BACKGROUND: Hepatitis B virus (HBV) infection is a major cause of mortality and morbidity globally. The quest continues to identify viral factors that influence disease progression and severity as well as responses to treatment of HBV infection. Based on variations in HBV, the virus has been divided into a number of genotypes.
DATA SOURCES: Review of published literature on HBV genotypes.
RESULTS: HBV genotypes are likely to be important in determining the severity and progression of HBV-induced liver disease as well as responses to different anti-viral agents.
CONCLUSION: Although HBV genotyping is not yet recommended for routine use in treating HBV infection, available data suggest that, as in hepatitis C virus infection, HBV genotyping is also likely to become a routine investigation for HBV treatment, perhaps in the not too distant future.

BACKGROUND: Diabetes mellitus (DM) is a frequent and serious complication in patients with liver diseases. We aimed to assess the prevalence and consequences of post-transplant DM (PTDM) in Chinese patients with HBV-related liver diseases and to determine the possible risk factors.
METHODS: Altogether 165 patients with HBV infection and undergoing cadaveric related liver transplantation (LT) were enrolled. The clinical data of patients with (PTDM group) and without PTDM (non-PTDM group) were compared.
RESULTS: Of the 165 patients, 28 had DM and 12 had impaired fasting glucose (IFG) before LT. Patients with pre-transplant DM or IFG had a survival rate similar to that of the others. Forty patients (24.2%) developed PTDM with a mean time of 36±17 days (range 2-300 days) after LT. Of those, 32 developed PTDM within 3 months post-LT and 29 needed insulin treatment. Pre-transplant hepatic encephalopathy and tacrolimus application were found more frequently in the PTDM group than in the non-PTDM group. The plasma tacrolimus levels were notably higher at 1 and 3 months post-LT in the PTDM group than those in the non-PTDM group. Compared to the non-PTDM group, the PTDM group showed remarkably poorer survival and tumor-free survival in patients with hepatocellular carcinoma, and significantly higher incidence of sepsis, fungal infection, chronic kidney diseases and biliary complications after LT.
CONCLUSIONS: Pre-transplant DM did not affect the patient survival after LT. Since PTDM is common, it has a negative impact on outcome and may contribute to tumor recurrence. Pre-transplant hepatic encephalopathy, a tacrolimus-based regimen, and high levels of tacrolimus are clearly associated with the occurrence of PTDM.

BACKGROUND: Ischemic-type biliary lesions (ITBLs) play an extremely important role in influencing the long-term survival and quality of life of recipients after orthotopic liver transplantation (OLT). Some patients can be cured by interventional therapies, however others lose their grafts at last and receive liver retransplantation (re-OLT). The aim of this study was to analyze the data of 66 patients who had received re-OLT at our center because of ITBL and to discuss the treatment of ITBL after OLT.
METHODS: We retrospectively analyzed 66 re-OLT cases due to ITBL from September 2001 to February 2007 at our center. The Kaplan-Meier method and the Cox-Mantel test were used to identify factors associated with mortality for univariate analysis and multivariate analysis, respectively.
RESULTS: Fifty-five of 66 ITBL cases underwent interventional therapies before re-OLT. The actuarial survival at 1 month and 1 year for these patients was 83% and 74%, respectively. Prognostic factors for mortality in univariate analysis were model of end-stage liver disease score (MELD) >16.5 (χ2=5.856, P=0.016), cold ischemia time >8 hours (χ2=6.539, P=0.011), infections (χ2=5.550, P=0.018) and complications (χ2=12.168, P=0.002) after re-OLT. In the multivariate analysis (Cox regression), the risk factors independently associated with mortality were MELD score >16.5 (RR: 3.140; P=0.035), cold ischemia time >8.2 hours (RR: 0.192; P=0.016) and complications (RR: 3.896, P=0.003).
CONCLUSIONS: The incidence of ITBL in China is higher than in other countries. Based on our experience, MELD score, cold ischemia time and complications after re-OLT are risk factors independently associated with mortality in retransplanted ITBL patients.

