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Primary hepatic neuroendocrine tumours are rare tumours effecting relatively young patients. As metastatic neuroendocrine tumours to the liver are much more common, extensive investigations are crucial to exclude a primary tumour elsewhere. We report a case of a 27 year old woman who presented with fatigue, increased abdominal girth and feeling of early satiety and bloating. Extensive work up failed to show tumour at another primary site. Hepatic artery embolization showed no effect, so the patient underwent total hepatectomy and live-donor liver transplant. Grossly the tumour measured 27 cm. Microscopic examination showed bland, monomorphic cells growing in tubuloglandular and trabecular growth patterns. Cells were positive for neuroendocrine (synaptophysin, chromogranin, CD56) and epithelial markers (MOC31, CK7, CK19). Cytoplasmic dense neurosecretory vesicles were seen on ultrastructural examination. Based on the Ki-67 rate, mitotic count, lack of marked nuclear atypia and absence of necrosis, a diagnosis of primary neuroendocrine grade 2 was conferred.

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RACIONAL: O carcinoma hepatocelular é um dos tumores malignos mais comuns em todo o mundo. Exames de imagens, especialmente tomografia computadorizada e ultra-sonografia, estão entre as principais técnicas diagnósticas, embora a acurácia destes métodos possa apresentar significativa variabilidade. OBJETIVOS: Determinar a prevalência de carcinoma hepatocelular em pacientes cirróticos submetidos a transplante hepático na Santa Casa de Misericórdia de Porto Alegre, RS; estimar a sensibilidade da tomografia computadorizada e da ultra-sonografia na detecção pré-transplante de carcinoma hepatocelular nesse grupo de pacientes; correlacionar características radiológicas com achados anatomopatológicos. MATERIAIS E MÉTODOS: Estudo de prevalência retrospectivo. População: pacientes adultos, cirróticos, submetidos a transplante hepático de janeiro de 1990 a julho de 2003. Entre os 292 pacientes transplantados, foi diagnosticado 31 casos de carcinoma hepatocelular, dos quais 29 foram incluídos no estudo. As características tomográficas e ecográficas dos tumores diagnosticados pré-transplante foram comparadas com as observadas em exame anatomopatológico. RESULTADOS: A prevalência da infecção pelo vírus da hepatite C nos pacientes com diagnóstico de carcinoma hepatocelular foi de 93,5% e a prevalência deste entre os pacientes transplantados foi de 10,6%. A sensibilidade dos métodos de imagem na detecção de casos de carcinoma hepatocelular foi de 70,3% para tomografia computadorizada e de 72% para ecografia. CONCLUSAO: A prevalência de carcinoma hepatocelular na instituição onde foi desenvolvido o estudo, bem como a sensibilidade da ultra-sonografia e da tomografia computadorizada para detecção dessa neoplasia na avaliação pré-transplante foi semelhante à relatada na literatura. Em contrapartida, a prevalência de infecção pelo vírus da hepatite C, fator etiológico de hepatopatia mais freqüente nos pacientes desta série, é das maiores já relatadas. Os fatores que influenciaram as taxas de detecção de carcinoma hepatocelular foram: tempo decorrido entre realização do exame e transplante; realização de tomografia computadorizada com fase arterial; tamanho da lesão. A fase arterial provou ser a mais importante no diagnóstico de carcinoma hepatocelular neste estudo.

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The ultrastructural pathology of non-invaded hepatocytes located in close proximity to metastases from diverse gastrointestinal carcinomas was studied. Observed abnormalities included swelling of rough and smooth endoplasmic reticulum, proliferation of lysosomes, and mitochondrial alterations as presence of granules and paracrystalline inclusions, marked pleomorphism, and lack of cristae. These results show that, contrary to the classical conception, the non-invaded cells surrounding primary tumours or their metastases could be abnormal.

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The electron microscopic examination of biopsies from liver metastases of a colon leiomyosarcoma showed the existence of alterations not previously reported in primary tumors of that kind. Those abnormalities included proliferation of lysosomal structures as multivesicular bodies, myelin-like figures, lipofuscin granules and autophagic vacuoles, along with mitochondrial changes as concentric and vesiculated cristae, and presence of dense granules and elongated inclusions. This study suggests that, in this tumor and host tissue, the so-called invasive phenotype, which is supposed to form the metastases, could have a distinct morphological picture at the ultrastructural level.

