Hepatocellular differential diagnosis

Roller s test (F. Roller, 1961) differentiates between a lack of coagulation factors due to hepatocellular damage or due to vitamin K deficiency. This test facilitates the differential diagnosis between hepatocellular and mechanical jaundice as well as between liver diseases and bile-duct diseases. The advantages are simple to perform, hardly any side-effects, low in costs. 

Chickenpox in infancy and shingles in adults are caused by the same varicella-zoster virus. Very rarely and almost exclusively in immunosuppressed patients, concomitant hepatitis can occur with pronounced (mainly focal) hepatocellular necrosis, sometimes even with a fatal course. (37) Leucocytic portal and periportal infiltration can spread to the blood vessels and bile capillaries. Intranuclear inclusion bodies are present (s. fig. 23.2). Diagnosis is based on increased GPT, GOT, GDH and y-GT values as well as the presence of varicella IgM antibodies alternatively, pathogens can also be demonstrated in cultures. In children, a differential diagnosis of Reye s syndrome must be considered. As therapy in a severe course, aciclovir is indicated. (38-43)... 

Differential diagnosis of circular hepatic foci helps to decide whether therapeutic measures are necessary, not required, or not feasible. The histological classification of benign coin-like hepatic lesions differentiates between (7.) hepatocellular tumours, (2.) cholangiocellular tumours, (i.) mesenchymal tumours, and (4.) tumour-like lesions. There may also be evidence of (J.) calcareous foci. (4, 7, 12, 15) (s. tab. 36.2)... 

Cassidy W, Reynolds T. Serum lactic dehydrogenase in the differential diagnosis of acute hepatocellular injury. J Clin Gastroenterol 1994 19 118-21. 

Enzymatic estimations are only moderately helpful in distinguishing the various hepatic disorders from each other. The belief that high serum alkaline phosphatase activities are indicative of biliary obstruction while normal or only moderately elevated activities occur in association with hepatocellular damage is now known to be an oversimplification. There is considerable overlap between values in obstructive and nonobstructive hepatic disease (Fig. 10), so that serum alkaline phosphatase elevation or nonelevation in the differential diagnosis of hepatobiliary disease is useful only in a statistical sense (H14). 

Wieezorek TJ, Pinkus JL, Glickman JN, Pinkus GS. Gompari-son of thyroid transcription factor-1 and hepatocyte antigen immunohistochemical analysis in the differential diagnosis of hepatocellular carcinoma, metastatic adenocarcinoma, renal cell carcinoma, and adrenal cortical carcinoma. Am J Clin Pathol. 2002 118 911-921. 

Fan Z, van de Rijn M, Montgomery K, Rouse RV. Hep par 1 antibody stain for the differential diagnosis of hepatocellular carcinoma 676 tumors tested using tissue microarrays and conventional tissue sections. Mod Pathol. 2003 16 137-144. 

Gaffey MJ, Traweek ST, Mills SE, et al. Cytokeratin expression in adrenocortical neoplasia An immunohistochemical and biochemical study with implications for the differential diagnosis of adrenocortical, hepatocellular and renal cell carcinoma. Hum Pathol. 1992 23 144-153. 

Hepatocellular carcinomas are nonreactive with monoclonal CEA, an important factor in the differential diagnosis with cholangiocarcinomas and metastatic carcinoma. ... 

Lei JY, Bourne PA, diSant Agnese PA, Huang J. Cytoplasmic staining of TTF-1 in the differential diagnosis of hepatocellular carcinoma vs cholangiocarcinoma and metastatic carcinoma of the liver. Am J Clin Pathol. 2006 125 519-525. 

Young RH, Gersell DJ, Clement PB, et al. Hepatocellular carcinoma metastatic to the ovary A report of three cases discovered during life with discussion of the differential diagnosis of hepatoid tumors of the ovary. Hum Pathol. 1992 23 574-580. 

The differential diagnosis of FNH includes other hypervascular tumors such as hepatocellular adenoma, hepatocellular carcinoma (particularly fibrolamellar hepatocellular carcinoma), and hypervascular metas-tases (Table 9.2). 

Many tumor markers have been identified in recent years since the improvements in proteomic technologies. For example, one study analyzed human serum with 2D-PAGE and MALDI-TOF-MS to identify a distinct repertoire of autoantibodies associated with hepatocellular carcinoma. These proteins differentiated the cancer patients from those chronically infected with hepatitis B or C, which constitute a high-risk group for developing hepatocellular carcinoma. Thus, proteomic-based technology was used to identify a set of four proteins that may have utility in early diagnosis of hepatocellular carcinoma [87]. 

Endothelial cell differentiation in hepatocellular adenomas implication for histopathological diagnosis. J. Hepatol. 2004 41 259 - 266... 

Shafizadeh N, Ferrell LD, Kakar S. Utility and limitations of glypican-3 expression for the diagnosis of hepatocellular carcinoma at both ends of the differentiation spectrum. Mod Pathol. 2008 21 1011-1018. 

Spiral CT, with the recent introduction of multidetec-tor-row scan technology, currently plays a fundamental role in the diagnosis and staging of HCC (Awai et al. 2002 Kawata et al. 2002). The different blood supply to the lesion, in fact, is the most important CT feature that may help differentiate among small hepatocellular lesions that have emerged in a cirrhotic liver (Choi 2004). Indeed, small, overt HCCs show... 

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