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BACKGROUND/AIM Contrast-enhanced ultrasonography (US) has improved the detection and characterization of focal hepatic lesions. Recently, the importance of obtaining high-quality samples in the biopsy of hepatic lesions has been increasing not only in the field of pathological diagnosis but also in molecular analysis for predicting the effectiveness of anticancer agents and molecular targeted drugs. We evaluated the utility of Sonazoid-enhanced ultrasonography (SEUS) in guiding percutaneous biopsy of focal hepatic lesions by comparing the results of histopathological diagnosis between B-mode US and SEUS guidance. METHODS AND MATERIALS This retrospective study examined 121 focal hepatic lesions in 108 patients (mean age: 63.8 years) referred for US-guided percutaneous biopsy. The technical success rate was defined as the percentage of the lesions diagnosed clearly at the initial biopsy. RESULTS Among 121 lesions, 56 lesions were subjected to biopsy with B-mode US guidance whereas 65 were subjected to SEUS guidance. The technical success rate was significantly higher under SEUS guidance than under B-mode US guidance (92.3 vs. 76.8%, respectively, P

There are no published abattoir bovine hepatic lesion prevalence studies in cattle in Rwanda. This study estimated that 12.3% of the livers (n=4751) examined at Nyabugogo slaughterhouse in Kigali were condemned. Condemnation prejudiced the nation of 3492.00kg of meat with attendant economic losses of US$8932.40 during the study period. Risk factors for these lesions were also assessed. Male and female animals from 11 districts were used in this study. Hepatic lesions were higher in females (14.6%; n=1494) than in males (11.1%; n=3257). About 78.7% of the condemnations were due to fascioliasis, followed by abscesses (5.7%), hepatitis (5.3%), cirrhosis (4%) and other lesions (6.3%). Female animal livers showed more fascioliasis and abscesses (82.2% and 9.5%) than male animal livers (73.3% and 3.3%). The highest rate of condemnation was observed from Kayonza (40.2%; n=413) and the least was from Gakenke district (0.9%; n=1031). Cattle from the Eastern Province showed significantly (P

Poster: "ECR 2015 / C-1262 / Shear wave elastography (SWE) predicts outcome in patients receiving anti-vascular agents for hepatic malignancy " by: " M. Abel , H. Wasan, E. L. Leen; London/UK"

Diffusion-weighted (DW) MRI has been more frequently used in abdominal imaging with the introduction of echo-planar imaging and parallel imaging techniques that reduce the examination time and eliminate time-related artifacts. Detection of focal hepatic lesions can be accomplished by visual assessment of signal changes on DW images. Diffusion characteristics of focal hepatic lesions are represented by quantitative apparent diffusion coefficient values. Utility of DW-MRI as a complementary imaging method in evaluation of focal hepatic lesions depends on comparison between the results of DW-MRI and conventional MRI sequences. Detection and characterization of focal hepatic lesions in DW-MRI will be reliable with the advances in MRI technology that provide high-quality images and avoid artifacts.

Focal nodular hyperplasia (FNH) is the second most common benign hepatic mass. The primary purpose of this article is to provide a relevant case study and offer a review of the recent literature related to FNH with a discussion of both the clinical and imaging findings of this classically benign hepatic lesion. Although magnetic resonance imaging is considered the gold standard of FNH imaging, the sonographic and computed tomography appearance also is offered in this article. Furthermore, contrast-enhanced ultrasound, which boasts a 96% success rate at differentiating FNH from other hepatic tumors, is analyzed. The historical treatment options, including medical and possible surgical intervention, are provided as well. Last, this article offers an analysis of the prognosis for the patient diagnosed with FNH.

To evaluate whether incorporation of a 3D turbo spin-echo sequence during T2-weighted MR imaging improves the detection of focal hepatic lesions by 3T MR imaging. Seventy-nine consecutive patients including 67 patients with 62 malignant and 71 benign lesions and 12 patients having no hepatic lesion underwent respiratory-triggered fat-suppressed axial T2-weighted turbo spin-echo imaging using two-dimensional (2D-TSE) and 3D (3D-TSE) sequences. Coronal multiplanar reformatted images (MPR-3D-TSE) were generated from 3D-TSE images. Breath-hold fat-suppressed 2D axial T2-weighted half-Fourier turbo spin-echo (HF-2D-TSE) images were combined for reading. Two independent radiologists reviewed three imaging sets, (1) 2D-TSE and HF-2D-TSE, (2) 3D-TSE and HF-2D-TSE, and (3) 3D-TSE, HF-2D-TSE and MPR-3D-TSE, for detection of malignant and benign lesions. Lesion-to-liver contrast ratio (CR) and the conspicuity of anatomical boundaries were assessed. For benign lesions, lesion-to-liver CRs with 3D-TSE (2.77 ± 1.91, p = .0002) and MPR-3D-TSE (2.47 ± 1.42, p = .012) were higher than with 2D-TSE (2.13 ± 1.80). Sensitivity for lesions of ≤10-mm was higher with 3D-TSE (86 %, p = .0039) and MPR-3D-TSE (84 %, p = .0078) than with 2D-TSE (72 %). However, the edge of left lateral lobe was less conspicuous with 3D-TSE (p < .0001) and MPR-3D-TSE (p = .0003) than with 2D-TSE because of susceptibility artifacts. Incorporation of 3D T2-weighted sequence may incrementally improve the detection of focal hepatic lesions.

