, Balabaud C;
et al, International Liver Pathology Study Group. Histopathology 2019
Jan;74(2):219-226.
https://www.ncbi.nlm.nih.gov/pubmed/30129657
Idiopathic non-cirrhotic portal
hypertension (INCPH) is a vascular liver disease of unknown etiology,
characterized by clinical signs of portal hypertension (PH) in the absence of
cirrhosis. As much uncertainty exists about INCPH pathophysiology, and as no
definite diagnostic tests are available, liver biopsy is an essential tool for
achieving a definite diagnosis. The histological diagnosis of INCPH is not always
straightforward. The terminology and dentition are ambiguous, which adds
complexity to the already complex clinicopathological scenario. An international study group of liver
pathologists and hepatologists pursued a consensus on nomenclature for the
portal vascular lesions of INCPH. The
authors describe the portal and periportal changes in INCPH, characterized by
portal vein narrowing, portal vascular spaces directly abutting the hepatic parenchyma
at the limiting plate, increase in the number of portal vascular spaces and
abnormal spaces immediately adjacent to a portal tract. The authors aim at
simplification and providing a basis for standardization, proposing a
nomenclature that is intended to be descriptive enough to be used without
pathophysiological implications.
Human Pathology
Somatic HNF1A mutations in the malignant transformation of hepatocellular adenomas: a retrospective analysis of data from MSK-IMPACT and TCGA.
Hechtman JF, Abou-Alfa GK,
Stadler ZK, et al. Hum Pathol 2019 Jan;83:1-6.
https://www.ncbi.nlm.nih.gov/pubmed/30121369
Mutations of HNF1A gene are well
documented in hepatocellular adenoma. The role of HNF1A mutations in
hepatocellular carcinoma remains to be determined. In this study, all
hepatocellular neoplasms evaluated by Memorial Sloan Kettering-Integrated
Mutational Profiling of Actionable Clinical Targets assay or the Cancer Genome
Atlas sequencing, and cases reported in the literature, were queried for HNF1A
mutations. 11 of 672 (1.6%) HCCs harbored HNF1A mutations. 3 of these 11 HCCs
arose in a background of adenomatosis. Information on pre-existing adenoma for
the remaining cases (8) was not available. Their findings suggest that
malignant transformation of HNF1A-mutated hepatocellular adenoma occurs, albeit
infrequently.
Gastroenterology
Epidemiology and Management of Hepatocellular Carcinoma.
Kulik L, El-Serag HB.
Gastroenterology. 2019 Jan;156(2):477-491.
A review of the emerging data on
the risk and determinants of HCC in these conditions and the implications of
HCC surveillance.
Genomic Medicine and Implications for Hepatocellular Carcinoma Prevention
and Therapy.
Dhanasekaran R, Nault JC, Roberts
LR, et al. Gastroenterology. 2019 Jan;156(2):492-509.
https://www.ncbi.nlm.nih.gov/pubmed/30404026
A review of recent advances in
genomics which have increased our understanding of the mechanisms by which
hepatitis B virus, hepatitis C virus, alcohol, fatty liver disease, and other
environmental factors.
Targeted and Immune-Based Therapies for Hepatocellular Carcinoma.
Greten TF, Lai CW, Li G, et al.
Gastroenterology. 2019 Jan;156(2):510-524.
https://www.ncbi.nlm.nih.gov/pubmed/30287171
Provides a summary of the
targeted and immune-based agents in trials of patients with advanced
hepatocellular carcinoma and discusses the future of these strategies for liver
cancer.
Journal of Gastroenterol and Hepatology
Biliary transporter gene mutations in severe intrahepatic cholestasis of pregnancy: Diagnostic and management implications
Yeap SP, Harley H, Thompson R, et
al. Journal of Gastroenterology and Hepatology 2019, 34: 425–435
Five women with a total of 8
pregnancies with Intrahepatic cholestasis were included in the study.
Two cases showed biallelic
heterozygosity for several ABCB11 mutations, one was homozygous for an
ABCB4mutation and a fourth case was heterozygous for another ABCB4 mutation.
Archives of Pathology and Laboratory Medicine
Colorectal Liver Metastases. A Pathologist’s Guide to Creating an Informative Report and Improving Patient Care.
Moreno Prats M, Sasatomi E1,
Stevenson HL. Arch Pathol Lab Med. 2019 Feb;143(2):251-257.
https://www.ncbi.nlm.nih.gov/pubmed/29790787
The authors review the important
pathologic elements for reporting colorectal cancer (CRC) liver metastases as
well as background changes that can be seen in the liver, including those
following chemotherapy for CRC.
Calcifying Nested Stromal-Epithelial Tumor of the Liver: An Update and
Literature Review
Benedict M, Zhang X. Arch Pathol
Lab Med. 2019 Feb;143(2):264-268.
This is a resident short review
that covers the clinical, radiologic, behavioral, and pathologic findings as
well as the differential diagnosis and treatment of calcifying nested
stromal-epithelial tumor of the liver.
Prepared by (in alphabetical order):
Daniela Allende MD (Editor), Cleveland Clinic
Vishal Chandan, MBBS; University of California Irvine
Robert Goldin MD; Imperial College, London
Bella Goyal, MD; California Pacific Pathology Medical Group
Grace Guzman MD; University of Illinois
Mojgan Hosseini MD; University of California San Diego
Nafis Shafizadeh MD; Southern California Permanente Medical Group
Maria Westerhoff MD; University of Michigan
Eric Yee MD; University of Arkansas for Medical Sciences
Prepared by (in alphabetical order):
Daniela Allende MD (Editor), Cleveland Clinic
Vishal Chandan, MBBS; University of California Irvine
Robert Goldin MD; Imperial College, London
Bella Goyal, MD; California Pacific Pathology Medical Group
Grace Guzman MD; University of Illinois
Mojgan Hosseini MD; University of California San Diego
Nafis Shafizadeh MD; Southern California Permanente Medical Group
Maria Westerhoff MD; University of Michigan
Eric Yee MD; University of Arkansas for Medical Sciences
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