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Summary: Background: Microscopic colitis is an increasingly common cause of watery diarrhoea. Several classes of medications have been associated with microscopic colitis in prior studies. Aims: To determine the association between the use of previously implicated medications and microscopic colitis. Methods: This was a case‐control study of patients referred for elective, outpatient colonoscopy for diarrhoea. Patients were excluded for inflammatory bowel disease, C difficile, or other infectious diarrhoea. Colon biopsies were reviewed by the study pathologist and patients were classified as microscopic colitis cases or non‐microscopic colitis controls. Results: The study population included 110 microscopic colitis cases and 252 controls. The cases were older, better educated and more likely to be female. Cases reported a greater number of loose, watery, or liquid stools, nocturnal stools, more urgency and weight loss compared to controls. There was no association with proton pump inhibitors (PPIs), adjusted OR (aOR) 0.66, 95% CI 0.38‐1.13 or nonsteroidal anti‐inflammatory drugs, aOR 0.68, 95% CI 0.40‐1.17. Cholecystectomy was less common in cases, aOR 0.33, 95% CI 0.17‐0.64, but microscopic colitis cases had more frequent bowel movements following cholecystectomy. Conclusion: Compared to similar patients with diarrhoea, cases with microscopic colitis were not more likely to have taken previously implicated medications. They had more diarrhoea following cholecystectomy, suggesting that bile may play a role in symptoms or aetiology. We conclude that the appropriate choice of controls is crucial to understanding risk factors for microscopic colitis. [ABSTRACT FROM AUTHOR]

Purpose: To describe the magnetic resonance imaging (MRI) appearance of hepatic combined hepatocellularcholangiocarcinoma (cHCC-CC) in 11 patients. Materials and Methods: The database of the Department of Pathology was cross-referenced with the MRI database to identify patients with confirmed cHCC-CC who had undergone MRI. Eleven consecutive patients were included (seven female, mean age 57.6 years). All patients were Caucasian. Five of 11 had a clinical history of chronic liver disease. Two radiologists retrospectively analyzed the images in consensus. Results: cHCC-CC was a single mass in 10/11 patients. Margins were well-defined in 6/11. All tumors showed heterogeneous hyperintensity on T2. On postcontrast imaging, 6/11 showed early ring-enhancement (four noncirrhotic), with progressive enhancement in central portions, and 5/11 patients showed a diffuse heterogeneous early enhancement. Three of these five were cirrhotic and displayed partial washout with portions of contrast retention on later phases. Other findings included: late capsule enhancement (two patients), biliary dilatation (one), venous invasion (three), lymphadenopathy (six), and findings of cirrhosis (five). Conclusion: cHCC-CC presents most commonly as a single mass. Five of 11 had MR findings of cirrhosis. Clues to the diagnosis were moderately high signal on T2, portions of tumor that show progressive enhancement/ contrast retention, and frequent lack of capsule. Early enhancement patterns included early ring-enhancement and diffuse heterogeneous enhancement. [ABSTRACT FROM AUTHOR]