The purpose of our study was to identify extrahepatic soft tissue mimicking applicator-tract implantation after percutaneous radiofrequency ablation of hepatic malignancy on triple-phase dynamic CT.A database was reviewed for 131 patients who underwent percutaneous radiofrequency ablation for treatment of a hepatic tumor over a 3-year period. Patients who developed extrahepatic soft tissue adjacent to the previous ablation zone mimicking applicator-tract implantation were identified. The clinical features of patients, characteristics of extrahepatic soft tissue on CT, soft-tissue changes on follow-up CT, and histopathologic results were evaluated.Extrahepatic soft tissue developed in five patients (3.8%) at 2-8 months after percutaneous radiofrequency ablation. Extrahepatic soft tissue showed progressive enhancement during the delayed phase of dynamic CT. Four lesions were completely resolved without any treatment. However, one lesion was enlarged and xanthogranulomatous inflammation was diagnosed by percutaneous biopsy. Univariate analysis showed that an index tumor with a subcapsular location and a prior biopsy had high odds ratios.The possibility of a benign inflammatory lesion should be considered when extrahepatic soft tissue showing radiologic findings similar to applicator-tract implantation develops after radiofrequency ablation of a hepatic tumor.

Gadoxetate disodium (Gd-EOB-DTPA) is a hepatobiliary MRI contrast agent widely used in adults for characterization of liver tumors and increasingly used in children. Hepatoblastoma is the most common primary hepatic malignancy of childhood. In this review, we describe our experience with this agent both before and after initiating therapy in children with hepatoblastoma.

Radiofrequency ablation (RFA) is commonly used for treating unresectable hepatic malignancies. Some commonly associated complications of RFA include fever, symptomatic pleural effusion, abscess, hepatoma and hepatic insufficiency. Here, we report a case of diaphragmatic hernia in a patient following RFA for hepatic malignancy with cirrhosis.

Our goal was to investigate the effect of displayed image magnification on perception of the size of hepatic lesions on abdominal computed tomography (CT) scans. Institutional review board approval and informed observer consent were obtained. Three experienced radiologists reviewed 90 CT image pairs in one session. Each image pair demonstrated a solitary, well-defined hypodense hepatic lesion measuring greater than 1 cm obtained at two points in time. The image pairs were presented three times in random order, once with the left image magnified, once with the right image magnified, and once with neither image magnified. The radiologists were asked to determine on which image the lesion was smaller or if there was no difference. The responses were analyzed statistically. The proportion of correct responses increased significantly as the difference in lesion size increased (p

Hepatoblastoma is the most common hepatic malignancy during childhood. However, little is still known about the molecular mechanisms that govern the development of this disease. This review is focused on the recent advances regarding the study of microRNAs in hepatoblastoma and their substantial contribution to improv our knowledge of the pathogenesis of this disease. We show here that miRNAs represent valuable tools to identify signaling pathways involved in hepatoblastoma progression as well as useful biomarkers and novel molecular targets to develop alternative therapeutic strategies in this disease, This research was funded by PI15/00934 and PI16/01468 grants from Instituto de Salud Carlos III FEDER.

Colorectal metastases represent the most common hepatic malignancy, and experience has shown that surgical resection may offer long-term cure in select patients. Advances in operative technique and adjuvant therapy have increased 5-year survival rates to more than 50%. During the last decade, the introduction of laparoscopic liver resection has progressed from a novelty to a viable surgical option. With the growing enthusiasm for laparoscopic hepatectomy, multiple centers are utilizing a minimally invasive approach to hepatic colorectal metastases. As with any new surgical procedure, several concerns have arisen with laparoscopic hepatectomy. These include the safety of this procedure as well as its oncologic integrity. Despite these concerns, recent series have demonstrated the equivalence of laparoscopic and open hepatectomy for colorectal metastases, resulting in many of these fears being put to rest. Given these promising results, centers that have developed the necessary expertise to safely perform laparoscopic hepatectomy should begin to apply this approach to hepatic colorectal metastases.