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Morphometric analysis by both light and electron microscopy was performed in cells from five cases of human, hepatocellular carcinoma (HCC) and in three control cases. In each case, three fragments were examined individually and the following morphometric parameters evaluated: a) nuclear, cytoplasmic and cell volumes; b) volume density and absolute volume of the rough ER, smooth ER, mitochondria, Golgi apparatus, peroxisomes, dense bodies and cytoplasmic matrix; c) surface density, surface/ volume ratio, and total surface area of rough ER, smooth ER and outer mitochondrial membranes. The parameters obtained from HCC cases showed ample scatter of data, all control values lying within the interval between the extreme values for the various parameters. Both the original and the logarithmically transformed data on volume and total membrane surface area of organelles (y) and of the cytoplasmic volume (x) were regressed using first degree regression equations. The original values for volume and total surface area of rough ER, total ER and mitochondria were linearly related to the corresponding values for cytoplasmic volume. The allometric analysis carried out with the logarithms also revealed significant regressions between cytoplasmic volume and smooth ER parameters not detectable when using the original x and y values. It showed, in addition, that in progressively larger cytoplasmic volumes, the cisternae of both rough and smooth ER tend to appear more compacted and a higher portion of the total ER membrane tends to be constituted of smooth ER. Within the wide range of variation in cytoplasmic volume of the HCC cells, the volume and total surface of the organelles do not vary randomly. These data indicate that in the small, normal-sized and large tumoral cells the mechanisms responsible for the cytoplasmic volume and for the corresponding total volume and membrane surface area of each major organelle are interdependent. Such an interdependence gives no support to ideas implying that the variation in size of cancer cells, an element of pleomorphism, would result of anarchical intracellular synthetic and/or degradative conditions.

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Se estudió mediante microscopía de luz, electrónica e inunohistoquímica un caso de colangiolocarcinoma en un hombre de 68 años de edad. El tumor se encontraba constituido por células neoplásicas formando estructuras parecidas a ductos. El estudio inmunohistoquímico mostró positividad para células ductales (citoqueratina 7) y hepatocitos (fibrinógeno) en las células neoplásicas. El estudio ultraestructural mostró células con características de células epiteliales de conducto y hepatocitos. De estos hallazgos se concluye que los colangiolocarcinomas puede derivar de una célula transicional común, probablemente similar a las células ovales observadas en los modelos de carcinogénesis experimental en hígado de ratas

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El presente trabajo fue realizado con el objetivo de estudiar el efecto por el lapachol (LAP) al ser administrado a rats en forma simultánea con un carcinógeno químico, el 20-merilcolantreno (MCA). Los animales fueron divididos en 4 lotes: A-Lote tratado con 80 mg de MCA (n=11 animales), B-Lote tratado con 80 mg de MCA+LAP 100 mg/Kg peso/día (n=15 animales), C-Lote tratado con LAP 100 mg/Kg peso día (n=12 animales), D-Lote control sin tratamiento (n=13 anisales). Los estudios citológicos así como la aplicación de técnicas citoquímicas permitieron conocer el diagnóstico de benegnidad o malignidad apenas producida la aparición del tumor. Estudios histopatológicos posteriores confiraaron la aparición el el 53 por ciento de los animales del lote B de tumores compatibles con adenocarcinomas pobremente diferenciados de glándula salival y en el 18.2 por ciento (2/11) de los animales del lote A de fibroadenomas de la glándula mamaria. Asimismo fue observada la presencia de uno o varios nódulos suprahepáticos en vencidad al ligamento suspensorio e histológicamente definidos como de hiperplasia nodular en el 33 por ciento (4/12) de los animales del lote C y en 13.3 por ciento (2/15) del B no produciéndose desarrollo de dichos nódulos en los lotes A y D. En el riñón fue observada dilatación quística de los túbulos en el 60 por ciento (9/15) y 83.3 por ciento (10/12) de los animales del lote B y C respectivamente. A partir del tumor primitivo de glándula salival fue desarrollada uma linea de tumores transplantables cuyo seguimiento fue realizado citológicamente. Se reafirma la importancia del diagnostico citológico e histopatológico para el estudio del efecto farmacológico de drogas que como el Lapachol son empleadas como antitumorales sin conocerse sus efectos nocivos.

