vasoactive-intestinal-peptide and Carcinoma--Hepatocellular

This review has focused on the unique role of radionuclide scintigraphy in characterization of hepatic mass lesions. Radionuclide scintigraphy, unlike most other imaging modalities, is based on specific physiological and biochemical properties of each pathological entity that affects the liver. Hepatic scintigraphy, with its widespread availability, noninvasive nature, and relatively low cost is a powerful adjunct to other imaging techniques in the investigation of hepatic mass lesions. We have reviewed clinical presentation and characteristic findings of most hepatic lesions and have described reported findings with all available imaging modalities with particular emphasis on hepatic scintigraphy (Table 1) as well as a suggested algorithm for workup of solid hepatic masses (Fig 6). Additionally, the role of newer, more specialized techniques including PET scanning, 123I-labeled VIP, and 111In-labeled DTPA-D-Phe-octreotide scanning are reviewed. Hepatic nuclear scintigraphy continues to play an important role in the management of patients with solid hepatic masses.

Topics: Algorithms; Carcinoma, Hepatocellular; Costs and Cost Analysis; Hemangioma, Cavernous; Humans; Indium Radioisotopes; Iodine Radioisotopes; Liver Diseases; Liver Neoplasms; Neuroendocrine Tumors; Octreotide; Pentetic Acid; Terbium; Tomography, Emission-Computed; Vasoactive Intestinal Peptide

Topics: Animals; Apoptosis; bcl-X Protein; Carcinoma, Hepatocellular; Cell Line, Tumor; Cells, Cultured; Cyclic AMP; Cyclic AMP Response Element-Binding Protein; Hep G2 Cells; Humans; Liver Neoplasms; Phosphorylation; Receptors, Vasoactive Intestinal Peptide, Type II; Receptors, Vasoactive Intestinal Polypeptide, Type I; Signal Transduction; Vasoactive Intestinal Peptide

Paraneoplastic syndromes are frequently associated with various types of malignant tumors but are fairly rare in the course of hepatocellular carcinoma (HCC). We describe the clinical case of a 76 year old man with chronic hepatitis C infection related to liver disease who had suffered for several months from chronic runny but blood and mucus-free diarrhea, together with progressive weight loss and flushing of the face. Serological tests made on admission confirmed the chronic liver disease and showed an increase of serum levels of some neuroendocrine hormones, i.e. 5-hydroxytryptamine and vasoattive intestinal peptide. Ultrasound and CT scans led to the diagnosis of HCC. The diarrhea and the increase in some neuroendocrine hormones were therefore interpreted as expression of a paraneoplastic-like neuroendocrine syndrome that had preceded the onset of HCC by some months. The patient died a few months after the diagnosis of HCC, from total portal vein thrombosis and consequent liver and renal failure. This clinical report draws the attention to the possibility of paraneoplastic syndrome expression before the clinical onset of HCC and to the role that neuroendocrine hormones may have on the growth and spread of HCC.

Topics: Aged; Carcinoma, Hepatocellular; Diarrhea; Hepatitis C, Chronic; Humans; Liver Neoplasms; Male; Paraneoplastic Syndromes; Radiography, Abdominal; Serotonin; Time Factors; Tissue Polypeptide Antigen; Tomography, X-Ray Computed; Vasoactive Intestinal Peptide

Thirty primary liver neoplasms (16 hepatocellular, nine biliary, and five epithelioid haemangioendotheliomas) were studied for the expression of the general 'neuroendocrine' markers, neurone specific enolase (NSE) and protein gene product 9.5 (PGP 9.5). Grimelius silver staining for neurosecretory granules and immunostaining for S100 protein, HMB-45, vasoactive intestinal polypeptide (VIP), and calcitonin were also performed. Eleven of the 16 hepatocellular carcinomas stained positively for PGP 9.5, four for NSE, six for HMB-45, and two for S100 protein. Seven exhibited granular staining by the Grimelius method; eight showed immunostaining for VIP, and two for calcitonin. Three of the five haemangioendotheliomas demonstrated positive immunostaining for PGP 9.5, and two for NSE; of the nine biliary carcinomas, two showed staining for PGP 9.5 and NSE, and four contained cells staining with the Grimelius technique. Primary neoplasms of liver may show 'neuroendocrine' differentiation and this aspect of their phenotypic expression has to be considered before predicting the site of origin of a tumour in the liver.

Topics: Bile Duct Neoplasms; Biomarkers, Tumor; Calcitonin; Carcinoma, Hepatocellular; Cell Differentiation; Hemangioendothelioma; Humans; Liver Neoplasms; Neuropeptides; Phosphopyruvate Hydratase; S100 Proteins; Ubiquitin Thiolesterase; Vasoactive Intestinal Peptide

A 44-year-old woman with hepatocellular carcinoma presented with intractable watery diarrhea and her condition was evaluated angiographically. Surgical ablation of the tumor resulted in complete resolution of the diarrhea. The tumor cells of the hepatocellular carcinoma were found to contain vasoactive intestinal polypeptide, gastrin, and prostaglandinlike immunoactivity. To our knowledge, this is the first report of such an association.

Topics: Adult; Carcinoma, Hepatocellular; Diarrhea; Dinoprostone; Female; Gastrins; Histocytochemistry; Humans; Liver Neoplasms; Paraneoplastic Endocrine Syndromes; Prostaglandins E; Radiography; Vasoactive Intestinal Peptide