Purpose To evaluate the incidence of extrahepatic deposition of technetium-99m–labeled albumin macroaggregates (99mTc-MAA) after pretreatment angiography, before yttrium-90 radioembolizaton (90Y-RE), and to report on technical solutions that can be used to ensure safe delivery of 90Y-microspheres in patients with initial extrahepatic deposition. Materials and Methods A retrospective analysis of 26 patients with primary and secondary liver malignancies, who were scheduled for treatment with 90Y-RE in our institution in 2009, was performed. The angiograms and single-photon emission computed tomography images of all patients were reviewed by an interventional radiologist and a nuclear medicine physician, respectively, to identify and localize extrahepatic deposition of 99mTc-MAA when present. Subsequently, the technical solutions were used to successfully perform 90Y-RE in these patients were evaluated and described. Results Extrahepatic deposition of 99mTc-MAA was observed in 8 of 26 patients (31%). In 7 of 8 patients, a second pretreatment angiography was performed to detect the cause of extrahepatic deposition. The technical solutions to enable safe 90Y microspheres delivery included more distal placement of the microcatheter in the proper/right hepatic artery in 4 of 7 (57%) patients; (super)selective catheterization of multiple segmental branches in 2 of 7 (29%); and additional coiling of a newly detected branch in the remaining patient (14%). This was confirmed by a second MAA procedure. 90Y-RE was eventually performed in 25 of 26 (96%) patients. No procedure-related complications (

Diabetes mellitus promoted an overproduction of free radicals and an increased incidence of both diabetic nephropathy and liver disease. In this report, we evaluated the effects of Chinese and Brazilian propolis on streptozotocin-induced hepatorenal injury in rats. The results demonstrated that Chinese propolis-treated rats had a 7.4% reduction in the glycated hemoglobin (HbAlc) level compared with untreated diabetic rats. Additionally, Chinese propolis induced an increase in the serum superoxide dismutase (SOD) level significantly while Brazilian propolis raised serum SOD and reduced level of malonaldehyde (MDA) and nitric synthetase (NOS). Of the measurable decrease in serum alanine transaminase (ALT), aspartate transaminase (AST) and microalbuminuria demonstrated the propolis-mediated improvement of hepatorenal function, which was further confirmed by histological examination. We also observed that Chinese and Brazilian propolis increased hepatorenal glutathione peroxidase (GSH-px) level and inhibited MDA production significantly. These results suggested that propolis may prevent hepatorenal injury by inhibiting lipid peroxidation and enhancing the activities of antioxidant enzymes.

Laparoscopic liver resection has been increasingly gaining popularity worldwide with the advance of laparoscopic instruments and techniques in the last decade. Laparoscopic approach for left side hepatic lesion has become the standard procedure. In this video manuscript, we showed the technique of laparoscopic non-anatomical left lateral sectionectomy for tumor located in segment 3. The first and most important step is to identify hepatic artery to segment 2 and 3 and mark the transection border according to ischemic line. Following that, liver parenchyma transection begins with laparoscopic ultrasonic device and/or other energy devices. Intrahepatic vessels encountered are divided with metallic or Hem-o-lok clips. Finally, left hepatic vein is divided by laparoscopic linear stapler.

Hepatic perfusion imaging with magnetic resonance (MR) imaging is an emerging technique for quantitative assessment of diffuse hepatic disease and hepatic lesion blood flow. The principal method that has been used is based on T1 dynamic contrast-enhanced MR imaging. Perfusion imaging shows promise in the assessment of tumor therapy response, staging of liver fibrosis, and evaluation of hepatocellular carcinoma. The future standardization of imaging protocols and MR imaging pulse sequences will allow for broader clinical applications.