BACKGROUND: With the improvement of MR technology, three-dimensional dynamic contrast-enhanced MR angiography (3D-DCE-MRA) may be the optimal vascular imaging method for preoperative evaluation of liver transplantation candidates. This study was undertaken to determine the value of 3D-DCE-MRA in the assessment of recipient vessels in orthotopic liver transplantation (OLT).
METHODS: The surgical and pathological records were taken as the "gold standards". Eighteen cases of OLT were retrospectively analyzed to assess the image quality of MRA, including the signal-to-noise ratio (SNR) in arteries and veins, depiction of vascular variation and vessel disease, and the accuracy of vascular diameter measurement.
RESULTS: 3D-DCE-MRA of 34 cases was carried out before OLT. The rates (excellent and good) showing hepatic arteries and portal vein for 3D-DCE-MRA were 94.1% (32/34) and 88.2% (30/34), respectively. The SNRs of the celiac axis and portal vein measurements from 3D-DCE-MRA were 20.58±3.74 and 13.43±4.12, and the mean diameters were 3.4±0.3 mm and 13.1±3.2 mm, respectively. There were 5 cases of vessel variation according to the Michel's classification. Of the 34 patients, 18 were compared radiologically and pathologically. The accuracy of depiction of the hepatic artery and portal vein with 3D-DCE-MRA was 100% for both; 3D-DCE-MRA precisely assessed 4 cases of more than moderate stenosis in hepatic arteries, 2 cases of small-caliber hepatic artery, 3 cases of venous stenosis at the second porta hepatis, 6 cases of collateral vasculature, 1 case of portal vein thrombosis and 1 case of portal vein aneurysm; all were confirmed pathologically.
CONCLUSION: 3D-DCE-MRA may be the first choice for recipient vascular assessment before OLT.

BACKGROUND: Although the use of non-heart beating donors (NHBDs) could bridge the widening gap between organ demand and supply, its application to liver transplantation is limited due to the high incidence of primary graft loss. Prevention of liver injury in NHBDs will benefit the results of transplantation. This study was conducted to evaluate the protective effects of L-arginine on liver grafts from NHBDs.
METHODS: One hundred and four Wistar rats were randomly divided into 7 groups: normal control (n=8), controls 1, 2 and 3 (C₁, C₂, C₃, n=16), and experimental 1, 2 and 3 (E₁, E₂, E₃, n=16). For groups C₁ and E₁, C₂ and E₂, and C₃ and E₃, the warm ischemia time was 0, 30, and 45 minutes, respectively. Liver grafts were flushed with and preserved in 4 ℃ Euro-collins solution containing 1 mmol/L L-arginine for 1 hour in each experimental group. Recipients of each experimental group were injected with L-arginine (10 mg/kg body weight) by tail vein 10 minutes before portal vein reperfusion. Donors and recipients of each experimental control group were treated with normal saline. Then transplantation was performed. At 1, 3, and 24 hours after portal vein reperfusion, blood samples were obtained to determine the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), nitric oxide (NO) and plasma endothelin (ET). At 3 hours after portal vein reperfusion, grafts samples were fixed in 2.5% glutaraldehyde for electron microscopic observation.
RESULTS: At 1 hour after portal vein reperfusion, the levels of NO in groups E₁, E₂, E₃ and C₁, C₂, C₃ were lower, while the levels of plasma ET, serum ALT and AST were higher than those in the normal control group (P<0.05). At 1, 3, and 24 hours, the levels of NO in groups E₁, E₂, E₃ were higher, while the levels of plasma ET, serum ALT and AST were lower than those in the corresponding control groups (C₁, C₂, C₃) (P<0.05). The levels of NO in groups C_{2 and C3 were lower than in group C1 (P<0.05), and the level of NO in group C3 was lower than in group C2 (P<0.05). At 1, 3 and 24 hours, the levels of plasma ET, serum ALT, and AST in groups E1, E2, E3 were lower than those in the corresponding control groups (C1, C2, C3) (P<0.05). The levels of plasma ET, serum ALT, and AST were lower in group C3 than in groups C1 and C2 (P<0.05). Pathological changes in groups E1, E2, E3 were milder than those in the corresponding experimental control groups (C1, C2, C3).
CONCLUSIONS: The imbalance between NO and ET plays an important role in the development of ischemia-reperfusion injury of liver grafts from NHBDs. L-arginine can attenuate injury in liver grafts from NHBDs by improving the balance between NO and ET.}

