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A primary benign hepatic schwannoma is an extremely rare disease with a good prognosis. A 55-year-old man with chronic hepatitis B was referred to our hospital because of jaundice, weight loss, and a hepatic lesion found during an ultrasound examination.Magnetic resonance image revealed a 55 × 120 mm solid mass lesion in the segment V and VIII of the liver. The mass extended directly to the segmental biliary ducts and common hepatic duct, causing obstruction of the biliary duct and upstream dilatation, particularly in the left liver lobe. Following the insertion of a percutaneous transhepatic biliary drainage, a biopsy was performed under ultrasound guidance.Histological examination confirmed a benign schwannoma, identified by characteristic pathological findings and positive immunoreactions with S-100 protein, but negative for c-kit, CD117, or CD34.The patient's tumor was removed and upon examination, it was discovered to be a mass filled with pinkish-yellow fluid, measuring 12 × 5 × 5 cm. This is the first known case of a benign schwannoma in the liver parenchyma of a patient with chronic hepatitis B. Furthermore, most previous cases of benign liver schwannomas have reported a smaller size than this case, which is slightly larger.

Objective: To compare the effects of dexmedetomidine and propofol on hemodynamics, stress response and immune function in children undergoing liver mass resection. Methods: The random number table method was used, 90 children who underwent elective liver mass resection in our hospital from May 2021 to April 2023 were divided into dexmedetomidine group (dexmedetomidine anesthesia) and propofol group (propofol anesthesia), 45 cases in each group. The changes of hemodynamics [heart rate (HR), mean arterial pressure (MAP)], stress response [cortisol (Cor), adrenocorticotropic hormone (ACTH)] and T lymphocyte subsets [CD4+, CD8+, CD4+/CD8+] were compared between two groups, and the incidence of adverse reactions during anesthesia was observed. Results: MAP in dexmedetomidine group was lower than that in propofol group at 10 min after anesthesia induction (T1) to the end of operation (T4), and HR was higher than that in propofol group(P<0.05). Cor and ACTH in dexmedetomidine group were lower than those in propofol group at T4 and 1 day after operation (T5) (P<0.05). CD8+ in dexmedetomidine group was lower than that in propofol group at T4 and T5, while CD4+ and CD4+/CD8+ were higher than those in propofol group (P<0.05). There was no difference in the incidence of adverse reactions between two groups(P>0.05). Conclusion: Compare with propofol anesthesia, dexmedetomidine can better stabilize hemodynamics, reduce stress response, and reduce immunosuppression in children undergoing liver mass resection. [ABSTRACT FROM AUTHOR]

Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providersmust be familiarwith the diagnosis andmanagement of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease involving multiple organs, including the liver. In SLE, the best-known involvement of the liver is autoimmune hepatitis. Hepatic hemangioma is the most common benign liver mass in the general population. In most patients, liver hemangioma is incidentally detected during abdominal imaging performed for another reason. Not many studies are available on hepatic hemangioma during SLE. A few case reports have been published in the literature, and the frequency of hepatic hemangioma in SLE was examined in a prospective study. Here, we report a 36-year-old woman diagnosed with SLE based on autoimmune hemolytic anemia, generalized lymphadenopathy, pleural effusion, renal involvement, and serological findings. A mass in the liver was detected on abdominal ultrasonography (USG), and multiple hepatic hemangiomas were detected on magnetic resonance imaging (MRI) of the liver. In this case report, a patient with SLE diagnosed with multiple hepatic hemangiomas was reported, and attention was drawn to the fact that the incidence of hepatic hemangioma in SLE may be increased.

Melese Ayllo,1 Abebe Habtamu Tamire,2 Mohammed Bereinto Legas,3 Gashaw Arega2 1Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia; 2Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Maternity and Reproductive Health, Tikur Anbessa Hospital, Addis Ababa, EthiopiaCorrespondence: Gashaw Arega, Email gashaw.arega@aau.edu.etBackground: Liver masses are a cause of morbidity and mortality in children worldwide. Although the patterns and clinical-radiological characteristics of primary liver masses have been studied in developed countries, few studies have been conducted in developing countries. Studying the patterns of liver mass in children helps to improve the outcome of liver masses and to design preventive strategies if the identified risk factors are preventable.Material and Method: A hospital-based cross-sectional study was conducted on children who met the inclusion criteria, using a self-administered structured questionnaire. The collected data were analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Statistical significance was set at P < 0.05. Descriptive and logistic regression analyses were used to assess the determinant factors.Results: A total of 74 children were included, with most patients being males (60.8%). More than one-third (n = 27) of the participants were between 1 and 4 years of age and the mean age at diagnosis of the liver mass was 4.6 years. The duration of illness at presentation to Tikur Anbessa Specialized Hospital was between 4 and 8 weeks, in 42% of the patients. The most common presenting symptom was abdominal swelling, accounting for 70.3% (n = 52) of the patients. Benign hepatic mass lesions accounted for 57.5% (n = 42), and 43.2% (n = 32) were malignant liver masses. Most lesions were solitary and involved the right lobe of the liver. The common benign hepatic masses were pyogenic liver abscesses (38.1%), and the most common malignant hepatic masses were hepatoblastomas (78.1%).Conclusion: Pyogenic liver abscess was the most common benign hepatic mass and hepatoblastoma was the most common malignant hepatic mass in our study. Most lesions were solitary and involved the right lobe. Understanding the patterns of liver masses will help in the early diagnosis and improve treatment outcomes in children with liver masses.Keywords: liver mass, liver abscess, hepatoblastoma, TASH, Ethiopia