Dichloroacetic acid (DCA) is a hepatocellular carcinogen in the male B6C3F1 mouse. Histopathologic analysis of a timed DCA dose response study has demonstrated three hepatic lesion sequences in this model. The purpose of the present study of 465 B6C3F1 male mice was to determine: (1) the persistence of early lesions in a “stop” study and (2) the efficacy of phenobarbital (PB) to promote these early lesions. The persistence of early lesions in mice exposed to drinking water containing 3.5 g/l DCA for 10 week intervals to 50 weeks was determined. One group remained exposed until the study was terminated at 100 weeks. Control animals received distilled water. In the promotion study, groups of animals exposed to drinking water containing 3.5 g/l DCA for 30 weeks were transferred to 0.6% phenobarbital (PB) or water alone and terminated at 60 or 90 weeks. Histopathologic analysis of liver lesions was performed on 1,481 formalin fixed, paraffin embedded tissue sections stained with hematoxylin and eosin. Lesions were identified and classified as altered foci (AF), hyperplastic nodules (HN), adenomas (AD) or carcinomas (CA). 10-50 weeks of DCA exposure doubled the prevalence of atypical (irregular misshapen and hyperchromatic) nuclei (82-95% vs 32% in untreated animals). Lifetime exposure to DCA was not required for induction of neoplastic lesions. Numerous neoplasms arose in animals exposed to 3.5 g/L DCA for 10, 20, 30, 40, or 50 weeks and then placed on water until 100 weeks. The prevalence of AD and CA increased with time to 50 weeks but decreased after 100 weeks, possibly reflecting the dose dependent suppression of proliferation in premalignant hepatic lesions such as hyperplastic nodules and adenomas by DCA. DCA exposure for 10-30 weeks doubled the prevalence of enlarged nuclei which were highly correlated with zonal changes. With increasing DCA exposure there was a shift in frequency of lesion types from hyperplastic nodues (20 weeks) to adenomas (40 weeks) to carcinomas (50 weeks). The major effect of PB promotion was to increase the number of eosinophilic AD at 60 and 90 weeks. These data demonstrate the continued development of preneoplastic hepatocellular lesions following termination of DCA treatment and are in agreement with studies which demonstrated that early-life exposure was as carcinogenic as life-long exposures for 98 weeks. Histopathologic analysis of these (DCA) stop and promotion studies in the B6C3F1 male mouse confirms that carcinomas can arise directly from single initiated cells in liver as well as within hyperplastic nodules and adenomas. Potentially, epigenetic-mediated effects may be involved since earlier reports indicate that RNA and micro-RNA profiles associated with prior DCA treatment were not sustainable. This work as supported by USEPA Cooperative Agreement #CR-814803-01-0. Citation Format: Julia H. Carter, Harry W. Carter, Anthony B. DeAngelo. Multiple hepatic lesion sequences in dichloroacetic acid (DCA) stop and promotion studies in the B6C3F1 male mouse [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5049.

e24276Background: Hepatocellular carcinoma (HCC), the most common hepatic malignancy, is the second leading cause of cancer-related death worldwide. China accounts for more than 50% of new HCC cases and deaths in the world. The genomic profiles of HCC in Chinese patients had not been thoroughly elucidated to facilitate diagnosis and treatment. Methods: FFPE tumor and matched blood samples of 181 Chinese HCC patients, including 152 males (median age of 54) and 29 females (median age of 52), were collected for next-generation sequencing-based 450 genes panel assay. Genomic alterations (including single base substitutions, short and long insertions/deletions, copy number variations, and gene rearrangement in selected genes) and tumor mutational burden were assessed. In addition, the expression of tumor cell PDL1 was also evaluated by FDA-cleared DAKO 22c3 antibody. Results: The most frequently mutated genes in 181 Chinese HCC were TP53 (59.7%), TERT (34.3%), CTNNB1 (21.5%), AXIN1 (12.2%), RB1 (11.0%), STK24 ...

Following transcatheter arterial chemoembolisation (TACE), the appearances on CT or MR images are largely related to the chemical and ischaemic insults to the portal tract. Understanding the mechanism of TACE-induced changes is essential for radiologists in order to determine the therapeutic effect as well as to distinguish these changes from recurrent tumours. This pictorial review illustrates the haemodynamic and substantial parenchymal changes related to TACE for hepatic malignancy.

Capsular retraction is an infrequent but characteristic feature of malignant liver lesions such as hepatic metastases and intrahepatic cholangiocarcinoma. Rarely, this finding may be observed in association with benign lesions, such as atypical haemangiomas. Capsular retraction has not previously been reported in association with hepatic inflammatory pseudotumour (IPT). Hepatic IPT is an uncommon benign hepatic lesion with a good clinical prognosis. In this report, we discuss the case of a 48-year-old woman with capsular retraction secondary to multifocal hepatic inflammatory IPTs.

Some intoxications are more specifically linked to the Aquitaine region than to other regions of France, due to environmental circumstances (fauna, flora, climate) or traditional activities (gastronomy). Three types of intoxications are particular in this area. Pine processionary caterpillar envenomations (Thaumetopoea pityocampa), a Southern Europe pinewood parasite, are frequently encountered in the Landes' forest. They are responsible of ocular and/or skin lesions with urticaria or contact dermatitis, seldom associated with immediate IgE hypersensitivity. According to the south Atlantic coastal region geology and the marine streams, venomous marine animals are mainly located in Charente-Maritime for jellyfish, in Gironde and in Landes for weeverfish and in Atlantic Pyrenees for sea anemone. Usually not dangerous, first-aid workers treat most cases of these envenomations. Some endemic mushrooms (Tricholoma auratum) which grow on the dunes of the Atlantic coastal region, are usually considered as very good comestibles, but were recently responsible for serious intoxications: T.auratum was responsible of several cases of rhabdomyolysis, without neurological involvement, nor renal or hepatic lesion. Three deaths were notified. Animal studies confirmed the responsibility of the mushrooms.

