pathology report question...

[happymom2v]

I was trying to add to my other question...but it wouldn't let me, so I am very SORRY to start another thread...

What are the chances that the HCC can come back post transplant, either in the new liver or as a metasized cancer elsewhere in the body???

Here is Pathology:
1. The trichrome stain confirms absence of fibrosis. there is no macrovesicular steatosis or necrosis.
2. The specimen reveals a 1.2cm partially necrotic subcapsular nodule in right lobe. The necrotic nodule demonstrates residual moderately differentitated hepatocellular carcinoma.

Tumor size 1.2cm,
Solitary tumor in right lobe
Tumor Necrosis: present 80%
Tumor extension:Tumor confined to liver
Hilar margin: hilar margin is uninvolved by carcinoma
Distance of invasive carcinoma from closest margin:  5cm,
Primary tumor
pT1: solitary tumor without vascular invasion
Fibrosis score: 4

Based on this pathology report...Is there a chance HCC will come back either in new liver or as a mestastic cancer?

[Thomas D Schiano, MD]

there is no difference between MRI and CT scan surveillance.  there is not a major difference between moderate and well differentiation when it comes to recurrence.  the most important factor is absence of vascular invasion which is very good for you.  No difference between HBV and HCV regarding recurrence rate. at some centers MRI may be favored by the radiologists, etc. scanning every 3-4 months is a little more aggressive than we do at Mount Sinai.  Recurrent HCC can come back in the new liver or elsewhere, such as in the lung.  I am confident that you will be fine.

[happymom2v]

In addition to my questions above...I also wanted to add...

Cirrohsis was due to Hepatitis B. Does HCC from Hepatitis B act differently than HCC caused by Hepatitis C? The hepatitis B DNA was undetected prior to transplant. Does this also effect reoccurance of the HCC?

Thanks.

[happymom2v]

1. I am sorry if I keep asking the same question, but with a "moderately differentiated" tumor, are the chances for recurrance that much greater versus a tumor that is "well differeniated"?

2. If the HCC does reoccur, does it come back in the liver or does it show up as a mestatic cancer, elsewhere/in another organ? As you might be able to tell, I have a HUGE fear that the HCC will come back.

3. Is a CT scan every 3-4 months an aggressive followup approach?

4. Why do some transplant centers use Mri over CT scan?

5. In your opinion, which do you feel is a better scan, CT or Mri?

Thank you.

[Thomas D Schiano, MD]

frankly i dont think there is much difference between well and moderatre differentiation with regard probability of post-transplant recurrence.We screen with MRI or CT scan (either is equivalent at out center) every 6 months for the first 2 years post-transplant, as well as checking Afp

[happymom2v]

1. Because the tumor was described as  "moderately differentiated", is there more of a chance that the tumor/HCC can reappear as opposed to if it was a "well differentiated" tumor?

2.How often should a patient be scanned POST transplant (especially someone who's been transplanted due to HCC)? Which scan is preferred, an Mri or CT?

As always, thank you very much for helping me.

[Thomas D Schiano, MD]

differentiation means how far away from from normal cells the cancer--poorly differentiated is the worst.  if the portal vein thrombosis was due to the cancer they would've seen it..  There was no steatosis (fat) in the liver.  partially necrotic capsule means that the treatment you received prior to the transplant was quite successful in attacking the HCC