Introduction: A variety of liver disorders are associated with characteristic histopathological findings that help in their diagnosis and treatment. However, percutaneous liver biopsy (PLB) is prone to limitations and complications. We evaluated all PLBs done in our hospital in a 13-year period, aiming to assess PLB's utility and complications. Methods: All PLBs conducted in an internal medicine department of a tertiary university hospital in Athens, Greece, during a 13-year period were reviewed. Recorded data included demographic characteristics, laboratory results acquired on biopsy day, indication for liver biopsy, and occurrence of side effects. All patients were followed for 1 month post-hospital discharge for possible PLB-related complications. Results: A total of 261 patients underwent PLB during the study period. The commonest indication of PLB was investigation of liver mass, followed by transaminasemia. PLB assisted in setting a diagnosis in 218 patients and was unhelpful in only 43, in 14 of them due to inadequate or inappropriate biopsy specimen. Complications attributable to PLB were rare, with 10 patients exhibiting pain, either at biopsy site or in the right shoulder, and 3 having bleeding episodes; no deaths were noted. Conclusions: Our study shows that PLB is still a powerful diagnostic tool in everyday practice, provided it is used when indicated. [ABSTRACT FROM AUTHOR]

Objectives: In high‐BMI patients with and without fatty liver, we evaluate performance of a commercially available specially designed ultrasound probe (SDP) for scanning at depth. Greyscale and contrast‐enhanced ultrasound (CEUS) capability of SDP for parenchymal assessment and liver mass characterization, emphasizing HCC, is compared with standard curvilinear probes. Methods: This retrospective study included 60 patients. Fifty‐five with measured BMI included 46/55 (84%) overweight or obese, and 9/55(16%) in the normal range with severe fatty liver. Fifty‐six patients with focal liver abnormality included 37 with a mass and 19 with post‐ablative treatment site. Masses included 23 confirmed malignancies, 15 HCC, 4 ICC, and 4 metastases. SDP followed suboptimal ultrasound using a standard probe. Images with varying fat content were compared for depth of penetration on greyscale and ability of CEUS to diagnose tumors. Results: SDP showed statistically significant improvement P = <.05 in CEUS penetration for all degrees of fatty liver (mild, moderate, and severe). In malignant tumors, SDP improved detection of lesion washout in the portal venous/late phase (PVP/LP) at depth >10 cm, and in all malignant masses (P <.05). Fifteen confirmed deep HCC showed arterial phase hyperenhancement on standard probe in 10/15 (67%) and 15/15 (100%) on SDP. PVP/LP washout on standard probe was shown in 4/15 (26%) and on SDP, 14/15, (93%). Therefore, 93% of LR‐5 tumors were diagnosed with SDP. Removing necessity for biopsy. Conclusions: Metabolic syndrome and obesity challenge ultrasound, especially CEUS. SDP overcame limitations of standard probes for CEUS penetration especially in fatty liver. SDP was optimal for the liver mass characterization by detecting washout. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound (EUS) is a minimally invasive diagnostic and therapeutic modality with a number of established as well as evolving uses in patients with chronic liver disease. Compared to other diagnostic tools such as cross-sectional imaging or conventional endoscopy, EUS has been shown to increase diagnostic sensitivity and therapeutic success for many clinical scenarios and applications with a low rate of adverse events. In this review, we discuss and focus on the current and growing role of EUS in the evaluation and/or treatment of hepatobiliary masses, hepatic parenchymal disease, portal hypertension, esophageal and other varices, and indeterminate biliary strictures.