The presence of visceral hemangiomas in the syndrome of multiple enchondromas and subcutaneous hemangiomas, also named Maffucci syndrome, is exceedingly rare; until now noncutaneous hemangiomas have been described in 4 patients: they were found in the tongue in one patient, in the oral cavity in the second patient, in both the oral cavity and the colon in the third patient, and in the spleen in the fourth patient. We report the first case of hemangioma localized in the liver in a patient with Maffucci syndrome; furthermore, due to the impossibility of carrying out an MRI to define the hepatic lesion, an ultrasonographic real-time perfusion imaging study with a contrast agent was performed.

Von Meyenburg complexes (VMC) are a cluster of benign liver malformations including biliary cystic lesions, with congenital fibrocollagenous stroma. This rare entity can mimick multiple secondary hepatic lesions. We report a case of a 56-year-old woman who had multiples liver lesions 12 years after operation for breast cancer. Biopsy of the hepatic lesion confirmed the diagnosis of VMC. Preoperative discovery of multiple gray-white nodular lesions scattered on the surface of the liver should not always contraindicate curative liver resection. The diagnosis of VMC should be known and confirmed with liver biopsy.

Purpose To retrospectively evaluate the safety and effectiveness of the use of the AngioSeal device for repeat arterial closure in patients with hepatic malignancy. Materials and Methods A retrospective analysis of patients with hepatic malignancy who had undergone repeated arterial closure with the AngioSeal device was performed. All charts for patients undergoing transarterial chemoembolization or TheraSphere radioembolization were reviewed for the method of hemostasis and the number of arterial closures. A total of 53 patients (58.5% men, 41.5% women; mean age, 58.7 years) had repeat AngioSeal arterial puncture closure after chemoembolization or TheraSphere treatment. Percutaneous closure of the common femoral artery with the AngioSeal device was performed in accordance with the manufacturer's recommendations. The patients were examined for complications on follow-up. Effectiveness was defined by the ability to obtain satisfactory hemostasis. Safety was assessed by the absence of groin complications and by vessel patency on follow-up angiograms of the puncture site obtained at subsequent liver-directed therapy sessions. Results Fifty-three patients in this study group had a total of 203 common femoral artery punctures. There were a total of 161 closures with the AngioSeal device (79.3%): 58 (36%) single closures and 103 (64.0%) repeat closures. Of the 161 attempts at AngioSeal closure, there was one closure failure in the single-puncture group, yielding a success rate of 98.3%; and one closure failure in the repeat-puncture group, yielding a success rate of 99%. In these two patients, hemostasis was achieved with traditional manual compression without the need for any other device, and no complications were noted. The overall success rate of AngioSeal device closure was 98.7%. Conclusions The repeat use of the AngioSeal closure device is safe and effective in patients with hepatic malignancy undergoing regional oncologic interventional procedures.

OBJETIVO: Avaliar o efeito do consumo crônico de di e trieptanoínas sobre a esteatose hepática (EH) em ratos. METODOLOGIA: Ratos Wistar submetidos à dieta AIN-93 com 0%, 30% ou 50% de substituição do óleo por óleo rico em di e trieptanoína, grupos TAGC(7)0, TAGC(7)30 e TAGC(7)50, respectivamente, por nove meses. O grupo-controle recebeu ração Labina®. Analisaram-se histologia e provas de função e lesão hepática, glicemia e perfil lipídico sérico. Realizaram-se análise de variância, teste F, teste de Dunnet e análises de regressão uni e multivariadas (p < 0,05). RESULTADOS: TAGC(7)0, TAGC(7)30 e TAGC(7)50 desenvolveram EH; 80% de casos graves no TAGC(7)0 contra 40% no TAGC(7)50. Os pesos absoluto (PAF) e relativo do fígado (PRF) foram maiores em TAGC(7)0 e TAGC(7)30 e a glicemia foi maior em TAGC(7)30 e TAGC(7)50, que no grupo-controle. Colesterol total, LDL-c, LDL-c/HDL-c e proteínas totais foram maiores no grupo-controle. O óleo experimental reduziu o PRF e determinou tendência de redução do peso corporal, PAF, percentual de lipídios hepáticos e graus de EH (GHE). As variáveis explicativas para GHE foram peso final, glicemia, albumina, HDL-c, LDL-c, LDL-c/HDL-c, VLDL-c e fosfatase alcalina. CONCLUSÕES: Sugere-se que di e trieptanoínas exerçam efeito hepatoprotetor contra a EH, em ratos, em uma feição dose-dependente.

HAT has survived it's comparators as it has successfully evolved from hepatic artery chemotherapy(HAC), bland embolization (HAE), chemo-embolization (HACE) to;chemo bead embolization(HACBE), radioactive bead embolization(HARBE). The HAC is only indicated routinely in selected post hepatic metastatectomy patients with colorectal cancer whereas HACE and HARBE are routine choice for selected unresectable HCC.

