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KMID : 0383019730040010021
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Alumni Bulletin of Internal Medicine
1973 Volume.4 No. 1 p.21 ~ p.39
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A Clinical Study on the Primary Carcinoma of the Liver in Korea
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Abstract
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A clinical study was made on 947 cases of primary carcinoma of the liver who had been admitted to the Department of Medicine, Seoul National University Hospital during the period of 15 years. from 1955 through 1969.
Of the 947 cases, 295 cases were confirmed as the primary carcinoma of the liver either by needle biopsy or by operative biopsy and in other 652 cases the diagnosis´ was `based on the clinical and laboratory findings.
The results of the study. were as follows:
1. The number, 947, represented 4.0690 of all medical admission´s. The male to female´ ratio was 4.6 i in the total group, 7.3 : 1 in the confirmed hepatocellular carcinoma, and 4 : 1 in the confi-rmed cholangiocellular carcinoma. The mean age was 51 years and most of the patients were in their 5th or 6th decade.
2. The chief complaints included pain(34.6%), abdominal mass(8.3%), and abdominal distension (16.5%) in the order of frequency. The average preadmission period of the complaints were 2 months.
3. The predominant subjective symptoms were pain, most frequently right epigastric, (68.8%), indigestion(67.5%), anorexia(62.2%), weight loss(48.7%), general weakness(32.4%) and epigastric discomfort(32.0%) and fever was found in 19.4% of the patients.
4. The predominant physical findings were abdominal mass, including enlarged liver (95.7%), ascites(44.9%, and jaundice(36.5%). The spleen was palpable in 12.5% of the cases. The liver was hard, nodular and tender in most cases.
5. Hemogram showed mild anemia. The means were: Hb. 11.45±2.69g%; Ht. 35.92±8.63%; RBC 2.69±0.83 m/mm3; WBC 7,680±3,830/mm´; platelet 161,465±66,517/mm3; and ESR 19.77 mm/hr. In 1.4% of 722 cases examined the hemogloblin level was above 17.5g %. The total and differential counts of leukocytes were usually within the normal ranges. Marked leukocytosis above 18, 000/mm3 was noted in 2.5%. ESR was increased in 75.4%. Bleeding time and coagulation time were within normal limits in most cases. Prothrombin time was 50% or less in 15.4% of 689 cases.
6. Urinalysis revealed albuminuria in 45%, glucosuria in 26.9%, and bilirubinuria in 12.2% of cases.
7. Cn the stool examinations the ova of Trichuris trichiura were most frequently found(51.8%o), mod Moochis sinensis ova in 16.8% and no ova in 12.3% of 683 cases. Occult blood was positive in 32,496 of the 683 cases,
8. Serum albumin content decreased, globulin content increased and the A/G ratio was reversed frequently. The mean albumin and globulin contents were 3.24±0.75g% and 3.35±0.90g% respectively. The serum bilirubin level increased but mild in degree in most cases. The mean bilirubin level 3.50 rng%. The serum alkaline phosphatase activity was elevated in 85% of 866 cases, with the mean Of 10.9±7.43 B.U. Serum cholesterol level was elevated and the mean was 196.5± 75.0 mg9%. In 11% of 735 cases the cholesterol level was above 300mg%. SGOT was always higher than SGPT and mean activities of SGOT and SGPT were 96.2±72.25 u. and 44.5±35.8 u. respecti-vely. Other liver function tests, i.e., TTT, CCF, BSP and blood ammonia also showed abnormalities frequently. Blood sugar was examined in 55 camas and hypoglycemia of 60 mg% or less was found in 7.3%.
9. Ascites was recorded bloody in 57% of 217 cases. The specific gravities were usually between 1. 016 and 1.020. Rivalta tests were positive in 25%. Mean protein content was 1.56+0.62 g%. Cells of class 11 and V on Papanicolau smear were found in 20% of 229 cases.
10. Roentgenological findings were bulging in or elevation of the right diaphragm (about 25% of cases), mass density in the right´ upper, quadrant of the abdomen displacing the stomach or bowels, multiple coin lesion, in the lung fields suggestive of metastatic cancer (8%), and in small number of patients esoplageal varices. Associated findings´ included pulmonary tuberculosis, pleural effusion or . reaction and peptic ulcer.
11. Liver scan using 198Au-colkridal gold was .performed in 158 cases. Cold area was found in 152 cases(96.2%), hepatomegaly in 88.0%, and splenic visualization in 58.2%. No cold area was detected in 4 cases, 2. of the 4 showed mottling without definite cold area, and another 2 showed normal liver scans.
12. By the Vim Silverman needle biopsy or operative biopsy, 295 cases were confirmed as primary carcinoma of the liver. Of the 295 cases, 220 cases were hepatocellular carcinoma, 25 cholangiocellular carcinoma, 4 mixed type and 46 unclassified. Hepatocellular to cholangiocellular ratio was 8.8 : 1.
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