Tumors hepatic transplantable

Peliosis hepatis has been described in association with contraceptive-induced hepatic tumors and has sometimes developed in isolation, perhaps as a herald of more serious changes to follow, for example cirrhosis and portal hypertension one such case ultimately required an orthotopic liver transplant (219). 

Pack and Molander (PI) performed hepatic lobectomy in 23 patients suffering from tumors and allied diseases. Following surgery, serum alkaline phosphatase increased in the majority of patients, although prompt decreases occurred in several patients with extremely high preoperative levels. By the third week after surgery, 20 out of 33 patients had serum alkaline phosphatase values within reference limits. Decreases in serum alkaline phosphatase after hepatic resection were also observed by Almersjo et al. (A9). None of the 12 patients studied by Almersjo et al. (A9) showed a postoperative rise in serum alkaline phosphatase. Williams et al. (W23) reported massive falls in serum alkaline phosphatase values after liver transplantation. ... 

It is interesting that fatty acid synthesis and the levels of acetyl-CoA carboxylase and fatty acid synthetase in transplantable hepatic tumors are not responsive to alterations in nutritional state [131-135]. However, carboxylase and synthetase levels in the livers of host animals are markedly depressed by fasting and are restored by refeeding a fat-free diet. A comparison of the purified carboxylases from hepatic tumors and host livers reveals no differences in structural [135], kinetic [135], or immunological [93] properties. One possible explanation which has been offered [135] is that the tumor may exhibit altered repressor control of enzyme level. 

Lymphatic metastases in HCC are not common. They are seen in no more than 10-15% even in autopsy cases, especially in the hepatic hilar lymph nodes (Bartolozzi and Lencioni 1999). Extrahepatic hematogenous metastases are usually associated with advanced-stage tumors. The lung is the most common site of metastases, followed by the bone and the adrenal gland. CT is valuable for the diagnosis of adenopathies and distant metastatic disease, except for bone metastases. Assessment of tumor spread in selected patients (i.e. candidates for liver transplantation, inclusion in therapeutic trials) may therefore require thin section spiral CT of the chest and bone scintigraphy. 

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