Background: Patients with hepatic malignancy have a dismal prognosis with standard therapies. NV1020 is an oncolytic herpes simplex virus that has potential to be a safe and effective therapeutic agent for this disease. Objective: We set out to discuss the development of NV1020 as an oncolytic agent and explore the potential role of this particular virus in the setting of human hepatic cancer. Methods: The scope of this review includes an overview of preclinical experience with NV1020, as well as an examination of current standard and developing therapies for liver cancer. The primary focus, however, is on the safety and potential clinical efficacy of NV1020 against hepatic malignancy. Results/conclusion: We have found that NV1020 is a safe, novel therapeutic agent for treatment of refractory hepatic malignancy.

Dear Editor We read the article BFocal liver tuberculosis: a case report^ with great interest [1]. It was really an interesting case, and authors have discussed it very well. My only concern is that are we justified in labeling this lesion as tubercular despite absence of caseation and acid fast bacilli. There can be many other differential diagnoses of granulomatous liver lesions [2]. Hepatic granuloma is a unique inflammatory response that may be idiopathic or may be a response to a bacterial, viral, fungal, or parasitic infection. It may be a manifestation of drug-induced liver injury [2]. There are certain distinctive features which can identify tuberculous granulomas in the liver; these include acid-fast bacilli within the lesion, caseating necrosis with destruction of the reticulin framework (seen in up to 83 % of lesions), irregular contours with a particularly dense cuff of lymphocytes surrounding the lesion, and few lesions, with a tendency to coalesce [3]. Apart from histopathology, we can identify this lesion by detection of mycobacterial DNA on tissue specimen using PCR (88 % sensitivity and 100 % specificity). We should use all available diagnostic modalities to identify the lesion correctly as we know that all first-line antitubercular drugs are hepatotoxic, and prescription of these drugs to a patient having non-tubercular hepatic lesion may further worsen the clinical picture.

Hepatic malignancy with regional lymph node involvement is generally associated with poor prognosis. Lymphatic drainage from the liver to extrahepatic lymph nodes follows a complex and unpredictable pathway. To add to the complexity of management of regional lymph nodes in hepatic malignancies, not all liver cancers have the same propensity to metastasize through lymphatics. Lymphadenectomy has had mixed results in terms of improving patient survival. Other therapies especially anti-lymphogenic agents might play a role in the near future.

Focal nodular hyperplasia (FNH) is a rare benign hepatic lesion, which is usually asymptomatic and solitary. Complications such as rupture and bleeding are extremely rare and only five cases have existed since 1975. We report a case of a 26-year-old woman with spontaneous rupture and hemorrhage of huge FNH presenting as acute abdomen. Different to previously recorded cases, this case was concomitant with multiple hepatic adenomas, which was misdiagnosed as rupture of hepatocellular carcinoma (HCC) with multiple intrahepatic spreading in another hospital. Our case highlights thepossible association between the size of FNH and the risk of rupture, and emphasizes the need to consider this in making treatment decisions. Although a conservative approach for asymptomatic FNH is well established, the potential for surgical intervention should always be considered, especially for large FNH. We recommend surgical resection of large FNH (>5 cm), symptomatic or not, rather than observation.

Liver resection is the most frequently used method to treat hepatocarcinoma in pediatric patients. Approximately 70 % of hepatocarcinomas in children are malignant. In Europe and North America, primary hepatic malignancy is one of the ten most common malignancies in children, although it only accounts for approximately 1.1 % among other primary hepatic malignancies. Hepatoblastoma, the most common primary hepatic malignancy in pediatric patients, accounts for approximately 80 % of primary hepatic malignancies and 43–64 % of hepatocarcinomas in children. Hepatoblastoma is commonly seen in children under 3 years of age, is rarely observed in those beyond 5 years of age, and is predominantly present in males (male/female ratio 2.5:1); it can also be seen in adults. Hepatocellular carcinoma (HCC) is another common malignancy in children, accounting for approximately 23 % of pediatric hepatocarcinomas. The prevalence distribution of pediatric HCC is bimodal, with the first peak at ages

With great interest, we read the article "Differential diagnosis between hepatic metastases and benign focal lesions using DWI with parallel acquisition technique: a meta-analysis" (by Wei CG et al.). This article suggests that diffusion-weighted imaging was useful for differentiation between hepatic metastases and benign focal lesions. The result is encouraging. We would like to contribute regarding the value of DWI with parallel acquisition technique in the differentiation of metastases and benign hepatic lesions.