BACKGROUND: Solitary necrotic nodule of the liver is a rare nonmalignant lesion. The present study aimed to clarify the clinical features of the disease. 
METHOD: The medical records of 51 patients with histologically confirmed solitary necrotic nodule of the liver who received surgical resection at our institution were retrospectively reviewed. 
RESULTS: Solitary necrotic nodule of the liver was found mainly in males (68.6%, 35/51), and patients ranged in age from 5 to 69 years with a mean of 45.3. Most of the patients (72.5%) had no significant symptoms, with negative results for the serum tumor markers alpha-fetoprotein, carbohydrate antigen 19-9 and carcinoembryonic antigen. The mean diameter of the nodule was 23 mm (range 10-55 mm). Compared with ultrasonographic and computed tomography findings, the specific features of magnetic resonance imaging were more helpful for differential diagnosis of the disease. 
CONCLUSIONS: Solitary necrotic nodule of the liver is a rare nonmalignant lesion, showing no notable symptoms and potential complications. The pathological change of the disease is not significant over a lifetime. Conservative treatment and clinical follow-up are recommended.

BACKGROUND: p130Cas (p130Crk-associated substance) is a junction protein that is important to the adhesion between cytoskeleton and extracellular matrix. Also, the adhesion molecules E-cadherin and β-catenin play important roles in the invasiveness of carcinoma. This study was undertaken to investigate the effects of p130Cas, E-cadherin and β-catenin on the invasion, metastasis and prognosis of hepatocellular carcinoma (HCC).
METHODS: Immunohistochemistry was used to evaluate the expression of p130Cas, E-cadherin, and β-catenin in 40 patients with HCC. All patients were followed up postoperatively, and the relationship between expression and clinicopathological prognostic parameters was analyzed.
RESULTS: The positive expression rates of p130Cas and E-cadherin in HCC tissue (n=40) were 62.50% and 55.00%, but in normal liver tissue 10%, and 100%, respectively (P<0.05). The abnormal expression rate of β-catenin in HCC tissue was 70%, while in normal liver tissue it was 13.33% (P<0.05). The positive rate of p130Cas was correlated with lymph node invasion, pathological stage, TNM stage, and a worse prognosis, but not with gender, age, HBV infection, hepatic cirrhosis, alpha-fetoprotein (AFP) level before operation, and tumor diameter. Similarly, the expression of E-cadherin and β-catenin was correlated with lymph node invasion, pathological stage, TNM stage, and worse prognosis, but not with gender, age, HBV infection, hepatic cirrhosis, AFP level before operation, and tumor size. Correlations were found between p130Cas and abnormal E-cadherin/β-catenin expression (P<0.001 and <0.05, respectively).
CONCLUSIONS: In HCC, there is a negative correlation between the positive expression of p130Cas and the normal expression of the adhesion molecules E-cadherin/β-catenin, and p130Cas plays important roles in the invasion, metastasis and prognosis of HCC. p130Cas may be involved in alterating the structure and function of E-cadherin/β-catenin, by regulating tyrosine phosphorylation via the p130Cas-Src signal pathway.

BACKGROUND: CT perfusion has been reported to have great advantages in detecting hepatic diseases. However, currently there are no studies showing the potential value of multi-slice CT perfusion with the deconvolution model method in diagnosing early hemodynamic changes caused by liver tumors. This study was undertaken to determine if early hemodynamic changes caused by liver tumors can be depicted with the perfusion imaging of multi-slice CT.
METHODS: Ten New Zealand white rabbits before and after VX2 liver tumor inoculation served as the experimental animals. Ten normal rabbits served as controls. All underwent multi-slice CT perfusion for the measurement of hepatic blood flow (HBF), hepatic blood volume (HBV), mean transit time (MTT), permeability of capillary vessel surface (PS) and hepatic artery index (HAI).
RESULTS: With the exception of MTT, which decreased significantly at the tumor periphery, HBF, HBV, PS and HAI increased significantly compared with the surrounding normal tissue. All these changes occurred at days 5-9 after tumor inoculation. Statistically significant changes in these values were detected with tumor growth.
CONCLUSIONS: The hemodynamic changes in the liver caused by rabbit VX2 liver tumor can be detected after tumor inoculation, and functional CT can evaluate the physiological characteristics of early tumor angiogenesis.

