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Ryou SH, Shin HD, Kim SB. Hepatocellular carcinoma presenting as organized liver abscess: A case report. World J Clin Cases 2023; 11:8078-8083. [DOI: 10.12998/wjcc.v11.i33.8078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is difficult to treat and has a high mortality rate, emphasizing the importance of early diagnosis and treatment. If characteristic radiologic findings and underlying liver disease are present, a diagnosis can be made without a biopsy. However, when HCC is accompanied by a liver abscess, diagnosis might be delayed by atypical radiologic findings. This case report aims to assist in the diagnosis of HCC, which can manifest in various forms.
CASE SUMMARY A 75-year-old male presented to the Emergency Department with worsening fever and mental changes. He was diagnosed with liver cirrhosis six months earlier. Abdominal computed tomography (CT) raised our suspicion of an organized liver abscess. A follow-up CT scan after four weeks of antibiotic treatment showed a decrease in the liver lesion size. However, high fever recurred, and C-reactive protein increased to 14 mg/L. Aspiration of the liver lesion was performed, but no bacteria were identified. Blood culture revealed the presence of fungi. The patient received an additional four weeks of antibiotics and antifungal agents before being discharged. Approximately 10 mo later, a CT scan showed an increase in the lesion size, and biopsy was performed. The biopsy revealed an organized abscess with focal carcinomatous changes, for which surgery was performed. Postoperative histopathological examination revealed HCC, clear-cell variant. The nontumor liver tissue showed cirrhosis and an organized abscess.
CONCLUSION Even if a liver abscess is suspected in a patient with cirrhosis, the possibility of HCC should be considered.
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Affiliation(s)
- Sung Hyeok Ryou
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea
| | - Hyun Deok Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea
| | - Suk Bae Kim
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea
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Masuda T, Kobashi K, Sugimoto R, Ishii H, Tsunemitsu K. Intrahepatic cholangiocarcinoma with a liver abscess due to hepatic actinomycosis. Surg Case Rep 2023; 9:43. [PMID: 36949213 PMCID: PMC10033780 DOI: 10.1186/s40792-023-01625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Liver tumors with liver abscesses are unusual and rarely reported. In particular, studies of intrahepatic cholangiocarcinoma with liver abscesses due to hepatic actinomycosis have not been reported. CASE PRESENTATION A 73-year-old woman presented with swelling of the right hypochondrium. Computed tomography revealed a mass lesion that was continuous with the abdominal wall in the right lobe of the liver, suggesting a liver tumor invading the abdominal wall. A liver biopsy revealed intrahepatic cholangiocarcinoma with a liver abscess. The histopathological specimen contained bacterial masses of actinomycosis, and the cause of the liver abscess was determined to be hepatic actinomycosis. As a result of percutaneous drainage and antibiotic therapy, the part of the tumor attached to the abdominal wall disappeared; therefore, we assumed that most of the lesion was not cholangiocarcinoma but a liver abscess due to hepatic actinomycosis. Radical surgery for residual intrahepatic cholangiocarcinoma was performed after chemotherapy. Currently, the patient is alive without recurrence 2 years and 9 months after the operation. CONCLUSION We encountered a difficult-to-diagnose case of intrahepatic cholangiocarcinoma with a liver abscess due to hepatic actinomycosis. A needle biopsy allowed early diagnosis and percutaneous drainage was an effective treatment.
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Affiliation(s)
- Tomoya Masuda
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan.
