الفهرس 
Introduction
Chapter 1 : AnnexinsOnly 14 pages are availabe for public view
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancy in the world and one of the main causes of death due to its bad prognosis.
Also HCC is considered one of the most common malignant tumors in Egypt which develop usually from liver cirrhosis secondary to hepatitis viruses which increased in the recent years and lead to increase the risk of HCC in Egyptian patients.
Tumor markers are substances synthesized and secreted by the malignant cells and they are not normally found and they are not biologically active if they present as they present in much smaller amounts.
Few of them are produced in a sufficient large proportion so they can be used as serum markers of tumors and they become helpful in screening , diagnosis and follow up of cases.
Annexing are multigen family of calcium dependent phospholipid- binding proteins which are present in most organisms. In humans there are 12 annexin subfamilies (A1 – A11) and A13 that exert diverse biological functions in a wide range of cellular processes such as ion transport, cell division and a poptosis .
Enhanced expression of Annexin A4 was also known to induce chemo resistance.
Accumulating evidences indicate that annexinA4 acts as oncogenic protein and play important roles in cell motility and invasion of human cancer
It has also been reported that annexin A4 may promote cell proliferation by regulating cancer associated ;proteins .
In vitro studies have demonstrated that over expression of annexin A4 facilitated HCC migration and invasion via regulating epithelial mesenchymal transition.
The aim of the present study is to access the level of annexin a4 in the sera of patients with hepatocellular carcinoma and correlate its level with different clinical, radiological and laboratory features in these patients.
The study included 100 cases which divided into 60 cases with hepatocellular carcinoma, 20 cases with liver cirrhosis and 20 healthy persons as a control.
Serum annexin A4 levels were significantly high in HCC patients than liver cirrhosis group and there was no significant elevation in the normal persons and levels are very small in them.
This study showed that serum levels of annexin A4 in HCC group were affected by the tumor size and portal vein thrombosis.
The sensitivity and specificity of annexin A4 for selective detection of the HCC group over cirrhotic group, was 98.33% and 80% respectively at a cut off value of 115 ng/ ml.
So annexin A4 level in serum appears to be additional marker for HCC detection.