Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Diffuse-Type Hepatoma: A grave prognostic marker(Karger Medical and Scientific Publishers, 2017) Siriwardana, R.C.; Liyanage, C.A.H.; Gunetilleke, B.; Niriella, M.A.; de Silva, H.J.; Dassanayake, A.S.; Jayatunga, S.P.BACKGROUND: Data on diffuse-type hepatocellular carcinoma (HCC) are rare. HCC in Sri Lanka is rising, and the majority is related to nonalcoholic fatty liver disease. This study was planned to compare nodular- and diffuse-type HCC in this cohort. METHODS: CT scans of 227 patients with HCC negative for infective hepatitis were analyzed and grouped as nodular and diffuse from July 2011 to July 2014. Diffuse-type cancer was defined as a tumor without convex/distinct margin, diffusely infiltrating the hepatic parenchyma. There were 45 (20%) cases. The baseline liver functions, etiology, treatment, and the outcome were compared with nodular-type cancers. Stage III diffuse cancers were matched with 2 stage III nodular cancers looking at the T stage and background liver. RESULTS: There was no difference in the age (63 vs. 62 years, p = 0.937) and gender. Diffuse cancers had a low BMI (24 vs. 22, p = 0.009), a higher alpha fetoprotein (AFP) level (p < 0.001), a higher incidence of major vascular invasion (14 vs. 80%, p < 0.001), and a history of significant alcohol consumption (39 vs. 67%, p = 0.001). The baseline liver functions were similar in diffuse and nodular cancers. A large proportion (27 vs.77%, p < 0.001) of diffuse cancers were not candidates for active treatment. Overall survival was poor in the diffuse type(4.7 vs. 25 months, p < 0.001). Diffuse-type stage III cancers had a poor survival compared to matched nodular cancers (2.5 vs. 15.8 months, p = 0.001). CONCLUSION: HCC without a background of infective hepatitis were common in our cohort. These tumors are associated with high AFP levels, major vascular invasion, and a poor prognosis.Item 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.