Background: Image-guided percutaneous radiofrequency ablation (RFA) has been the most commonly used modality in the treatment of nonresectable hepatic malignancies. However, tumors in the subcapsular location are still technically challenging. This study was undertaken to evaluate the feasibility, safety, and efficacy of computed tomographic-guided percutaneous RFA with hydrodissection for hepatic malignancies in the subcapsular location. Methods: A total of 103 patients with 253 hepatic lesions were treated with computed tomographic-guided percutaneous RFA. Computed tomographic-guided percutaneous RFA with hydrodissection was performed in 15 patients with 15 hepatic nodules. All tumors located in the hepatic subcapsular location were considered difficult to treat on planning sonography. Hydrodissection was performed with 5% dextrose in water or saline solution in displacing adjacent structures ≥ 10 mm away from the liver capsule. Two RFA systems with multitined expandable electrodes or straight internally cooled single electrodes were used for treatment of hepatic malignancies. The feasibility, safety, and efficacy of this technique were analyzed on follow-up contrast-enhanced computed tomography or magnetic resonance imaging. Results: Hydrodissection was successfully achieved in 15 (100%) patients, displacing the adjacent structures ≥ 10 mm that were originally < 10 mm away from the liver capsule with administration of a mean of 376 mL of dextrose in water or saline solution. The average distance between an adjacent structure and the liver capsule after hydrodissection was 1.50 ± 0.40 cm and 0.11 ± 0.15 cm prior to hydrodissection, which was statistically significant (p

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide and the most common primary hepatic malignancy. It arises on a background of hepatic cirrhosis in approximately 95% of the cases in the United States. A wide variety of treatment modalities have been applied in the treatment of HCC. Liver transplantation has emerged as the preferred treatment for patients with small HCC. Transplantation for patients whose tumors do not exceed the Milan criteria yields results equivalent to those of transplantation for non-HCC indications. Controversy now exists regarding the use of living donors, expansion of selection criteria, and role of adjuvant therapy.

Background Hepatic cystic lesions are rare; however, their management and treatment is dependent on early recognition and diagnosis. Methods In this report, the authors discuss a 72-year-old woman who presented to their clinic for treatment of a hepatocystadenoma. Results The history, physical examination, and diagnostic modalities lead to surgical intervention despite an unclear diagnosis. Conclusions This case illustrates an unusual hepatic lesion in which the diagnosis was not known until the time of laparotomy. However, diagnostic modalities were important in establishing the need for surgical intervention. The authors offer a pertinent review of the literature and discuss current treatment modalities.

The purpose of this study was to report a new technique for localization of hepatic tumors that are poorly visible with CT fluoroscopy. Forty-three hepatocellular carcinomas were not visible with CT fluoroscopy. A 22-gauge Chiba end-hole needle was inserted in the approximate location of a lesion estimated on the basis of anatomical landmarks demonstrated on both previous MR and CT images. We injected 3 ml of a mixture of nonionic contrast material and saline solution. Following the first injection, contrast solution filled the hepatic lesion in 29 of 43 cases. In 8 of 43 cases, contrast solution was distributed in the normal surrounding liver. In 7 of these 8 cases, repositioning allowed us to adjust the needle in the tumor. In the other 6 of 43 cases, contrast solution spread within capsule or pseudocapsule (pattern 3). In all 6 cases, repositioning allowed to adjust the needle in the tumor. This new technique allows an accurate localization of hepatic tumors that are poorly visible with CT fluoroscopy.

Background/Aim: A cholangiocarcinoma, the second most common primary hepatic malignancy, can present with diagnostic dilemmas. The aim of this study is to assess the role of CA 19-9 in patients with a cholangiocarcinoma without primary sclerosing cholangitis. Methods: The prospectively collected information on patients with biopsy-proven cholangiocarcinomas who had the CA 19-9 level measured was obtained (n = 68) from our computer database and medical records. These patients were compared with patients who had benign liver tumours (n = 25) and benign bile duct strictures (n = 13) who also had their CA 19-9 concentration measured. Results: Sensitivity and specificity of CA 19-9 in the diagnosis of a cholangiocarcinoma were 77.9 and 76.3%, respectively, when using a cut-off value of 35 kU/l, while sensitivity and specificity were 67.5 and 86.8%, respectively, when the cut-off value was raised to 100 kU/l. The specificity was found to be higher in patients with peripheral cholangiocarcinomas (96%) using a CA 19-9 cut-off value >100 kU/l. A CA 19-9 value >600 kU/l was associated with non-resectable tumours (p = 0.05). Conclusions: This study demonstrates that CA 19-9 is a useful adjunct in the diagnosis of cholangiocarcinomas without primary sclerosing cholangitis, especially in the diagnosis of peripheral cholangiocarcinomas. However, it does not provide a reliable guide for the pathological staging of these tumours.

Management of hepatic malignancies is a ubiquitous medical problem. Surgical resection of primary or metastatic liver cancer, with or without adjuvant chemotherapy, is the most effective method for enhancing survival; however, hepatic malignancies in the vast majority of patients are unresectable both at initial manifestation and at recurrence. In these patients, palliative cytoreductive therapies may help to retard tumor progression and therefore favorably alter the course of the disease. Since hepatic neoplasms are principally supplied by the hepatic artery, various arterially delivered cytotoxic agents have been developed to achieve these objectives. Recently, the Food and Drug Administration approved the transarterial administration of yttrium-90 microspheres for liver-directed therapy. Effective use of these devices requires knowledge of the accumulated clinical experience and a dedicated multidisciplinary effort to ensure optimal outcomes and avoid therapy-specific life-threatening complications. © ...

