Video Endoscopic Sequence 1 of 6.

Laparoscopy of Hepatocellular Carcinoma

This is a 23 year-old male who presented with intractable vomiting had been admitted for a week in a public hospital, discharged without giving any diagnosis, had worked at a gas station, possibly was the triggering factor of this tumor. "gasoline odor".

In the abdominal ultrasonography this mass is detected as well as the MRI.

Laparoscopy is performed with biopsy of metastases to the peritoneum.

Hepatocellular carcinoma (HCC) is a primary malignancy of the hepatocyte, generally leading to death within 6-20 months. Hepatocellular carcinoma frequently arises in the setting of cirrhosis, appearing 20-30 years following the initial insult to the liver. However, 25% of patients have no history or risk factors for the development of cirrhosis. The extent of hepatic dysfunction limits treatment options, and as many patients die of liver failure as from tumor progression.

Although it is currently one of the most common worldwide causes of cancer death, a major impact on the incidence of hepatocellular carcinoma should be achieved through current vaccination strategies for hepatitis B virus (HBV) infection, screening and treatment for hepatitis C virus (HCV) infections, and from the reduction of alcoholic liver disease. However, because the latency period from hepatic damage to hepatocellular carcinoma development is very long, it may be many years until the incidence of hepatocellular carcinoma decreases as a result of these interventions.

Pubmed: Risk of liver cancer and exposure to organic solvents and gasoline vapors among Finnish workers.

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Video Endoscopic Sequence 2 of 6.

Laparoscopy of Hepatocellular Carcinoma

Multiple peritoneal metastases are observed with several nodules in the omentum

Age at diagnosis varies widely according to geographic distribution.

In the United States and Europe, the median age at diagnosis is 65 years. Hepatocellular carcinoma is rarely diagnosed in persons younger than 40 years. However, between 1975 and 1998, the 45- to 49-year age group had the highest rate, a 3-fold increase in the incidence of hepatocellular carcinoma.

In Africa and Asia, age at diagnosis is substantially younger, occurring in the fourth and fifth decades of life, respectively. Diagnosis at a younger age is thought to reflect the natural history of hepatitis B and C related hepatocellular carcinoma.

Video Endoscopic Sequence 3 of 6.

Laparoscopy of Hepatocellular Carcinoma

The noplasia is displayed

In general, cirrhosis of any etiology is the major risk factor for hepatocellular carcinoma. About 80% of patients with newly diagnosed hepatocellular carcinoma have preexisting cirrhosis. Major causes of cirrhosis in the United States are attributed to alcohol, hepatitis C infection, and hepatitis B infection.

Alcohol
In the United States, about 30% of hepatocellular carcinoma cases are thought to be related to excessive alcohol use. Chronic alcohol use (>80 g/d or >6-7 drinks per day) for more than 10 years increases risk of hepatocellular carcinoma 5-fold.

Video Endoscopic Sequence 4 of 6.

Laparoscopy of Hepatocellular Carcinoma

For biopsies, some of the nodes metastases are removed.

Approximately 50% of US patients have histories of alcohol abuse. As many as 50% of alcoholics may have subclinical hepatocellular carcinoma at autopsy.

The risk of hepatocellular carcinoma is greater once the patient stops drinking alcohol, because heavy drinkers do not survive long enough to develop cancer.

The risk of hepatocellular carcinoma in patients with decompensated alcoholic cirrhosis is approximately 1% per year.

Hepatitis B virus infection
The global incidence of chronic hepatitis B virus (HBV) infection is estimated to be 350 million persons; chronic HBV infection is the most common cause of hepatocellular carcinoma worldwide. In the United States, about 20% of hepatocellular carcinoma cases are thought to be related to chronic hepatitis B infection.

Video Endoscopic Sequence 5 of 6.

Laparoscopy of Hepatocellular Carcinoma

For biopsies, some of the nodes metastases are removed.

Hepatitis C virus (HCV) infection is a global pandemic affecting 170 million persons. HCV infection results in a higher rate of chronic infection compared with HBV infection (approximately 80% of infected subjects).

HCV infection has become the most common cause of hepatocellular carcinoma in Japan and Europe, and it is also responsible for the recent increased incidence in the United States. About 2.7 million Americans have chronic HCV infection. In the United States, about 30% of hepatocellular carcinoma cases are thought to be related to HCV infection. Some 5-30% of individuals with HCV infection develop chronic liver disease. In this group, about 30% progress to cirrhosis, and in these, about 1-2% per year develop hepatocellular carcinoma.

The lifetime risk of hepatocellular carcinoma in patients with HCV is approximately 5%, appearing 30 years after infection.

Co-infection with HBV further increases the risk; many patients are co-infected with both viruses. Alcohol use in the setting of chronic HCV doubles the risk of hepatocellular carcinoma compared with HCV infection alone.

Recent studies suggest that antiviral treatment of chronic HCV infections may reduce the risk of hepatocellular carcinoma significantly.

Video Endoscopic Sequence 6 of 6.

Laparoscopy of Hepatocellular Carcinoma

Multiple metastases to the omentum is observed.