ABSTRACT:BACK GROUND :The development of HCC is a major global health problem , It's incidence has increased world wide and nowadays it constitute the 5th most frequent cancer representing around 5% of all cancers, and estimated to rank 4th in terms of mortality of cancers incidence world wide , it accounts for 80 –90% of all primary liver tumors . The Etiology of this tumor is multifactorial , certain viral, environmental & hereditary causes of cirrhosis have a strong correlation with HCC . HCC is a highly malignant tumor with poor prognosis .OBJECTIVE:To evaluated the Etiological , Epidemiological , Patho physiological , Diagnostic series , Therapeutic approaches & Advanced studies in detection and prevention of HCC .PATIENTS AND METHODS :Across sectional study of (57) patients with HCC ( 43 males , 14 females ) during the period from January 2000 to December 2002 . The patients were collected from medical & surgical units of Baghdad teaching hospital & the gastroenterology & hepatology teaching hospital .History taken from these patients & physical examination , Lab investigation ,CBP, liver function test ,Virology study , serum AFP. Titer ,U/S study , MRI , CT scan . Ascitic fluid tapping , Liver biopsy.Modalities of treatment : Palliative Treatment, Chemotherapy, Injection of Alcohol , Hemilobectomy ,Segmental resection , Debulking resection of tumor in the liver, Conservative treatment , any complications or hazards during surgical procedures were recorded.RESULTS :Male to female ratio is approximately (3:1), The mean age of (57.1) yr . more common between (51-60) yrs old ( 28.25% ) , Most of the patients were from Baghdad ( 47.4% ) . Increasing no. of patients from 2000 ( 21.1 % ) to 2002 ( 45.6 % ). (84% ) have previous history of chronic liver disease & (16%) haven't such a history . Most of chronic liver diseases are due to previous history of hepatitis B- infection (41.6%) . High level of AFP ( 66.6% ), all of them are of standard type of HCC. Ascitic fluid cytological study bloody (14%) & positive malignant cells (17.2%) . Liver biopsy (82.7%) had chronic liver diseases, and (96.5%) moderate to poorly differentiated type of standard HCC,(3.5%) fibrolamellar type .Outcome of treatment , Conservative (35%), Injection therapy (3.5%) , Chemotherapy (28%), Surgical procedures (16%) , Segmental & Right lobectomy (3.5%) for each , Debulking (9%) .CONCLUSION :AFP and U/S study are very important in the early detection and follow up of the patient with HCC , Liver biopsy - very important study to detect various type of HCC , Surgical resection is the only potentially curative treatment of HCC

hepatocellular carcinoma --- presentation --- management

Background:Lymphotoxin α, β and their receptor play an important role in the control of lymphoid organ development and support of immune responses against pathogens.Objective:To investigate expression of the lymphotoxin α, β and their receptor TLβRs using immunohistochemistry technique in patients with chronic active hepatitis and hepatocellular carcinoma.Methods:Thirty five formalin fixed, paraffin embedded liver tissues, obtained from Liver and Digestive System Technical Hospital and private laboratories in Baghdad, were studied. In addition, thirteen apparently normal liver autopsies were collected from the Forensic Medicine Institute Archives after permission and used as control group. Liver tissue sections were cut at 4 µm and placed on positively-charged slides, used for the detection of lymphotoxin α, β and receptor TLβRs by immunohistochemistry technique.Results:The expressions of lymphotoxin α, β and receptor TLβRs were detected in most patients infected with HCV, 88%, 84%, 76% respectively in patient with chronic active hepatitis and 80%, 70%, 90% respectively in patients with hepatocellular carcinoma while low level of expression of these markers was observed in healthy control group.Conclusion:Lymphotoxin α, β and their receptor TLβRs may play an important role in the development and progression of HCV associated liver pathology.Key words:lymphotoxin, TLR, carcinogenesis hepatocellular carcinoma.