BACKGROUND: Nitric oxide (NO) and prostacyclin (PGI₂) are both powerful vasoactive substances correlated with the hyperhemodynamics of portal hypertension (PHT), a common syndrome characterized by a pathological increase in portal venous pressure. The purpose of the present study was to evaluate the possible interaction between these two endothelial vasodilators, together with their respective roles in the hyperdynamic splanchnic circulation of PHT.
METHODS: Ninety-six male Sprague-Dawley rats were randomly divided into three groups: intrahepatic portal hypertension (IHPH) induced by injection of CCl₄ (n=31), prehepatic portal hypertension (PHPH) induced by partial stenosis of the portal vein (n=33), and sham-operated controls (SO) (n=32). Animals of each group received indomethacin (INDO), a cyclooxygenase (COX) inhibitor, either short-term (7 days) or long-term (15 days), with saline as control. Free portal pressure (FPP), together with the concentration of NO and PGI₂ in serum were measured. The activity of constitutive nitric oxide synthase (cNOS) and inducible nitric oxide synthase (iNOS) in the abdominal aorta and small intestine were determined by spectrophotometry. RT-PCR was performed to measure the levels of cNOS and iNOS mRNA in the arteries and small intestines.
RESULTS: Compared with SO rats, the concentrations of NO and PGI₂ in PHT rats were elevated, which were consistent with the increased FPP (P<0.05). Although administration of INDO persistently decreased the concentration of PGI₂ in serum (P<0.05), the long-term INDO-treated IHPH and PHPH groups had restored splanchnic hyperdynamic circulation, demonstrated by the enhanced FPP (P<0.05). Furthermore, the changes of dynamic circulatory state in both IHPH and PHPH rats were concomitant with the expression and activity of iNOS and the concentration of NO (P<0.05). Although the expression and activity of cNOS in abdominal aorta of PHT rats were higher than in SO rats (P<0.05), there was no difference in small intestinal tissues between PHT and SO rats (P>0.05). Moreover, the changes of iNOS activity and mRNA expression were more marked than cNOS in PHT rats, and there was no difference in expression and activity of cNOS between PHT rats treated by short- and long-term INDO (P>0.05).
CONCLUSIONS: iNOS plays an important role in the hemodynamic abnormalities of PHT induced by overproduction of NO. There is a possible interaction between PGI₂ and NO in hyperhemodynamics of PHT, but PGI₂ may not be a mediator in the formation and development of the hyperdynamic circulatory state in PHT rats.

BACKGROUND: Melanoma differentiation associated gene-7 (mda-7) is a novel tumor suppressor gene, which has suppressor activity in a broad spectrum of human cancer cells both in vitro and in vivo through activation of various intracellular signaling pathways. In this study, we investigated the potential effect of mda-7 on human hepatocellular carcinoma (HCC) in vitro.
METHODS: Cells from the human HCC cell line Hep3B and the human liver cell line L-02 were assigned to three groups. One was cultured in Dulbecco's modified Eagle's medium without serum (control). The others were transfected with adenovirus expressing the mda-7 gene (Ad.mda-7) or adenovirus vector serving as negative control (Ad.vec). The expression of MDA-7 and Bcl-2 proteins in Hep3B and L-02 cells was confirmed by the reverse transcriptase-polymerase chain reaction and enzyme-linked immunosorbent assay. The methyl thiazolyl tetrazolium colorimetric assay and flow cytometry were used to assess tumor cell proliferation and the cell cycle. Hoechst and Annexin-V/propidium iodide staining were used to study mda-7 gene expression in Hep3B and L-02 cells. The expression of MDA-7, Bcl-2 and Bax proteins were detected by Western blotting.
RESULTS: The mda-7 gene was expressed in Hep3B and L-02 cells. The protein concentrations of MDA-7 in supernatants were 790 and 810 pg/ml, respectively. mda-7 induced Hep3B growth suppression and apoptosis, compared with Ad.mda-7 and control (P<0.01). In addition, cell block in G2/M was identified by exposure of HCC cells to secreted MDA-7 protein, but this was not found in L-02. The gene expression of Bcl-2 was markedly decreased in Hep3B but not in L-02.
CONCLUSIONS: mda-7 selectively induces growth inhibition and apoptosis in the HCC cell line Hep3B but not in the normal liver cell line L-02 via downregulating the anti-apoptosis protein Bcl-2. It could be an ideal gene for gene therapy in HCC.

