Pyogenic Liver Abscess as the Initial Manifestation of Underlying Hepatocellular Carcinoma
Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taiwan. The American journal of medicine
(Impact Factor: 5).
12/2011; 124(12):1158-64. DOI: 10.1016/j.amjmed.2011.08.012
Pyogenic liver abscess and hepatocellular carcinoma are common in Taiwan. We investigated the frequency of, risk factors for, and prognosis of pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma over a 12-year period in Taiwan.
We extracted 32,454 patients with pyogenic liver abscess from a nationwide health registry in Taiwan during the period 1997-2008. The frequency of and risk factors for pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma were determined. The prognosis of these patients was compared with patients with hepatocellular carcinoma but without liver abscess.
A total of 698 (2.15%) patients presented with liver abscess as the initial manifestation of underlying hepatocellular carcinoma during the 12-year period. Liver cirrhosis, hepatitis B virus infection, hepatitis C virus infection, and age ≥65 years were independent risk factors for liver abscess as the initial manifestation of underlying hepatocellular carcinoma. Furthermore, these patients had a lower 2-year survival rate than patients with hepatocellular carcinoma but without liver abscess (30% vs 37%; P=.004).
The prognosis of patients who presented with pyogenic liver abscess as the initial manifestation of underlying hepatocellular carcinoma was poor. Physicians should not ignore the possibility of underlying hepatocellular carcinoma in patients with risk factors for the disease in regions with a high prevalence of both pyogenic liver abscess and hepatocellular carcinoma.
Available from: Chang-Fu Kuo
- "). Lin et al. reported 2.15% of patients with underlying hepatocellular carcinoma (HCC) presented with PLA as the initial manifestation (Lin et al., 2011). They arbitrarily defined patients with PLA as the initial manifestation of underlying HCC when the diagnosis date of HCC was within 60 days of diagnosis of PLA, which might lead to misclassification bias regarding HCC status (Copeland et al., 1977). "
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There have been no large-scale population-based studies to estimate the subsequent risk of primary liver cancer (PLC) among patients with pyogenic liver abscess (PLA). This study aimed to provide relevant data.
Materials and methods:
The Taiwan Longitudinal Health Insurance Database for the years 2000 and 2005 was used. The PLA group were adult inpatients who were newly diagnosed with PLA from 2000 to 2008. The control group was randomly selected and matched with the PLA group in terms of age, sex, and date in which medical treatment was sought other than for PLA.
There were 1,987 patients each in the PLA and control groups. In total, 56 had PLC, 48 (2.4%, 601.5 per 100,000 person-years) from the PLA group, and 8 from the control group. After adjusting for potential covariates, the hazard ratio of PLC for the PLA group was 3.4 times that of the control group (95% confidence interval = 1.6-7.3, p <0.001). The PLC risk for the PLA group was significantly higher within the first year after PLA diagnosis (hazard ratio: 35.4) as compared with the control group and became insignificant (hazard ratio: 2.0, 95% confidence interval = 0.8-4.9) more than one year after PLA diagnosis.
Patients with PLA have a higher rate of PLC than matched controls, especially within the first year after the diagnosis of PLA, suggesting PLA is a warning sign for PLC.
Asian Pacific journal of cancer prevention: APJCP 08/2013; 14(8):4727-4731. DOI:10.7314/APJCP.2013.14.8.4727 · 2.51 Impact Factor
Available from: PubMed Central
- "Although the diagnosis of HCC is easier to be established mainly in relation to the improved radiodiagnostic examinations, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes . Multicystic HCC mimicking a liver abscess associated with septic-type fever and leucocytosis is rare, has a poor prognosis, and poses diagnostic and therapeutic dilemmas . We present the case of an 80-year-old patient presented with fever, leucocytosis, and large cystic masses involving right and left lobes of the liver initially considered abscesses and finally diagnosed as HCC after open drainage and liver biopsy. "
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ABSTRACT: The diagnosis of hepatocellular carcinoma (HCC) became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Multicystic HCC mimicking a liver abscess associated with septic-type fever and leukocytosis is rare, has a poor prognosis, and poses diagnostic and therapeutic dilemmas. We present the case of an 80-year-old patient, who presented with fever, leukocytosis, and large cystic masses involving right and left lobes of the liver initially considered abscesses and finally diagnosed as HCC after open drainage and liver biopsy. Although the patient died on the tenth postoperative day due to pulmonary oedema, the authors emphasize the high index of suspicion needed in the diagnosis of this unusual presentation of HCC.
01/2013; 2013:374905. DOI:10.1155/2013/374905
Available from: Yi-Tsung Lin
- "Laboratory data and microbiological data are not included. The highly trustworthy National Health Insurance Research Database has been used in the research of PLA published in peer-reviewed journals , . The dataset used in this study consists of de-identified secondary data released to the public for research purposes. "
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ABSTRACT: Taiwan is endemic for pyogenic liver abscess (PLA). Septic ocular or central nervous system (CNS) complications derived from PLA can result in catastrophic disability. We investigated the epidemiology and long-term prognosis of PLA patients with septic ocular or CNS complications over an 8-year period.
We extracted 21,307 patients with newly diagnosed PLA from a nationwide health registry in Taiwan between 2000 and 2007. The frequency of and risk factors for PLA with septic ocular or CNS complications were determined. The 2-year survival of these patients was compared between those with and without septic ocular or CNS complications. Septic ocular or CNS complications accounted for 2.1% of all PLA patients. Age and the Charlson comorbidity index were significantly lower in PLA patients with ocular or CNS complications than those without. Diabetes and age <65 years were independent predictors of septic ocular or CNS complications. The 2-year mortality of patients with septic ocular or CNS complications was similar to those without complications (24.8% vs. 27.5%, p = 0.502). However, among patients <65 years old and a Charlson index ≤ 1, the 2-year mortality was significantly higher in those with than without complications (18.6% vs. 11.8%, p = 0.001).
Physicians should recognize that catastrophic disability due to ocular or neurological complications from PLA could lead to a poor long-term prognosis, and should follow-up these patients more closely.
PLoS ONE 03/2012; 7(3):e33978. DOI:10.1371/journal.pone.0033978 · 3.23 Impact Factor
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