lymphotoxin --- TLR --- carcinogenesis hepatocellular carcinoma

ABSTRACT: BACKGROUND: Hepatectomy is usually performed because it is the most effective way of removing liver tumour(s). Cryosurgery, Radiofrequency, Laser, Microwave and Chemo-therapies are less effective alternatives. OBJECTIVE: To review the experience of hepatectomy in Baghdad Teaching Hospital – Medical city,Iraq with a review of the obstacles and needs for promotion and development. PATIENTS AND METHODS: During the period from March 1999 to September 2005, Out of 27 patients admitted to the second surgical unit in Baghdad Teaching Hospital – Medical City with liver tumours, 15 had hepatectomy done by the same surgical team. The remaining 12 cases were beyond resection. RESULTS: The age of patients ranged from 2 to 65 years old with mean age of 34.4 years. Only one (6.7%) patient underwent left lobectomy, 2 (13.3%) left segmentectomy, while the rest 12 patients (80%) underwent right partial or total lobectomy, divided equally between anatomical & non-anatomical resection. Two main techniques were used in transection of liver parenchyma: CUSA Dissector which is used in 9 patients (60%) and clamp-crushing or finger fracture technique was used in the remainder. In addition to CUSA knife, argon beam was used in 5 cases (33.3%). Postoperative mortality rate was 26.7% (4patients). The histopathological examination of resected segments of the liver revealed 11 (73.3%) cases of hepatocellular carcinoma, 2 (13.3%) of hepatoblastoma, 1 (6.7%) case metastatic colorectal carcinoma, and 1 (6.7%) case of benign cells (haemangioma). CONCLUSION: Hepatectomy for liver tumours can be performed with acceptable safety and efficacy in a suitably staffed and equipped center. The outcome will improve with time and experience

hepatectomy --- liver tumour --- hepatocellular carcinoma --- HCC.

A prospective study of (13) patients, from both sex, with hepatocellular carcinoma was done in Salahuldeen government in Tikrit teaching hospital in period extent from Feb. 2006 to Aug. 2010. Patients divided into: 1-Those underwent FNAC for liver mass (5 patients) (38.5%), for diagnosis in addition to clinical and radiological evaluation with measurement of alfa-fetoprtein (AFP) level in the serum of them. 2-Those didn't undergo FNA and diagnosis made by clinical and radiological evaluation, and measurement of serum AFP level, in addition to excisional biopsy for liver mass. Follow up of patients for both groups made by 6-12and18 months by clinical and radiological evaluation for tumor seeding along needle tract, distant spread and median survival. It has been showed that tumor seeding along needle tract didn't encountered in this study. Distant spread included brain, bone, lung and abdominal wall no statistically differ in both group, and seen in three patients of those underwent FNA (60%),and five patients of those didn’t undergo FNAC (62.5%) (P=0.7). Median overall survival rate was 13 months(8-18 months) in FNA group and 12 months in non-FNA group (8-16). The cumulative 6, 12- and 18 months overall survival were 80%, 60% and 40% respectively for FNAC group and 75%, 50 and 37.5% respectively for non FNAC group. There was no statistically differences between two groups (P= 0.77).

وأجريت دراسة استطلاعية ل(13) مريضا، من كلا الجنسين، مع سرطان الكبد في الحكومة Salahuldeen في المستشفى التعليمي في تكريت مدى الفترة من فبراير 2006 إلى أغسطس 2010. المرضى تنقسم الى: 1-أولئك خضع FNAC لكتلة الكبد (5 مرضى) (38.5٪)، لتشخيص المرض، بالإضافة إلى السريرية والإشعاعية تقييم مع قياس ألفا، fetoprtein (اف ب) مستوى في مصل الدم منها. 2-أولئك لم يخضع FNA والتشخيص السريري الذي أدلى به والتقييم الإشعاعي، وقياس مستوى المصل لوكالة فرانس برس، بالإضافة إلى خزعة استئصالية للكتلة الكبد. متابعة المرضى لكلا الفريقين التي أدلى بها 6 أشهر من قبل 12and18 السريرية والإشعاعية تقييم للبذار ورم على طول المسالك الإبرة، وانتشار بعيدة ومتوسط ​​البقاء على قيد الحياة. ولقد اظهرت ان لم يكن مصادفة بذر ورم على طول إبرة الجهاز في هذه الدراسة. وشملت انتشار بعيد الدماغ والعظام والرئة وجدار البطن لا تختلف إحصائيا في كل مجموعة، وينظر في ثلاثة مرضى الذين خضعوا FNA (60٪)، وخمسة من المرضى الذين لم يخضعوا FNAC (62.5٪) (P = 0.7 ). وكان متوسط ​​معدل البقاء على قيد الحياة عموما 13 شهرا (8-18 شهرا) في مجموعة FNA و 12 شهرا في غير FNA للمجموعة (8-16). وكانت أشهر و 18 شهرا البقاء الإجمالي 80٪، 60٪ و 40٪ على التوالي للفريق FNAC و 75٪ و 50 و 37.5٪ على التوالي للفريق غير FNAC - التراكمي 6 و 12. لم يكن هناك أي اختلافات إحصائية بين المجموعتين (P = 0.77).

Fine Needle Aspiration Cytology of Hepatocellular Carcinoma --- علم الخلايا غرامة إبرة الطموح من سرطان الكبد