| | - Kenta Kobashi
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan
| | - Ryoma Sugimoto
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan
| | - Hiroshi Ishii
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan
| | - Kensuke Tsunemitsu
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan
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Deep Learning-Based CT Imaging for the Diagnosis of Liver Tumor. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3045370. [PMID: 35755728 PMCID: PMC9225866 DOI: 10.1155/2022/3045370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/05/2022] [Accepted: 05/14/2022] [Indexed: 12/24/2022]
Abstract
The objective of this research was to investigate the application value of deep learning-based computed tomography (CT) images in the diagnosis of liver tumors. Fifty-eight patients with liver tumors were selected, and their CT images were segmented using a convolutional neural network (CNN) algorithm. The segmentation results were quantitatively evaluated using the Dice similarity coefficient (DSC), precision, and recall. All the patients were examined and diagnosed by CT enhanced delayed scan technique, and the CT scan results were compared with the pathological findings. The results showed that the DSC, precision, and recall of the CNN algorithm reached 0.987, 0.967, and 0.954, respectively. The images segmented by the CNN were clearer. The diagnostic result of the examination on 56 cases by CT enhanced delay scanning was consistent with that of pathological diagnosis. According to the result of pathological diagnosis, there were 6 cases with hepatic cyst, 9 with hepatic hemangioma, 12 cases with liver metastasis, 10 cases with hepatoblastoma, 3 cases with focal nodular hyperplasia, and 18 cases with primary liver cancer. The result of CT enhanced delay scanning on 58 patients was consistent with that of pathological diagnosis, and the total diagnostic coincidence rate reached 96.55%. In conclusion, the CNN algorithm can perform accurate and efficient segmentation, with high resolution, providing a more scientific basis for the segmentation of liver tumors in CT images. CT enhanced scanning technology has a good effect on the diagnosis and differentiation of liver tumor patients, with high diagnostic coincidence rate. It has important value for the diagnosis of liver tumor and is worthy of clinical application.
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Liu M, Chen J, Huang R, Huang J, Li L, Li Y, Qin M, Qin W, Nong H, Ding K. Imaging features of intrahepatic cholangiocarcinoma mimicking a liver abscess: an analysis of 8 cases. BMC Gastroenterol 2021; 21:427. [PMID: 34772340 PMCID: PMC8588691 DOI: 10.1186/s12876-021-02002-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/26/2021] [Indexed: 01/12/2023] Open
Abstract
Background In rare cases, intrahepatic cholangiocarcinoma can present as a pyogenic liver abscess and are often misdiagnosed. This study aimed to analyze the imaging features of intrahepatic cholangiocarcinoma mimicking a pyogenic liver abscess. Methods The clinical data and imaging results of eight patients with pathologically confirmed intrahepatic cholangiocarcinoma mimicking a liver abscess were retrospectively collected. Results The mean age was 58 years with a range of 46–68 years. Fever and leukocytosis were present in six patients. All the eight lesions were a single mass. Air–liquid levels were present in two patients. Only one patient showed hepatic lobar atrophy and hepatic capsule retraction. The double target sign of liver abscess was not noticed in the CT/MRI images of all eight patients. The inner wall of the lesion was rough and irregular, with multiple dot/patchy and wall nodule enhancements. The abscess wall and the marginal parenchyma were supplied by the hepatic artery in four patients, and the intralesional arteries were rough and disrupted. Bile duct dilatation was seen adjacent to the lesion. In seven patients, diffusion-weighted images showed irregular patchy restricted diffusion in the marginal parenchyma of the necrotic area in addition to the prominent restricted diffusion in the necrotic area. Two patients with cholangiolithiasis showed patchy slight CT hypodensity, slight T1 hypointensity, slight T2 hyperintensity, and patchy delayed enhancement. Multiple lymph nodes enlargement in the hepatic hilar area and the retroperitoneal space were seen in five patients. Conclusion Intrahepatic cholangiocarcinoma mimicking a pyogenic liver abscess have unique imaging features and require careful image examination to avoid misdiagnosis.