BACKGROUND: Understanding any factors which influence the morbidity and mortality in patients with obstructive jaundice in each society will better guide appropriate management and lead to improved survival. This study aimed to assess baseline etiologies, clinical manifestations, diagnostic results, and morbidity and mortality related to obstructive jaundice in Iranian patients.
METHODS: The hospital recorded files of 133 patients with the final diagnosis of obstructive jaundice who had been admitted to the Taleqhani Hospital in Tehran between January 2001 and September 2004 were reviewed.
RESULTS: The most common etiologies of obstructive jaundices were neoplasia and then common bile duct stone in the two genders. The results of ultrasonography were positive in less than half of the patients. However, the most positive results were related to endoscopic retrograde cholangiopancreatography (ERCP). The in-hospital mortality rate in patients less than 50 years old and elderly patients was 0% and 6.76%, respectively. The in-hospital morbidity rate was 2.25% and 7.51%, respectively in both patients and it was commonly related to infection of ulcer (44.46%), pneumonia (14.75%), myocardial infarction (14.75%), and subdiaphragmatic abscess (11.29%). In patients with a diagnosis of benign obstruction, only one patient died of severe sepsis. In malignant group, preoperative characteristics, such as weight loss (P=0.015) and serum bilirubin concentration more than 16 mg/dl and postoperative complications, such as sepsis (P<0.001), cardiac arrest (P<0.001), and hepatic coma (P<0.001) were main predictors for the in-hospital mortality rate.
CONCLUSION: Although the mortality and morbidity of obstructive jaundice in our study are less than those in other studies, the determination of preoperative clinical and laboratory indices and postoperative complications of patients is needed for the control of mortality and morbidity rate.

BACKGROUND: Mirizzi syndrome is a rare complication of cholelithiasis, characterized by the narrowing of the common hepatic duct as a result of mechanical compression and/or inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct. In this study, we aimed to describe the clinical presentations, investigations, operative details, and complications of seven patients who underwent endoscopic retrograde cholangiopancreatography and were finally diagnosed with Mirizzi syndrome in our center.
METHOD: We performed a retrospective analysis of the records of 7 patients with Mirizzi syndrome who underwent endoscopic retrograde cholangiopancreatography.
RESULTS: The incidence of Mirizzi syndrome was 1.07% of 656 patients given endoscopic retrograde cholangiopancreatography. Ultrasonography was able to diagnose one case. Endoscopic retrograde cholangiopancreatography suggested the diagnosis in five cases and helped further in the management of these patients. Four patients had cholecystectomy and T-tube placement, and two had cholecystectomy and choledochoduodenostomy. One patient with type Ⅰ Mirizzi syndrome according to the Csendes classification successfully underwent laparoscopic cholecystectomy.
CONCLUSIONS: In the study, the incidence of Mirizzi syndrome was 1.07% of patients who underwent endoscopic retrograde cholangiopancreatography. Preoperative diagnosis of Mirizzi syndrome by endoscopic retrograde cholangiopancreatography is important to prevent complications.

