الفهرس 
TitleOnly 14 pages are availabe for public view
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Abstract
Liver neoplasms are one of the most common tumors worldwide which may be benign focal hepatic lesions or malignant focal hepatic lesions. Some benign hepatic lesions resemble HCC so that we should differentiate between them as practical guide for oncological clinician.
HCC is the most common primary liver cancer and the third leading cause of cancer related death. The incidence of HCC has been increasing in Egypt with doubling in its incidence in the last 10 years due to high prevalence of HCV and liver cirrhosis.
The second most common primary malignant neoplasm of the liver is CC. The liver is common site for metastasis which may be known or unknown origin. The differentiation between metastatic AC and CC is very difficult and particularly challenging on core biopsy.
For this reasons the use of panel of immunohistochemistry is very useful to help us for reaching to the correct diagnosis.
GPC3 is a member of the heparin sulfate, detected normally in embryonic weeks 18 to 30 but absent in normal adult hepatic tissue. It is more sensitive and specific for HCC.
ARG-1 is a key enzyme of the urea cycle; it is a novel marker for hepatocellular differentiation and more sensitive and specific than HepPar-1.
Cytokeratins are a highly complex subclass of the intermediate filaments gene family and comprise more than 20 different polypeptides. CK7 and CK20 markers are not present in most HCCs, but they exist in many adenocarcinomas, including CC. This combination has found to be helpful in discriminating primary and metastatic tumor.
The present work was done on a total of 55 cases diagnosed as focal hepatic lesions classified into benign and malignant lesion. The benign lesions were HA, FNH, NRH, LGDN and HGDN. The malignant lesions were primary carcinoma (HCC & CC) and metastatic AC in the liver. The number of cases as the following 12 benign cases( 2 cases FNH, 2 cases HA,4 case NRH and 4 cases DN) , 43 malignant cases( 20 HCCs, 4CCs and 19 metastatic ACs from various primary origins). The majority of our cases were males and the mean age for all study group cases was 51.5 years ± 6.65 SD. All cases were subjected to H&E histopathological examination and immunohistochemical staining for GPC3, ARG-1, CK7 & CK20 using Avidin- Biotin immunoperoxidase technique to achieve our aim.
GPC3 immunohistochemical reaction was found negative in 10 of 12(83.3%) benign focal hepatic lesions and positive in 16 of 20 (80%) cases of HCC . the four included cases of CC are negative for GPC 3 expression and 17 out of 19 (89.5%) metastatic cases are also negative.
There were statistically significant differences between GPC3 positive and GPC3 negative groups regarding the type of lesions (P< 0.001). The sensitivity of GPC3 to differentiate HCC from benign lesions was 80%, while its specificity was 83.3 %. The sensitivity of GPC3 to differentiate HCC from metastasis was 89.47%, while its specificity was 80%.
There were statistically significant differences between ARG-1 positive and ARG-1 negative groups regarding the type of lesions (P< 0.001). The sensitivity of ARG-1 to differentiate HCC from benign lesions was 90%, while its specificity was 0.0 %. The sensitivity of ARG-1 to differentiate HCC from metastasis was 100%, while its specificity was 90%.
There were statistically significant differences between CK7 positive and CK7 negative groups regarding the type of lesions (P= 0.014). The sensitivity of CK7 to differentiate HCC from metastasis was 36.84 %, while its specificity was 95%.
There were statistically significant differences between CK20 positive and CK20 negative groups regarding the type of lesions (P< 0.001). The sensitivity of CK20 to differentiate HCC from metastasis was 52. 63 %, while its specificity was 85%.
There were no statistically significant differences between all markers (GPC3, ARG-1, CK7 and CK20) and the tumor grade in all malignant types (HCC, CC& metastasis) of the studied cases.