الفهرس 
coverOnly 14 pages are availabe for public view
 |  | from | 110 |  |  |
| | | from | 110 | | |
Abstract
Sixty four cases of hepatic focal lesion(s) have been diagnosed as adenocarcinoma including 3 cases as extrahepatic cholangiocarcinoma (by clinical and radiological means) and 61 cases of intrahepatic adenocarcinoma . After exclusion the extrahepatic cholangiocarcinoma cases the rest of cases are evaluated with CK19 ,c-Kit immunohistochemistry ; It has been found that CK19 status ( as positive/ negative) alone statistically doesn’t help the differential diagnosis of primary hepatic adenocarcinomas from the metastatic adenocarcinomas to liver. Comparing the clinical history of metastasis with the CK19 score we find that the score of CK19 can efficiently differentiate the primary vs the metastatic adenocarcinoma that all the cases with known metastatic are negative or weak in intensity and focal positive , around the cut off value of CK19 positivity (5%) ;score 1 has been excluded from further evaluation and accordingly the use of a combination of c-Kit &CK19 score 2,3 can be used as a primary step to exclude the metastatic adenocarcinoma until prove it by metastatic work or rather more importantly to select the primary liver adenocarcinomas and examine them for targeted therapy.
CK18 has to be used to confirm this selection as adenocarcinomas of primary hepatic progenitor cell origin as long as progenitor cells can differentiate into hepatocytes and cholangiocytes, which in turn can give rise to hepatocellular carcinoma/cholangiocellular carcinoma. All of the selected cases CK19 &c-Kit score 2,3 ;each has been found expressing CK18.
Eight cases have been stained with CD133 . It has been found that not all the primary intrahepatic adenocarcinomas of progenitor cell origin) express CD133 .Only 62.5% of our cases CK19+ve /c-Kit +ve/ CK18 +ve primary intrahepatic adenocarcinomas (of progenitor cell origin) express CD133 ie; of Cancer Stem Cell Phenotype .
Special category : Hepatocellular carcinoma (HCC) with progenitor cell features:
Among the cases histologically diagnosed as HCC by H&E , there is a group of HCC are expressing CK19 (n=8) . 75% of the HCCs expressing CK19 (n=6) is CK19 score 1 ( > 5% ; the cut off positive value and of focal weak intensity in comparison to only two cases are of score 3 ,with statistically significant value ( P value < 0.5) which unlike the staining pattern of CC (moderate and diffuse ).
Florescent In Situ Hybridization (FISH) (using The Vysis LSI 4q12 Tri-Color Rearrangement Probe
Vysis LSI 4q12 Tri-Color Rearrangement Probe through Fluorescent In Situ Hybridization (FISH) test has been used to estimate the c-Kit gene expression aberrations /rearrangements among the five hepatic adenocarcinomas of cancer stem cell origin cases (CK19 +ve/c-Kit +ve /CK18 +ve /CD133 +ve cases).
from data analysis it has been found that the c-Kit amplification or aberrant gene patterns whether separate or combined together or combined with abnormal one tricolor gene expression are the most common aberration /rearrangement . This finding is coming with the strong and moderate immunohistochemistry expression of c-Kit and CD133 in those five hepatic adenocarcinomas of cancer stem cell origin cases (CK19 +ve/c-Kit +ve /CK18 +ve /CD133 +ve cases .