The term splenosis, first used in the medical literature in 1939, refers to the autotransplantation of splenic tissue in a heterotopic location. We report the case of a known hepatitis C carrier in whom computed tomography scanning revealed a hepatic lesion suggestive of hepatocarcinoma. Magnetic Resonance imaging was performed for suspected hepatic splenosis, which was confirmed by Tc-99m labeled heat-denatured red blood cell scintigraphy. In addition to confirming the suspected diagnosis, this technique showed several pathological foci in distinct abdominal locations compatible with splenosis that had not previously been identified.

Testicular carcinoids are rare and the majority are of primary testicular origin. Testicular carcinoids can also be secondary from extra-testicular primary tumors, but the incidence is even less common. The case described here is a patient who initially had an infiltrating cecal carcinoid with hepatic metastasis. Following surgery, he was managed with octreotide and had close monitoring of the levels of serum serotonin and its urinary metabolite. He experienced a fairly indolent clinical course and 5 years after excision of the primary cecal carcinoid, his hepatic lesion has virtually been unchanged. However, he developed a secondary testicular metastasis. He has otherwise remained well, without evidence of metastases elsewhere on imaging studies.

Rationale and objectives The purpose of this study was to compare hepatic enhancement characteristics using two different contrast media injection protocols with multidetector helical computed tomography. Materials and methods Twenty-three patients with known or suspected liver lesions scheduled to undergo biphasic hepatic multidetector helical computed tomography were randomized into one of two groups: (1) 150 mL of iopamidol (300 mgI/mL) at 5 mL/second, or (2) 100 mL of iopamidol (370 mgI/mL) at 4 mL/second. Unenhanced images were acquired initially, followed by both hepatic arterial phase (scan delay, 33 seconds) and portal venous phase (PVP; scan delay, 65 seconds) imaging. Three abdominal radiologists independently graded the images on a scale from 1–5 for enhancement and overall scan quality. Time-attenuation curves were generated from operator-defined region-of-interest measurements of liver parenchyma and aorta. Results Qualitatively, the three reviewers found no significant difference between the two study groups in terms of overall scan quality ( P = .23) or aortic enhancement (hepatic arterial phase, P = .9; PVP, P = .24). However, liver enhancement during the PVP was considered to be less in the Isovue 370 group ( P = .04). Quantitatively, during the hepatic arterial phase, there was no statistically significant difference between the two injection protocols comparing either aortic or hepatic parenchymal enhancement ( P = .62 and .80, respectively). During the PVP, these differences were statistically significant, with both aortic and hepatic parenchymal enhancement lower in the Isovue 370 group ( P P = .04, respectively). Conclusion It is important to consider the amount of iodine injected per second and the duration of the injection when setting up protocols to achieve target organ enhancement. 100 mL of iopamidol 370 at 4 mL/second can be used to obtain images of the liver with good diagnostic quality compared to more conventional protocols using 150 mL of iopamidol 300 at 5 mL/second. However, the degree of liver parenchymal enhancement during the PVP using the latter injection scheme is lower, which in turn could potentially reduce hepatic lesion conspicuity.

OBJECTIVE To investigate the frequency of and the risk factors for hospital readmission within the first year after liver transplantation (LT). MATERIALS AND METHODS Between January 1999 and August 2013, LTs were performed in 890 adult patients at our center. We collected medical data from the Chinese Liver Transplant Registry and performed a retrospective review of the medical records of these patients. We aimed to identify the factors that contribute toward readmission during the first year after LT. We also first investigated the relationship between the number and severity of post-transplant complications and the risk of readmission. The survival outcomes of patients with and without readmission were also studied. RESULTS A total of 165 rehospitalizations occurred in 142 patients (18.0%) within 1 year after discharge from their index admissions. The risk factors included hepatic malignancy as an indication for LT (P=0.01), previous abdominal surgery (P=0.03), the occurrence of any complications (P

A 70-year-old man underwent an FDG PET/CT for a possible primary liver malignancy or metastasis found on an abdominal MRI obtained as part of a workup for intermittent abdominal pain. The MRI showed an enhancing lesion at the dome of the right lobe of the liver. The lesion was FDG avid with a discrete central calcification. In conjunction with the patient's history of laparoscopic cholecystectomy 1 year prior, the findings were consistent with inflammation around a migrated subdiaphragmatic gallstone. One month after the scan, a CT-guided percutaneous biopsy of this lesion revealed chronic inflammatory cells with no evidence of malignancy.