Sarcomatoid hepatocellular carcinoma (SHC) is a relatively rare subtype of liver cancer reported in 1.8–2.0% of surgically resected cases. Previous studies have found that SHC was more likely to occur in patients who received repeated anticancer therapies, but the underlying mechanism has not been exactly illustrated. We report a case of a 62-year-old man with SHC. With the initial implication of abscess suspected liver mass by radiological exams (enhanced Computed Tomography and liver Magnetic Resonance Imaging), the patient underwent a laparoscopic pus debridement and biopsy. The diagnosis of SHC was considered by pathologists. After a short recovery, a second radical resection of the liver tumor and hepatic hilar lymph node dissection were conducted. Postoperative pathology revealed a tumor-free incisal margin and negative lymph node. The recovery of the patient was uneventful. When confronting an occasional liver mass with previous Hepatitis B virus infection, SHC should be included for a candidate diagnosis. If diagnosis is confirmed, high biological malignancy and poor survival should be expected. Surgery is still a main option to treat SHC.

Amebic liver abscess (ALA), caused by Entamoeba histolytica , is prevalent in endemic regions such as Central/South America, Southeast Asia/India, and Africa but is considered rare in North America. Symptoms of E. histolytica infection typically emerge eight to 20 weeks after exposure in endemic areas. We present the case of a 58-year-old woman who developed right-sided abdominal pain, weakness, fever, and significant weight loss. Radiological imaging revealed a large, non-cystic hepatic mass, raising suspicion of malignancy. Notably, the patient had not traveled to an endemic region in the past year. An ultrasound-guided liver biopsy drained 500 mL of purulent, grayish fluid. Cultures for bacteria and cytology for malignancy were negative. Further serological testing confirmed the diagnosis of ALA with positive E. histolytica IgG antibodies. The patient was treated with oral metronidazole, resulting in rapid symptomatic improvement. This case underscores the diagnostic challenges associated with ALA in non-endemic regions, particularly when initial presentation, imaging findings, and absence of recent travel history suggest hepatic malignancy. It highlights the importance of considering ALA in the differential diagnosis of hepatic masses, even in patients without clear exposure to endemic regions., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Kern Medical issued approval 24147. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Lee et al.)

Fatty acids are an essential component of mammalian bodies. They go through different metabolic pathways depending on physiological states and inflammatory stimuli. In this study, we conducted a liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based comprehensive analysis of lipid metabolites in urine of canine patients with liver mass. There were significant differences in quantity of some lipid metabolites that may be closely associated with the disease and/or general inflammatory responses, including increased metabolites of prostaglandin E2 and/or PGF2a. We demonstrated that our approach of profiling lipid metabolites in the urine is useful in gaining insights into the disease. These findings may also have an application as a screening test or a diagnosis tool for canine liver mass. [ABSTRACT FROM AUTHOR]

Background/Aims Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been accepted as a reliable tool in diagnosing and staging intra-abdominal tumors. In this study, we aimed to investigate the performance of EUS-FNA in the evaluation of liver masses and its impact on patient management and procedure-related complications retrospectively. Methods Data of patients who underwent EUS-FNA biopsies due to liver masses between November 2017 and July 2018 were retrieved retrospectively. Biopsies were performed using 22-G needles. The demographics, EUS-FNA results, sensitivity and specificity of the procedure, negative predictive value, positive predictive value, and specimen sufficiency rates were assessed. Results A total of 25 patients (10 females) were included in the study. The mean age was 62.73±15.2 years. The mean size of the masses was 34.50±16.04 mm. The technical success rate was 88%. During the EUS-FNA procedure, each patient had only one pass with 94.45% of aspirate sufficiency rate and 86.3% of biopsy sufficiency rate. The diagnostic accuracy rate was 86.3%. There were no complications. Conclusions For the evaluation of liver masses, EUS-FNA using a 22-G needle with even one pass had high aspiration and biopsy success rates accompanied with high diagnostic accuracy rates.

Abstract Objectives Metastases are common in non-cirrhotic livers but are considered unlikely in the setting of cirrhosis. However, the degree of fibrosis in cirrhosis may vary; thus metastases may still access the liver vasculature and present as a mass in cirrhotic livers. This possibility may affect pathologists’ diagnostic algorithms when faced with a liver mass biopsy. Methods We hypothesized that metastases can occur in cirrhotic livers if fibrous remodeling is not severe or abnormal veno-arterial shunting exists to override an obstructed portal system. We searched departmental archives for cirrhotic livers with masses, categorizing fibrosis by Laennec staging: 4A = mild cirrhosis, 4B = moderate, 4 C = severe. Results Of 1453 cirrhotic livers with masses, 1429 were primary tumors and 24 were metastases (1.7 %). Of livers with metastases, most had 4A or 4B cirrhosis by Laennec staging (n = 17; 71 %). Eleven patients were evaluated by ultrasound Doppler; 2 of 5 with Laennec 4 C had reversal of portal vein flow, but all 4A & 4B patients had patent portal veins without reversed flow. Echocardiograms (13 patients) showed no ventricular or atrial septal defects or arteriovenous shunts. Conclusions Metastases are uncommon in cirrhotic livers, accounting for 1.7 % of masses. Most involved livers had mild or moderate cirrhosis (Laennec 4A/4B) and patent portal veins; however, as some Laennec 4 C cases also contained metastases, obstructed portal access may not be enough to deter metastatic access.

