Browsing by Author "Wickramarathne, S.D.J."

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    Diffuse and nodular type hepatocellular carcinoma - a comparative study
    (Sri lanka Medical Association, 2015) Wickramarathne, S.D.J.; Jayarathne, V.S.; Siriwardana, R.C.; Liyanage, C.A.H.; Niriella, M.A.; Dassanayake, A.S.; Gunetilleke, M.B.; de Silva, A.P.; de Silva, H.J.
    INTRODUCTION AND OBJECTIVES: Incidence of hepatocellular carcinoma (HCC) is increasing. Diffuse HCC (dHCC) is rare and data on such tumours are limited. METHOD: Ail consenting patients with HCC referred to Colombo North Liver Unit, Ragama (September 2011-February 2014) were Included. Tumours with diffuse margins on imaging were categorized as dHCC, while tumours with clear nodular morphology were categorized as nodular HCC (nHCC). Baseline parameters, treatment options and survival were compared between the two types. RESULTS: 203 HCCs were included in the study [dHCC=41(20%):87.8% males; nHCC=162(80%) 89.5% males]. The median age at presentation in the two groups was similar [dHCC 63.58(47-76) years, nHCC 62.13(12-88) years]. More patients with dHCC had a significant alcohol intake (68.9% vs. 41.7%, p=0.002). Background cirrhosis was present in 90.2% of dHCC compared to 79.1% in nHCC (p<0.05). Aspartate transaminase, Alanine transaminase, INR, total bilirubin, platelet count and MELD scores were similar in the two groups. Median alfa fetoprotein (AFP) was significantly higher in dHCC (136 vs 31ng/mL, p<0.001). Similar typical enhancement pattern on dynamic imaging was noted in the two groups (80.5% dHCC, 84.4% nHCC). dHCC had high incidence of major vascular invasion(78% vs 23.5%, p<0.001). Seventy six point nine percent of dHCC had only palliative care compared to 28.4% in nHCC was two months compared to 8 months in nHCC. CONCLUSION: 1/5 of HCCs were of the diffuse type. Patients dHCC had a significant alcohol intake. They had higher AFP, advanced disease at presentation with more vascular invasion and a worse prognosis than nHCC.
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    Diffuse and nodular type hepatoma: a prospective, comparative study
    (Sri Lanka Medical Association, 2014) Wickramarathne, S.D.J.; Jayarathne, V.S.; Siriwardana, R.C.; Niriella, M.A.; Liyanage, C.A.H.; Dassanayake, A.S.; Gunetilleke, M.B.; de Silva, H.J.
    INTRODUCTIONS: Incidence of hepatocellular carcinoma (HCC) is increasing. Diffuse type HCC is rare and data on such tumors are limited. METHODS: All patients referred to North Colombo Liver Unit with HCC from September 2011 to February 2014 were included. Data were collected prespectively from 206 patients. Tumors with diffuse margin in imaging were categorized as diffuse HCC (n-41, 21%). Baseline parameters, treatment options and survival were compared with nodulartype'HCC. RESULTS: 87.8% of patients in the diffuse HCC group were males compared to 89.54 % in nodular HCC group. The median age in the two groups were similar (nodular 62.13 years (range 12-88), diffuse 63.58 years (range 47-76)). Heavy alcohol use was commoner in the diffuse HCC group (68.9% vs. 41.7 %, p=0.002). 90.2% with diffuse HCC had cirrhosis compared to 79.1% with nodular HCC (p<0.05). Aspartate transaminase (AST), alanine transarninase (ALT), INR, total bilirubin, platelet count, MELD score were similar in two groups. Alfa Feto Protein (AFP) value was significantly higher in diffuse HCC group (p<0.001). 80.5% patients with diffuse type HCC had typical enhancement pattern compared to 84.4% with nodular type. Diffuse HCC group had higher incidence of major vascular invasion (78% vs. 23.5%, p<0.001). 76.9% of diffuse HCC group had only palliative care compared to 28.4% in nodular type (p<0.001). Median survival in diffuse group was 2.0 months compared to 8.0 months in nodular type. CONCLUSIONS: 21% of HCC are diffuse type. Alcohol intake was commoner in this group. Diffuse HCC had poorer prognosis with high AFP level and vascular invasion. Majority had advanced disease at presentation.