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El presente trabajo fue realizado con el objetivo de estudiar el efecto por el lapachol (LAP) al ser administrado a rats en forma simultánea con un carcinógeno químico, el 20-merilcolantreno (MCA). Los animales fueron divididos en 4 lotes: A-Lote tratado con 80 mg de MCA (n=11 animales), B-Lote tratado con 80 mg de MCA+LAP 100 mg/Kg peso/día (n=15 animales), C-Lote tratado con LAP 100 mg/Kg peso día (n=12 animales), D-Lote control sin tratamiento (n=13 anisales). Los estudios citológicos así como la aplicación de técnicas citoquímicas permitieron conocer el diagnóstico de benegnidad o malignidad apenas producida la aparición del tumor. Estudios histopatológicos posteriores confiraaron la aparición el el 53 por ciento de los animales del lote B de tumores compatibles con adenocarcinomas pobremente diferenciados de glándula salival y en el 18.2 por ciento (2/11) de los animales del lote A de fibroadenomas de la glándula mamaria. Asimismo fue observada la presencia de uno o varios nódulos suprahepáticos en vencidad al ligamento suspensorio e histológicamente definidos como de hiperplasia nodular en el 33 por ciento (4/12) de los animales del lote C y en 13.3 por ciento (2/15) del B no produciéndose desarrollo de dichos nódulos en los lotes A y D. En el riñón fue observada dilatación quística de los túbulos en el 60 por ciento (9/15) y 83.3 por ciento (10/12) de los animales del lote B y C respectivamente. A partir del tumor primitivo de glándula salival fue desarrollada uma linea de tumores transplantables cuyo seguimiento fue realizado citológicamente. Se reafirma la importancia del diagnostico citológico e histopatológico para el estudio del efecto farmacológico de drogas que como el Lapachol son empleadas como antitumorales sin conocerse sus efectos nocivos. (AU)

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This article reports the results of 1080 ultrasonographic examinations of the liver in a clinic of the Ninth Region of Chile, using a SSD 620 Aloka equipment. In 61 examinations (5.6%) a focal liver lesion was found. Of these, 9 (14.7% of lesions) appeared as malignant (6 metastasis and 3 hepatomas) and 52 (85.3% of lesions) appeared as benign (10 inespecific calcifications of less than 10 mm, 6 vascular lesions, 12 simple cysts, 2 cases of polycystic liver and 9 cases fulfilled Gharbi's criteria for hepatic hydatidosis). The diagnosis in these 9 cases was confirmed by serology or surgery Thus, 14.7% of all focal lesions of the liver were due to hydatidosis. Considering that simple cysts are indistinguishable from hydatid cysts in early stages, hydatidosis could be misdiagnosed in this sample. It is concluded that serologic tests should be performed to all cystic hepatic ultrasonographic lesions, specially in zones with high infestations rates.

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Electron microscopic examination of an infantile hemangioendothelioma (IHE) type I of the liver, appearing in a five month old child, showed a high density of pericytes in the walls of the neoplastic vessels. These vessels, in part of the IHE patients, establish an important arteriovenous shunt leading to high output, congestive cardiac failure. It is unclear whether functions ascribed to pericytes, such as participation in microvascular contractility or as suppressors of endothelial cell proliferation are involved in two noteworthy aspects of the present case. The child exhibited no congestive heart failure and the multiple nodular lesions underwent spontaneous regression.

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Hepatoblastomas from B6C3F1 and BALB/c mice were examined by light and electron microscopy and by immunohistochemical reactions for alpha-fetoprotein, keratin, and vimentin. Tumors occurred in one group of a chronic bioassay for the interaction of diet, genetic strain, and the carcinogen, 2-acetylaminofluorene. Tumors had several populations (including epithelial and mesenchymal cells) in various stages of differentiation. Neoplastic epithelial cells had features of embryonal hepatocytes, such as sparse cytoplasmic organelles, absence of glycogen, abundant free ribosomes, occasional bile canaliculi, and peroxisome-like dense bodies. Embryonal fibroblast-like cells had pleomorphic and folded nuclei with prominent perinuclear chromatin and dispersed cytoplasmic organelles. Fibroblast-like cells were surrounded by bundles of collagen fibrils. Intermediate or transitional types of cells were seen. No tumor cells were immunoreactive for mouse alpha-fetoprotein (AFP) antibody, unlike those in hepatocellular adenomas or carcinomas. Epithelial and mesenchymal tumor cells contained intermediate filaments throughout the cytoplasm; some of these cells stained for keratin but not for vimentin. These findings suggest that mouse hepatoblastomas are derived from bipotential liver blastema cells and are composed of a mixture of several cell populations.

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We describe a fibrolamellar carcinoma of the liver in a 12-year-old girl and review the literature concerning the occurrence of this distinct hepatic neoplasm in children up to the age of 16 years. The results of our electron microscopic and immunohistologic studies suggest that some cells of this tumor exhibit neuroendocrine differentiation. This finding has important theoretical implications relative to the tumor's histogenesis and practical implications with respect to the search for tumor markers of clinical usefulness and possibly for therapy.

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