The demand for ecologically-friendly food produce, including those of animal nature, e.g. hen eggs, is increasing continuously in Latvia as well as all across the world. Research objective is to determine the most productive and most suitable for Latvian environment laying hen crosses that can be kept for bio-egg commercial production, as well as to decide upon most suitable biologically produced and economically efficient feed for these hen crosses. The research was held in Kandava municipality, Kandava rural territory, "Kurzemes olas" Ltd. laying hen farmstead "Upkalnu ferma". The research involved three Dominant laying hen crosses: Dominant Barred D 959, Dominant Tinted D 723 and Dominant Red Barred D 459. All in all, there were 6 groups, each of them consisting of 100 birds. One group of each hen cross was fed with manufactured complete bio-feed (group numbers D723K, D459K and D959K), while the second group - with home-made bio-feed designed for laying hens (group numbers D723S, D459S and D959S). The maximum results that were reached during the entire research period were as follows: D723K - 71% in September (26-29 weeks old), D723S - 82% October (30-34 weeks old), D459K - 56% November (35-38 weeks old), D459S - 58% October (30-34 weeks old), D959K - 54% November (35-38 weeks old) and D959S - 62% October (30-34 weeks old). The best productivity indicators on average were demonstrated by laying hen cross D723 (p<0.05). The cross D459S produced eggs with higher average weight and better proteins, correspondinly by 3.81 g and 11.15 Haugh units than D459K. The amount of dry matter, crude protein and fat in egg mass was equivalent and met physiological norm indications. Reproductive tract organs in all groups but D459K were developed evenly. Liver mass in all groups showed no visible pathologies. [ABSTRACT FROM AUTHOR]

Abstract Fever and deranged transaminases with liver mass(es) on imaging mandates further evaluation of the mass(es) and should be followed radiologically and clinically. In the absence of a definitive diagnosis, repeat biopsy should be done.

Abstract : Fine Needle Aspiration of the liver is a simpler technique and is reported to yield higher positivity in patients with hepatic malignancy as compared to core biopsy. Fine needle aspiration cytology has the advantage of causing significant less discomfort and a very low risk of complication. Of all the radiological procedures the ultrasound is most suited for fine needle aspiration cytology as real time images can be obtained and it prevents the perforation of gall bladder, colon and blood vessels, Ultrasound has higher level of practicality, requires no ionizing radiation and is widely applicable as compare to computerised tomography scan. Aim of the present study is to establish role of Ultrasound guided Fine Needle Aspiration in diagnosis of liver mass lesions. Methods : We have performed UGS guided FNAC on 42 suspected cases of liver mass lesion. Detail history, clinical examination was done and consent was taken from patient after explaining the procedure to them. Bleeding time, Clotting time and Prothrombin time were done prior to procedure. All patients with liver mass lesion diagnosed on radiology were included in the study. Under all aseptic precaution Ultrasound guided FNAC was done from liver mass lesion using 26 gauge lumbar puncture needle. The material obtained in the needle was expelled onto glass slide and smear was made by opposition technique. Results: Of 42 aspirates from liver, 13 were diagnosed as hepatocellular carcinoma, 23 were diagnosed as metastatic carcinomas. Attempt of grading and study of cellular patterns was done in hepatocellular carcinoma. Of 23 cases of metastatic carcinoma, in 11 cases primary site could be demonstrated. In 12 cases primary site could not be determined. 18 were adenocarcinomas and 5 were undifferentiated anaplastic carcinoma. Conclusion: Ultrasound guided Fine Needle Aspiration of liver mass is safe ,cost effective technique in localizing Liver lesion and acquiring adequate material for preoperative diagnosis of mass lesion of liver.