BACKGROUND: Magnetic resonance cholangiography (MRC) is a non-invasive method for imaging biliary ducts. When used to exclude common bile duct (CBD) stones, MRC may obviate the need for intra-operative cholangiography (IOC). In this prospective study, MRC and IOC were compared for the diagnosis of suspected stones of the CBD.
METHODS: Thirty patients with gallstones and suspected CBD lithiasis (abnormal serum liver tests and CBD >7 mm on ultrasound) had MRC followed by open cholecystectomy and IOC. MR imaging was done using a 1.5-T whole body scanner (Signa, General Electric Medical Systems). A torso phased-array coil with a 4-channel receiver was used for data acquisition.
RESULTS: Over a period of 18 months, 30 patients (average age 53.9±13.3 years; range 38-76 years) were enrolled in this study. Eleven patients were male (36.7%) and 19 female (63.3%). MRC revealed CBD stones in 19 patients, while IOC revealed CBD stones in 22. The sensitivity of MRC in detecting CBD stones was 81.8%, and the specificity was 87.5%. The positive predictive value was 94.7%, and the negative predictive value was 63.3%.
CONCLUSIONS: Pre-operative MRC may obviate the need for IOC. MRC reduces operative time, is less invasive, and may also alleviate damage to the CBD that can occur during IOC. MRC can identify CBD stones pre-operatively and can help surgeons plan safe procedures. Pre-operative MRC should be done routinely in patients whose clinical or biochemical findings suggest the possibility of CBD stones.

BACKGROUND: The presence of bacteria in bile is an important factor in the formation of pigment gallstones. The bile of healthy people is sterile and bacteria in the biliary system come from endogenous infection from the gut. Yet, the route of bacterial translocation into the bile duct is still unclear. Theoretically, two routes exist: one is through the intestinal barrier and the other is by direct reflux from the sphincter of Oddi. This study was undertaken to explore the relationship between the effectiveness of intestinal barrier and the formation of pigment gallstones in hamsters.
METHODS: Thirty-two hamsters were divided into an experimental and a control group, with 16 hamsters in each group. A low protein and high cellulose diet was given for 6 weeks to induce the formation of pigment gallstones in the experimental group (PS) and a normal diet was given to the control group (CON). Morphological changes, changes in the levels of serum endotoxin and diamine oxidase, and changes in the numbers of B lymphocytes, plasma cells and secretory immunoglobin A (sIgA) in the intestinal mucosa were assessed after 6 weeks.
RESULTS: Four hamsters died during lithogenesis and body weight decreased in the PS group. Pigment gallstones were found in 11 hamsters at the end of the experiment, giving a lithogenesis rate of 91.67%. The serum endotoxin level before and after gallstone formation in the PS group was 0.2960±0.1734 U/ml and 8.2964±4.6268 U/ml, respectively (P<0.05). The blood diamine oxidase level before and after gallstone formation in the PS group was 2.6333±0.8037 U/ml and 3.3642±0.9545 U/ml, respectively (P<0.05). The numbers of B lymphocytes, plasma cells and sIgA in the intestinal mucosa in the PS group were 71.56±2.89, 68.65±2.09 and 27.56±1.07, respectively, and were significantly decreased compared with the corresponding values in the CON group (94.25±3.69, 93.47±3.98 and 42.57±1.96, respectively, P<0.05).
CONCLUSIONS: A low protein and high cellulose diet can markedly reduce intestinal barrier function and facilitate the formation of pigment gallstones. The decrease of intestinal barrier function may take part in the formation of pigment gallstones.

BACKGROUND: Pancreatic cancer is closely related to epigenetic abnormality. The epithelial cell transforming sequence 2 gene (ECT2) plays a critical role in Rho activation during cytokinesis, and thus may play a role in the pathogenesis of pancreatic cancer. In this study, we investigated the relationships between aberrant expression and epigenetic changes of the ECT2 gene in pancreatic cancer.
METHODS: Four cell lines (PANC-1, Colo357, T3M-4 and PancTuⅠ) and pancreatic ductal adenocarcinoma (PDAC) tissues were used for mRNA detection. After restriction isoschizomer endonucleases (MspⅠ/HpaⅡ) were used to digest the DNA sequence (5'-CCGG-3'), PCR was made to amplify the product. And RT-PCR was applied to determine the expression of the gene.
RESULTS: The mRNA expression of the ECT2 gene was higher in pancreatic tumor tissue than in normal tissue. The gene was also expressed in the 4 PDAC cell lines. The methylation states of the upstream regions of the ECT2 gene were almost identical in normal, tumor pancreatic tissues, and the 4 PDAC cell lines. Some of the 5'-CCGG-3' areas in the upstream region of ECT2 were methylated, while others were unmethylated.
CONCLUSIONS: The oncogene ECT2 is overexpressed in pancreatic tumor tissues as verified by RT-PCR detection. The methylation status of DNA in promoter areas is involved in the gene expression, along with other factors, in pancreatic cancer.

