Merkel cell carcinoma (MCC) is a rare, aggressive neuroendocrine carci- noma of the skin. Treatment for locoregional MCC includes local excision with regional lymphadenectomy, followed by adjuvant radiotherapy. Immune checkpoint inhibitors (ICI) have emerged as a breakthrough treatment of metastatic MCC. Nevertheless, T-cell immune response is triggered against self-antigens resulting in immune-mediated toxicities, including ICI-medi- ated hepatotoxicity. We report a case of recurrent metastatic MCC treated with avelumab, a PD-L1 inhibitor, with subsequent significant liver biochem- ical flare. The initial clinical diagnosis was ICI-mediated hepatotoxicity. Workup to rule out competing causes of liver injury came back negative. Hence, avelumab was discontinued, and the patient was initiated on steroid therapy with stepwise escalation. Owing to clinical and laboratory deteriora- tion, it was then decided to perform a percutaneous liver biopsy to document steroid-refractory ICI-mediated hepatotoxicity and/or rule out other causes of potential liver injury. The liver biopsy showed MCC tumor cells almost entirely infiltrating the hepatic parenchyma, confirmed by immunohisto- chemistry. At that point, steroid therapy was discontinued, and the patient was transitioned into palliative care. In conclusion, patients with apparent ICI-related hepatotoxicity should always be considered for a liver biopsy to exclude massive infiltrative malignancy as the true cause of liver dysfunction.

Background and Aim: This study examined the effects of black cumin seed oil treatment on oxidative stress and the expression of radixin and moesin in the liver of experimental diabetic rats. Materials and Methods: Eighteen rats were divided into 3 equal groups (control, diabetes, treatment). The control group was not exposed to any experimental treatment. Streptozotocin was administered to the rats in the diabetes and treatment groups. A 2.5 mL/kg dose of black cumin seed oil was administered daily for 56 days to the treatment group. At the conclusion of the experiment, the blood level of malondialdehyde (MDA) and glutathi- one (GSH) was measured. The expression level and the cellular distribution of radixin and moesin in the liver were analyzed. Results: The plasma MDA (3.05±0.45 nmol/mL) and GSH (78.49±20.45 μmol/L) levels in the diabetes group were significantly different (p<0.01) from the levels observed in the control group (MDA: 1.09±0.31 nmol/mL, GSH: 277.29±17.02 μmol/L) and the treatment group (MDA: 1.40±0.53 nmol/mL, GSH: 132.22±11.81 μmol/L). Immunohistochemistry and west- ern blotting analyses indicated that while the level of radixin was not sig- nificantly between the groups (p>0.05) and moesin expression was signifi- cantly downregulated (p<0.05) in the experimental group, the treatment was ineffective. Conclusion: The administered dose was sufficient to prevent oxidative stress, but was not sufficient to alleviate the effects of diabetes on moesin expression in hepatic sinusoidal cells.

Background and Aim: In this study, we aimed to assess the hemostatic and histopathological impacts of the Algan hemostatic agent (AHA) with the liver injury model. Materials and Methods: 24 male rats, 10-12 week old, were randomly divided into three equal groups (n=8) as control (physiological saline solu- tion), AHA liquid and AHA powder. A total of three iatrogenic cut injuries were performed on the anterior surface of the left liver lobe. After bleeding started, sponges soaked with physiological saline, AHA liquid, AHA pow- der were gently pressed on the injured area for 20 seconds in corresponding groups, respectively. The bleeding time was measured with a timer. Failure to stop bleeding after three consecutive applications was considered as a failure. Animals were euthanized at the tenth minute of the procedure. Left liver lobes were removed for histopathological examination. Results: Bleeding control success rates of AHA liquid were significantly higher than that of the AHA powder group, and both forms were more effec- tive than physiological saline. A superficial thick granulation tissue with en- trapped powder residual materials was detected in the AHA powder group. Liver parenchyma was intact in liquid and powder groups. Conclusion: AHA is a fast-acting and applicable hemostatic agent in the liver bleeding model. However, further comparative studies in various or- gans are needed.

Background and Aim: This study aimed to evaluate the changes in the clinical characteristics of chronic Hepatitis B (CHB) patients at the initia- tion of treatment over a 15-years period. Materials and Methods: The study included 659 treatment-naive CHB patients who started receiving nucleos(t)ide analogs between January 2006 and December 2020. The patients included in the study were divided into three groups of five years each, according to the start date of treatment. Results: The mean age was 46.2±14.5 years and 445 (67.5%) were male. Two hundred and five (31.1%) patients had cirrhosis. Hepatocellular carci- noma (HCC) developed in forty-one patients (6.2%). Compared to patients in Group 1, Group 2 were younger and had lower decompensated cirrhosis, HCC and ascites, had higher Child A cirrhosis (all p<0.05). Cirrhosis and esophageal varices were higher in patients in Group 3 compared to patients in Group 2 (all p<0.05). Entecavir or tenofovir use increased from 66.5% in Group 1 to 99.2% in Group 3 (p<0.05). Conclusion: The mean age at initiation of treatment for CHB patients in- creased. The patients had less cirrhosis. In the last 5 years, almost all pa- tients were treated with entecavir or tenofovir.

Background and Aim: Hepatocellular carcinoma (HCC) is one of the most common and most lethal cancers worldwide. The objective of this study was to investigate the relationship between basal parameters and survival characteristics in patients with HCC. Materials and Methods: The records of 1447 HCC patients of a tertiary center during the period 2000-2017 were screened retrospectively. The demographic details; basal clinical, laboratory, and radiological characteristics; treatments; and survival time were recorded and prognostic scores were calculated. Results: A total of 788 patients with HCC (male/female: 623/165; mean age: 60.5±10.9 years) were included in the study. The median length of sur- vival was 26.3 months (95% confidence interval [CI], 22.3-30.4 months). The 5-year survival rate was 28.1%. The number and diameter of the tu- mors; platelet count; platelet-to-lymphocyte ratio; level of aspartate ami- notransferase, alanine aminotransferase, and gamma-glutamyl transferase; portal and hepatic vein involvement; and an alpha-fetoprotein level of <9.6 ng/mL were found to be independently related to survival. Conclusion: The positive predictive value of the prognostic index derived from independent survival-related parameters for 5- and 10-year survival or overall survival was approximately 86%. Integration of this prognostic index to the criteria used in making treatment decisions for patients with HCC should be considered.

-