Inflammatory pseudotumors of the liver are rare, non-neoplastic liver tumors. Due to the nonspecific clinical presentation, imaging features, and histopathological findings, they can mimic malignant tumors requiring invasive diagnostics. We present a case of a 61-year-old female patient with a history of type 2 diabetes mellitus, hypothyroidism, hyperlipidemia, and polymyalgia rheumatica who had initially presented with abdominal pain for 3 weeks. Further workup showed normal liver chemistries and tumor markers: AFP and CA 19-9. Magnetic resonance imaging (MRI) of the abdomen showed a segment 6 lesion measuring 4.1 × 4.0 × 3.7 cm. A liver biopsy then confirmed the diagnosis of an inflammatory pseudotumor of the liver with negative IgG4. On follow-up imaging, a rapid growth of this liver lesion was noted. Laparoscopy was done but did not show any distinct liver lesion. Follow-up imaging confirmed a decrease in the size of the mass. Interestingly, the patient had been on a higher dose of steroids for her polymyalgia rheumatic leading up to the follow-up imaging. This is the first case of an inflammatory pseudotumor of the liver in a patient with polymyalgia rheumatica. With this case, we would like to increase the awareness for inflammatory pseudotumors of the liver as a differential diagnosis of liver lesions in patients with underlying autoimmune disorders. [ABSTRACT FROM AUTHOR]

We present a 37 years old women with history of lower limb myxoid liposarcoma, who is presented for biopsy of a round, well defined, hypodense solitary liver mass with enhancement predominantly on portal venous phase seen on CT. Liver biopsy was performed with cut needle guided by ultrasound, myxoid liposarcoma metastasis was diagnosed. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a systemic disease with heterogeneous clinical manifestations that is characterized histologically by the presence of noncaseating granulomas in the affected organs. It can be a diagnostic challenge, especially when mimicking malignancy or fungal infections. Previous case reports of sarcoidosis presenting with multiple masses are highly suggestive of infectious or malignant etiology. In this case, our patient presented with enlarged lymph node and was found to have innumerable nodules in the mediastinum, lungs, and liver. Azygos vein enlargement was also seen on radiological imaging, and malignancy was highly suspected; hence, an extensive workup was conducted, including laboratory, radiology and biopsy evaluation, which were diagnostic of sarcoidosis. Our case showed the importance of correlation of the history, physical examination, radiological and histopathologic studies in confirming the diagnosis and the need to rule out other serious infections and malignancies, especially with azygous vein enlargement, which can sometimes be missed in chest radiograph.

Background/Aims: Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) has been accepted as a reliable tool in diagnosing and staging intra-abdominal tumors. In this study, we aimed to investigate the performance of EUS-FNA in the evaluation of liver masses and its impact on patient management and procedure-related complications retrospectively. Methods: Data of patients who underwent EUS-FNA biopsies due to liver masses between November 2017 and July 2018 were retrieved retrospectively. Biopsies were performed using 22-G needles. The demographics, EUS-FNA results, sensitivity and specificity of the procedure, negative predictive value, positive predictive value, and specimen sufficiency rates were assessed. Results: A total of 25 patients (10 females) were included in the study. The mean age was 62.73±15.2 years. The mean size of the masses was 34.50±16.04 mm. The technical success rate was 88%. During the EUS-FNA procedure, each patient had only one pass with 94.45% of aspirate sufficiency rate and 86.3% of biopsy sufficiency rate. The diagnostic accuracy rate was 86.3%. There were no complications. Conclusions: For the evaluation of liver masses, EUS-FNA using a 22-G needle with even one pass had high aspiration and biopsy success rates accompanied with high diagnostic accuracy rates. [ABSTRACT FROM AUTHOR]

Malakoplakia is a rare acquired histiocytic disorder first described in the urinary bladder. There have been 8 cases reported involving the liver, and this is the first reported case of malakoplakia involving an adult transplanted liver. We report a 63-year-old man with a medical history of orthotopic liver transplantation who presented with fever, chills, and abdominal pain. Imaging found confluent microabscesses in the right lobe of the liver that persisted despite prolonged antibiotics. He was taken to the operating room for a segment 6 hepatectomy of the abscess. Histologically, the inflammatory process showed malakoplakia., (© 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

We present a case of a 63-year-old male with a history significant for hypertension and a 45-pack-year smoking history who presented with severe symptomatic anemia. Rather quickly, upon imaging, he was found to have a 10 cm liver mass, a right renal mass, and a right atrial mass. A liver biopsy was performed and confirmed metastatic renal cell carcinoma (clear cell variant). Due to the extensive disease burden and patient preference, curative surgery was not pursued. This case highlights the rare but critical complications that can present as the initial presentation of renal cell carcinoma., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Romero et al.)