Purpose: To describe a new MRI sign, the liver-vessel cancellation artifact, on In-Phase and Out-of-Phase gradient-echo sequences related to ultra-high liver fat content (>90%) by qualitative histology. Materials and Methods: Institutional review board approval was obtained for this retrospective HIPAA-compliant study with waived informed consent. Patients with liver steatosis were searched in MRI (n = 195) and pathology (n = 116) databases between January 1, 2008, and June 20, 2010. Two readers blindly reviewed all MR images for the presence of the liver-vessel cancellation sign. Cross-reference of patients with biopsy-proven steatosis and MRI within one month was performed (n = 54; 25 males, 29 females; mean age 41.0 ± 18.9), with a population of 6 patients with ultra-high liver fat content (1 male, 5 females; mean age 15.5 ± 11.2). Performance diagnostic tests, including sensitivity and specificity, were performed. Results: Liver-vessel cancellation sign was present in all patients with ultra-high liver fat content but in none of the remaining patients. Calculated sensitivity and specificity for the detection of ultra-high liver fat content with this sign were 100% (95% confidence interval [CI]: 69.1-100%) and 100% (95% CI: 98.4-100%), respectively. Conclusion: The presence of liver-vessel cancellation artifact around intra-hepatic vessels is a feature of ultra-high liver fat content. J. Magn. Reson. Imaging 2012;. © 2011 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The main purpose of this study was to determine if hepatocellular carcinomas (HCCs) missed on prospective magnetic resonance (MR) study could be identified on retrospective MR analysis, and to determine the cause for misdiagnosis. Among 555 patients who underwent liver transplantation between 1993 and 2004, 279 were imaged with MR imaging and four of these revealed HCCs in explanted livers that were not reported on prospective MR reading. The main cause of missed lesions were suboptimal image quality due to inability of patients to suspend respiration; other causes were HCC misinterpreted as high-grade dysplastic nodule and isoenhancement of HCC on early phase images. J. Magn. Reson. Imaging 2006. © 2006 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Purpose To demonstrate both MRI and histopathological findings of hepatocellular adenomas (HCAs) in men. Materials and Methods HCAs in four men are reported. All patients underwent MR studies at 1.5T including serial gadolinium-enhanced gradient echo imaging. Results Three men had solitary non-hemorrhagic adenomas that exhibited a uniform capillary blush with no central scar, and uniform fading of the tumor to near isointensity with the liver parenchyma by one minute. One of the subjects had uniform fat content as shown by uniform low signal on out-of-phase images. One patient had a solitary hemorrhagic adenoma that measured 17 cm in diameter and was heterogeneous on all sequences. Two of the four patients had a history of anabolic steroid use, and in the other two patients no underlying explanation for the tumor was found. Conclusions Although three of the four patients had tumors that exhibited uniform homogeneous tumor blush and rapid fading of enhancement, because HCAs are rare in men and resemble hepatocellular carcinoma (HCC) in appearance, our findings suggest that histological confirmation of HCAs may not be avoidable in men. J. Magn. Reson. Imaging 2005;22:258-264. © 2005 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Purpose To assess the correlation between magnetic resonance (MR) imaging findings and angiogenetic activity in hepatocellular nodules evaluated by immunohistochemical staining with antibody of vascular endothelial growth factor (VEGF). Materials and Methods We searched the pathologic records of our institution from December 1999 to April 2002, and included 16 patients with hepatocellular carcinoma ( N = 14), large regenerative nodule ( N = 1), and dysplastic nodule ( N = 1) who underwent orthotopic liver transplantation (10 patients) or partial hepatectomy (six patients) and MR imaging within an interval of two weeks. The MR images were retrospectively assessed qualitatively and quantitatively. Angiogenetic activity of the hepatic nodules was evaluated by means of immunohistochemical study for VEGF. Analysis of variance and the Scheffé criterion were used for statistical evaluation. Results Hepatic nodules with moderate to strong immunoreactivity for VEGF showed higher signal intensity on T1-weighted images ( P < 0.05) and those with intense immunoreactivity for VEGF showed higher signal intensity on T2-weighted images ( P < 0.05). No correlation was found between the immunoreactivity for VEGF and tumor vascularity on postcontrast early- and late-phase images. Conclusion Our current results suggest that signal intensity on unenhanced T1- and T2-weighted MR images may correlate with immunoreactivity for VEGF. Correlation was not found between immunoreactivity for VEGF and signal intensity on gadolinium-enhanced MR images. J. Magn. Reson. Imaging 2004;20:426-434. © 2004 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Purpose To investigate and assess the radiologic, serological, and histopathologic findings in patients who presented with early heterogeneous enhancement (EHE) on gadolinium-enhanced early-phase magnetic resonance imaging (MRI) of the liver. Materials and Methods We searched our radiologic records of MRI of the liver from July 1999 to April 2002 to identify patients with EHE. Three investigators retrospectively evaluated in consensus the MR images in each patient for intensity and characteristic of EHE blinded to clinical information. Serological laboratory values and clinical information were obtained in all patients, and histologic findings were available in 19. Results We identified 67 patients with EHE. Of them, 62 patients (93%) had underlying chronic liver disease. Twenty-seven patients had viral hepatitis, 13 had alcohol abuse, 6 had primary sclerosing cholangitis, and the others had miscellaneous etiologies. The five patients without chronic liver disease had the following clinical histories: concurrent chemotherapy for extrahepatic malignancy (two patients), concurrent intraabdominal infection (one), and no known associated disease (two). Intensity of EHE was intense in 6 (9%), moderate in 22 (33%), and mild in 39 (58%). Pattern of EHE was geographic in 15 patients (22%), patchy in 37 (55%), and miliary in 15 (22%). All EHE showed rapid fading on postcontrast late-phase images. EHE showed mild to moderate hyperintensity on T2-weighted images in 30 patients (45%). In the 19 patients with histological correlation, 19 (100%) had hepatocellular necrosis, 19 (100%) had fibrosis, 18 (95%) had inflammatory cell infiltration, 17 (89%) had capillary-size vessels within fibrous septa, and 16 (84%) had ductal proliferation. No statistical correlation was found between the intensity or pattern of EHE on MR images and the extent of elevation of serological laboratory values or severity of histologic findings. Conclusion Several different types of underlying chronic liver disease were observed in most of the patients with EHE. Hepatocyte necrosis, fibrosis, or inflammatory processes were found in all patients with EHE who had histopathological correlation. J. Magn. Reson. Imaging 2004;20:242-249. © 2004 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Proliferating cell nuclear antigen (PCNA) grade (a semi-quantitative assessment of the entire tumor profile) and estimation whether PCNA grade is low (0-50% positive cells) or high (51-100% positive cells) has been demonstrated to be of prognostic significance in gastric carcinoma. Sixteen vertical growth phase melanomas with 8 or more years of clinical follow-up were reacted with antibody to PCNA. PCNA grade was independently evaluated by both authors without knowledge of clinical outcome. PCNA grade was subsequently correlated with clinical outcome and other prognostic indicators. Agreement in assigning PCNA grade was noted between the two observers in 13/16 cases. However, PCNA grade failed to accurately predict patient survival or death. Additionally, PCNA grade was not significantly correlated with other recognized prognostic attributes. While interpretation of the prognostic significance of PCNA grade based upon this small series of cases should he conservative, a semi-quantitative estimate of PCNA-positive cells appears to have little utility in predicting the clinical outcome in malignant melanoma. [ABSTRACT FROM AUTHOR]