BACKGROUND: Hepatoid tumors (HTs) are rare extra-hepatic neoplasms with the histological features, biochemical profile and, sometimes, even clinical course of hepatocellular carcinoma. We present a case of rectal hepatoid adenocarcinoma with metachronous liver metastases.
METHODS: Four months after total procto-colectomy for a rectal adenocarcinoma (Astler-Coller C2), a 42-year-old man with ulcerative colitis showed hypoechoic masses in the hepatic parenchyma by abdominal ultrasonography. Carcinoembryonic antigen was normal, but alpha-fetoprotein was 32 000 µg/L. Fine-needle biopsy revealed that liver masses were positive for hepatocellular carcinoma. The patient underwent left hepatectomy and alcoholisation of a small deep nodule in segment 8.
RESULTS: Immunohistochemistry and albumin mRNA in situ hybridization suggested that the nodules were metastases of a HT. The patient was well during the first 6 months and refused any adjuvant chemotherapy. He died from liver failure 19 months after initial diagnosis.
CONCLUSIONS: HT is a rare colon cancer. The preoperative diagnosis of this tumor requires a high degree of suspicion, the availability of a panel of immunohistochemical markers, and a certain amount of luck. The prognosis is poor despite an aggressive and multimodal therapeutic strategy. So far, none of the hypotheses proposed about the origin and the biology of these tumors is convincing.

BACKGROUND: Biliary tract cancer is uncommon, but has a high rate of early recurrence and a poor prognosis. There is only limited information on patients surviving more than 5 years after resection.
METHODS: We report a patient who developed recurrence 8 years after resection of cholangiocarcinoma. Descriptions of late recurrence after excision of cholangiocarcinoma are reviewed.
RESULTS: Few long-term survivors with biliary tract cancer have been reported. The survivors tend to have well differentiated or papillary tumors. The present case had no recurrence for 8 years despite poor prognostic factors including poor differentiation, invasion through the muscle wall and perineural invasion. It has been suggested that tumor cells left after the first operation grow and present as late recurrence. There is a need to differentiate a new primary and field change from recurrence of the previous tumor.
CONCLUSIONS: Long-term follow-up after resection of cholangiocarcinoma is needed because late recurrence after 5 years occurs. The mortality rate between 5 and 10 years after resection of cholangiocarcinoma ranges from 6% to 43% in different series. Early detection of local recurrence may give an opportunity for further surgical resection.

BACKGROUND: Aneurysm of the cystic artery is not common, and it is a rare cause of hemobilia. Most of reported cases are pseudoaneurysms resulting from either an inflammatory process in the abdomen or abdominal trauma.
METHOD: We report a healthy individual who developed hemobilia and acute pancreatitis associated with cystic artery aneurysm.
RESULT: The patient was managed with angio-embolization with an uneventful post-embolization course.
CONCLUSIONS: Visceral artery aneurysms are rare and can rupture with potentially grave outcome due to excessive bleeding. Angiographic embolization as a common method of treatment for visceral artery aneurysms was used in our patient with good outcome.

BACKGROUND: Posttransplantation lymphoproliferative disorder (PTLD) involving the central nervous system (CNS) is a rare and serious complication associated with solid organ transplantation. We treated a case of PTLD with CNS involvement in a liver transplant recipient and reviewed the literature.
METHOD: The clinicopathological features of a 53-year-old man were retrospectively analyzed.
RESULTS: Metastasis of the hepatoma was preoperatively considered on the basis of clinical findings. Craniotomy was performed and PTLD was diagnosed pathologically. The patient was treated with antiviral agents, radiation therapy, and chemotherapy; the immunosuppressive medication was reduced. The patient is still alive after follow-up for 14 months.
CONCLUSIONS: Definitive diagnosis of PTLD is only established on the basis of histopathologic evaluation of the tissue. Although there are several ways to manage PTLD with CNS involvement, the prognosis is still poor.