Pancreatic Neuroendocrine Tumors (NETs) are a group of tumors that are rare with guiding features on CT scans and MRI images. We report a 38-year-old man referring to our hospital with a history of approximately 20 kg weight loss, fever, and night sweating since 2 months ago. He did not mention any other significant complaint except for generalized pain. Lab data revealed mild anemia and an elevated level of lactate dehydrogenase and alanine aminotransferase. Abdominopelvic sonography showed multiple hypoechoic lesions in the liver in favor of metastasis. Upper gastrointestinal endoscopy and colonoscopy were normal. Abdominopelvic CT scan revealed multiple faint arterial hyperenhancing lesions with welldefined borders in all liver segments suggestive of hypervascular metastasis. Suspicious mass lesion near the posterior border of the pancreatic tail was also seen, suggestive of a pancreatic neuroendocrine tumor as the primary source of hypervascular metastatic lesions. The pathology and immunohistochemistry of the liver mass confirmed the diagnosis of NET. After staging evaluation, he was referred to an oncologist for chemotherapy.

Background: Early-stage diagnosis and treatment can improve survival rates of liver cancer patients. Dynamic contrast-enhanced MRI provides the most comprehensive information for differential diagnosis of liver tumors. However, MRI diagnosis is affected by subjective experience, so deep learning may supply a new diagnostic strategy. We used convolutional neural networks (CNNs) to develop a deep learning system (DLS) to classify liver tumors based on enhanced MR images, unenhanced MR images, and clinical data including text and laboratory test results.Methods: Using data from 1,210 patients with liver tumors (N = 31,608 images), we trained CNNs to get seven-way classifiers, binary classifiers, and three-way malignancy-classifiers (Model A-Model G). Models were validated in an external independent extended cohort of 201 patients (N = 6,816 images). The area under receiver operating characteristic (ROC) curve (AUC) were compared across different models. We also compared the sensitivity and specificity of models with the performance of three experienced radiologists.Results: Deep learning achieves a performance on par with three experienced radiologists on classifying liver tumors in seven categories. Using only unenhanced images, CNN performs well in distinguishing malignant from benign liver tumors (AUC, 0.946; 95% CI 0.914–0.979 vs. 0.951; 0.919–0.982, P = 0.664). New CNN combining unenhanced images with clinical data greatly improved the performance of classifying malignancies as hepatocellular carcinoma (AUC, 0.985; 95% CI 0.960–1.000), metastatic tumors (0.998; 0.989–1.000), and other primary malignancies (0.963; 0.896–1.000), and the agreement with pathology was 91.9%.These models mined diagnostic information in unenhanced images and clinical data by deep-neural-network, which were different to previous methods that utilized enhanced images. The sensitivity and specificity of almost every category in these models reached the same high level compared to three experienced radiologists.Conclusion: Trained with data in various acquisition conditions, DLS that integrated these models could be used as an accurate and time-saving assisted-diagnostic strategy for liver tumors in clinical settings, even in the absence of contrast agents. DLS therefore has the potential to avoid contrast-related side effects and reduce economic costs associated with current standard MRI inspection practices for liver tumor patients.

Objectives: Metastases are common in non-cirrhotic livers but are considered unlikely in the setting of cirrhosis. However, the degree of fibrosis in cirrhosis may vary; thus metastases may still access the liver vasculature and present as a mass in cirrhotic livers. This possibility may affect pathologists' diagnostic algorithms when faced with a liver mass biopsy. Methods: We hypothesized that metastases can occur in cirrhotic livers if fibrous remodeling is not severe or abnormal veno-arterial shunting exists to override an obstructed portal system. We searched departmental archives for cirrhotic livers with masses, categorizing fibrosis by Laennec staging: 4A = mild cirrhosis, 4B = moderate, 4 C = severe. Results: Of 1453 cirrhotic livers with masses, 1429 were primary tumors and 24 were metastases (1.7 %). Of livers with metastases, most had 4A or 4B cirrhosis by Laennec staging (n = 17; 71 %). Eleven patients were evaluated by ultrasound Doppler; 2 of 5 with Laennec 4 C had reversal of portal vein flow, but all 4A & 4B patients had patent portal veins without reversed flow. Echocardiograms (13 patients) showed no ventricular or atrial septal defects or arteriovenous shunts. Conclusions: Metastases are uncommon in cirrhotic livers, accounting for 1.7 % of masses. Most involved livers had mild or moderate cirrhosis (Laennec 4A/4B) and patent portal veins; however, as some Laennec 4 C cases also contained metastases, obstructed portal access may not be enough to deter metastatic access. [ABSTRACT FROM AUTHOR]