Prediction of long-term survival for clinical stage I malignant melanoma and guidance of therapy has long relied upon assessment of tumor thickness. This parameter is a strong, but not infallible predictor of prognosis. Clark et al. have developed a prognostic model based upon the concept of tumor progression and the evaluation of six readily assessable clinical and histologic attributes. They report the most accurate prediction of long-term survival of any prognostic method available for melanoma (100% accurate for radial-growth-phase and 84.1% accurate for vertical -growth-phase melanomas).This model was developed and validated via study of a patient population which largely resided in the northeastern portion of the United States. We report additional validation of this model using a data base of 55 patients from a different geographic location (North Carolina) and have observed virtual identity in the accuracy of predicting 8-year survival for radial-growth-phase (100%) and vertical -growth-phase (85.1%) melanomas. Twenty per cent of these cases were randomly selected and subjected re-evaluation for prognosis with extremely good precision obtained in the prognostic prediction. [ABSTRACT FROM AUTHOR]

Lymphangiomas are hamartomas which often occur during childhood. Their classification is primarily size dependent and predicts their clinical course. Larger lesions can be life threatening, but for many patients with lymphangiomas, cosmetic disfigurement is the primary concern. Treatment options are limited and have shown only variable success. Repetitive surgical excision may be necessary. We report a cystic lymphangioma of the axilla occurring in association with a Becker's nevus in an infant. Although Becker's nevi have been described in association with other hamartomas, primarily those of smooth muscle, an association with cystic lymphangioma has not been previously reported. We offer a brief discussion of possible developmental mechanisms for their coexistence. In our patient the simultaneous occurrence of a lymphangioma and a Becker's nevus appears to be a localized event, as no other developmental abnormalities are evident. [ABSTRACT FROM AUTHOR]

SUMMARY A case of haemangioma of the oesophagus is presented. The computed tomographic findings of an intramural mass with marked enhancement following intravenous contrast enable the diagnosis to be suggested pre-operatively. [ABSTRACT FROM AUTHOR]

Benign fibrous histiocytoma is a common soft tissue tumor that usually occurs in adults and is relatively rare in childhood. This report describes a 7-month-old Caucasian boy with an enlarging firm congenital nodule on his occipital scalp. Histologic analysis revealed a benign fibrous histiocytoma with osteoclast-like giant cells. Benign fibrous histiocytoma with osteoclast-like giant cells is a rare histologic variant. [ABSTRACT FROM AUTHOR]