Umbilical venous catheters (UVCs) have become a part of routine perinatal care. In the case of its misplacement, extravasation into liver parenchyma might be observed and unusual findings might be detected and a suspicion of tumoral lesions emerges during the ultrasound examination. To avoid the unnecessary liver biopsies and catastrophic complications of UVC misplacement in the pediatric population, clinicians and radiologists must be familiar with the radiological findings. We aimed to present sonographic and computed tomographic images of liver collections resulting from UVC malposition. [ABSTRACT FROM AUTHOR]

Fever and deranged transaminases with liver mass(es) on imaging mandates further evaluation of the mass(es) and should be followed radiologically and clinically. In the absence of a definitive diagnosis, repeat biopsy should be done. [ABSTRACT FROM AUTHOR]

Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment. [ABSTRACT FROM AUTHOR]

Splenosis is defined as the autotransplantation of viable splenic tissue throughout various anatomic compartments. Intrahepatic splenosis (IHS) is rare and diagnosis is often challenging. This study aims to provide a comprehensive review on IHS. A literature review was performed on PubMed database. Fifty-six articles with 59 reported cases were included. The majority of the patients were male (n = 49, 83.1%). Median age was 51 years. Risk factors for hepatocellular carcinoma (HCC) included hepatitis B (n = 8, 13.6%) and cirrhosis (n = 12, 20.3%). The majority of the patients were asymptomatic (62.7%) and did not have risk factors for HCC (55.9%). We report a diagnostic triad for IHS: 1) previous history of abdominal trauma or splenectomy, 2) absence of risk factors for liver malignancy and 3) typical imaging features. Non-invasive diagnostic tests such as technetium-99m-tagged heat-damaged red blood cell scintigraphy are useful in diagnosis. Malignancy should be ruled out in the presence of risk factors for HCC. [ABSTRACT FROM AUTHOR]

Background: Early-stage diagnosis and treatment can improve survival rates of liver cancer patients. Dynamic contrast-enhanced MRI provides the most comprehensive information for differential diagnosis of liver tumors. However, MRI diagnosis is affected by subjective experience, so deep learning may supply a new diagnostic strategy. We used convolutional neural networks (CNNs) to develop a deep learning system (DLS) to classify liver tumors based on enhanced MR images, unenhanced MR images, and clinical data including text and laboratory test results. Methods: Using data from 1,210 patients with liver tumors (N = 31,608 images), we trained CNNs to get seven-way classifiers, binary classifiers, and three-way malignancy-classifiers (Model A-Model G). Models were validated in an external independent extended cohort of 201 patients (N = 6,816 images). The area under receiver operating characteristic (ROC) curve (AUC) were compared across different models. We also compared the sensitivity and specificity of models with the performance of three experienced radiologists. Results: Deep learning achieves a performance on par with three experienced radiologists on classifying liver tumors in seven categories. Using only unenhanced images, CNN performs well in distinguishing malignant from benign liver tumors (AUC, 0.946; 95% CI 0.914–0.979 vs. 0.951; 0.919–0.982, P = 0.664). New CNN combining unenhanced images with clinical data greatly improved the performance of classifying malignancies as hepatocellular carcinoma (AUC, 0.985; 95% CI 0.960–1.000), metastatic tumors (0.998; 0.989–1.000), and other primary malignancies (0.963; 0.896–1.000), and the agreement with pathology was 91.9%.These models mined diagnostic information in unenhanced images and clinical data by deep-neural-network, which were different to previous methods that utilized enhanced images. The sensitivity and specificity of almost every category in these models reached the same high level compared to three experienced radiologists. Conclusion: Trained with data in various acquisition conditions, DLS that integrated these models could be used as an accurate and time-saving assisted-diagnostic strategy for liver tumors in clinical settings, even in the absence of contrast agents. DLS therefore has the potential to avoid contrast-related side effects and reduce economic costs associated with current standard MRI inspection practices for liver tumor patients. [ABSTRACT FROM AUTHOR]

Cholangiocarcinoma is one of the most lethal tumors because of its complex location and lack of good chemoradiotherapy options. When it is diagnosed, urgent intervention is needed, often involving radical surgical resection. It generally presents as a liver mass with biliary obstruction. We discuss the case of a young patient presenting with liver dysfunction and imaging mimicking a liver mass concerning for cholangiocarcinoma, where he actually had a liver infarct from splanchnic venous thrombosis from primary myelofibrosis. [ABSTRACT FROM AUTHOR]

Introduction: Lesions of the liver may be benign or malignant and they can arise from hepatocytes, biliary epithelium, mesenchymal tissue or metastases from extra hepatic tissue. Along with Ultrasonography (USG), triple phase Multidetector Computed Tomography (MDCT) scan is a good non-invasive tool in characterising and differentiating benign from malignant liver lesions. Aim: To characterise various hepatic masses with the help of triple phase MDCT scan and to correlate them with histopathological/ cytopathological findings. Materials and Methods: By convenient sampling, in this observational study, 55 patients with primary diagnosis of hepatic masses on the basis of USG, were recruited and their triphasic MDCT scan findings were evaluated and later correlated with histopathology. SPSS version 22 and electronic Microsoft Excel spreadsheets were used. Categorical data has been represented as frequency (number) and proportions (percentages), continuous data as Mean±Standard Deviation (SD). ANOVA and Chi-square tests were used. Agreement between different diagnostic modalities was made using Kappa-statistic. The confidence level was kept at 95%, hence a p-value

Abstract Background/Purpose The Abernethy malformation (AM) is a congenital venous malformation in which the splanchnic venous return bypasses the liver and drains directly into the systemic circulation. This deprives the liver of hepatotrophic growth factors and allows metabolic products of digestion to enter the systemic veins without the benefit of passing through the liver. The histologic features of liver biopsies in children with an AM were reviewed. Methods A retrospective review of liver biopsies in patients with AM between 1997 and 2017 was performed. Patients were divided into two groups for comparison of histologic features: presence (M +) or absence (M −) of a coexistent liver mass on imaging. Biopsies were reviewed by a pediatric pathologist. Chi-square test was used for statistical analysis between groups. Significance was assigned to p values < 0.05. Results Eighteen liver biopsies were reviewed. Masses were present in only 6 patients who had a liver biopsy. Masses were observed with similar frequencies in either type of the Abernethy malformation (I or II). Nine of 12 M − patients and 3/6 M + patients had the type I AM. Histologically, all patients were noted to have small or absent portal veins. Isolated capillaries were seen more frequently in patients with a known liver mass (p = 0.045), while crowding of portal tracts was more commonly seen in patients without a liver mass (p = 0.019). Conclusion Liver biopsies in patients with AM demonstrate abnormal vascular and parenchymal histologic features. Livers with coexistent masses were more commonly found to have features suggesting an increased dependence on arterial blood supply. Level of evidence III. [ABSTRACT FROM AUTHOR]

Aim: An adrenal incidentaloma (AI) is an adrenal mass incidentally found on an imaging study that was not performed to diagnose an adrenal problem. Incidental hepatic and renal masses are often seen in abdominal imaging; however, for this research we aimed to determine the frequencies and kinds of hepatic and renal incidental masses in patients with AIs. Material and Method: A retrospective evaluation of 381 AI patients (245 females and 136 males) and 285 control subjects (168 females and 117 males) was conducted. The adrenal masses were divided into two groups according to the Hounsfield unit (HU) scale (≤10 or >10) and classified as bilateral, right, or left sided. Hepatic or renal incidental masses and those with both were compared between AI patients and controls also; comparison was made within AI patients. Results: The incidental renal mass frequency and both hepatic and renal incidental masses frequency were found to be higher in the AI group than in the controls. In those AI patients who had unilateral, bilateral, and left sided adrenal masses >10 HU, the frequencies of both hepatic and renal incidental masses were found to be greater than in the AI patients with masses ≤10 HU (p=0.001, 0.049, and 0.001, respectively). Conclusion: In AI patients with adrenal masses >10 HU, due to the increased frequencies of both hepatic and renal incidental masses, physicians should evaluate these cases carefully. Additional large studies are needed to define the incidence and follow-up of AI patients with hepatic and renal incidentalomas. [ABSTRACT FROM AUTHOR]

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Mucinous cystadenomas (MCAs) of the liver (also called hepatic biliary cystadenomas) are rare tumors that comprise about 5% of cystic masses of the liver in adults. These slow-growing lesions most commonly occur in middle-aged individuals, with a female sex predominance. Herein, we present a MCA in a 6-year-old male, one of only very few such cases described in the pediatric literature to date. Although MCAs are generally considered benign lesions, malignant transformation rarely occurs. The recurrence rate is high when partial cyst excision is performed. Therefore, complete surgical cyst resection with clinical follow-up, including imaging, is warranted.

Myofibromas are rare fibrous tumors, which can be solitary (myofibroma) or multiple (myofibromatosis). They can be dermatological or visceral in origin. Usually the dermatological tumors are benign and have good prognosis while those with visceral involvement are associated with poor outcome. The extent and location of these lesions are the important prognostic factors with a mortality rate of 75% with multifocal visceral involvement. The major difficulty in diagnosis is variable clinical presentation of these tumors. We report two cases which represent the wide clinical spectrum of these tumors ranging from protein losing enteropathy in infancy to liver tumor in childhood. Delay in the diagnosis and inappropriate management can be life threatening as each requires a specific treatment approach.