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Affiliation(s)
- Manrong Liu
- Department of Ultrasound, Guangxi Medical University Third Affiliated Hospital, Nanning, 530031, China
| | - Jiong Chen
- Department of Radiology, Guangxi Medical University Third Affiliated Hospital, Nanning, 530031, China
| | - Ruisui Huang
- Department of Radiology, Guangxi Medical University Third Affiliated Hospital, Nanning, 530031, China
| | - Jianning Huang
- Department of Radiology, Guangxi Medical University Third Affiliated Hospital, Nanning, 530031, China
| | - Lin Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Third Affiliated Hospital, Nanning, 530031, China
| | - Yunqian Li
- Department of Pathology, Guilin Medical University First Affiliated Hospital, Guilin, 541001, China
| | - Mi Qin
- Department of Radiology, Guangxi Medical University Third Affiliated Hospital, Nanning, 530031, China
| | - Wenqi Qin
- Department of Radiology, Guangxi Medical University Third Affiliated Hospital, Nanning, 530031, China
| | - Haiyang Nong
- Department of Radiology, Guangxi Medical University Third Affiliated Hospital, Nanning, 530031, China
| | - Ke Ding
- Department of Radiology, Guangxi Medical University Third Affiliated Hospital, Nanning, 530031, China.
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Clinical application of thioredoxin reductase as a novel biomarker in liver cancer. Sci Rep 2021; 11:6069. [PMID: 33727662 PMCID: PMC7966739 DOI: 10.1038/s41598-021-85688-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/26/2021] [Indexed: 12/24/2022] Open
Abstract
Hepatic cancer is often amenable to surgery, including percutaneous ablation, trans-arterial chemoembolization. However, in metastatic cases, surgery is often not an effective option. Chemotherapy as a conventional clinical method for treatment of malignant diseases may be useful in such cases, but it is likewise not always able to slow or halt progression, therefore novel approaches for treatment of hepatic cancer are needed. Current research suggests that molecular tumor markers (TM) can play a crucial role for diagnosis and prognostic evaluation of malignancies, and TM such as AFP, CEA, CA19-9 have been reported in many malignant diseases. Thioredoxin reductase (TrxR), a type of anti-oxidant biomarker, has become a TM of significant interest. However, little is known about the above TM and TrxR activity in liver cancer. Therefore, this paper aimed to assess these TM with regards to diagnosis and and monitoring treatment efficacy in both primary and metastatic liver cancer. Our results showed TrxR had superior performance for discriminating between liver cancer patients and healthy controls than AFP, CEA, and CA19-9. TrxR also exhibited superior performance for assessing benefits of chemotherapy regardless if patients had PLC or MLC. Meanwhile, due to diagnostic efficiency of unresponsive chemotherapy patients, TrxR also showed a higher activity levels than other general markers in liver metastasis patients. Our results suggest that application of TrxR in combination with other tumor markers may maximize the efficiency of diagnosis and assessment of therapeutic efficiency, and provide new insights for the clinical application of TrxR as a candidate biomarker for liver cancer.
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Wang H, Ren Y, Liu Z, Chang Z. Multiple septae as potential protective factors against spontaneous pyogenic liver abscess rupture: a propensity score matching analysis. Abdom Radiol (NY) 2021; 46:992-997. [PMID: 32939635 DOI: 10.1007/s00261-020-02758-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/25/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The symptoms of spontaneous rupture of a pyogenic liver abscess (PLA) are severe and often life-threatening. Multiple septae are important imaging features of PLA. However, the relationship between septation and abscess rupture is still under debate. METHODS Patients diagnosed with PLA from January 2011 to November 2019 in our hospital were included. We collected demographic, clinical, and computed tomography data. Univariate and multivariate analyses determined liver abscess rupture risk factors. The relationship between multiple septae and abscess rupture was evaluated by propensity score matching after matching other influencing factors. RESULTS A total of 583 patients of pyogenic liver abscesses were included in the study: 30 ruptured and 553 unruptured. Multivariate analysis revealed diabetes, single lesion, gas formation, left hepatic lobe location, and a diameter > 66.5 mm as independent risk factors for ruptures, while multiple septae were identified as a protective factor. After matching all the influencing factors (excluding multiple septae), multiple septae and abscess rupture maintain a negative relationship. CONCLUSIONS Multiple septae were identified as a potentially protective factor against spontaneous pyogenic liver abscess ruptures.
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Yacoub H, Hassine H, Boukriba S, Haouet S, Ayari A, Kchir H, Maamouri N. Intrahepatic cholangiocarcinoma mimicking a liver abscess. Clin Case Rep 2020; 8:2510-2513. [PMID: 33363768 PMCID: PMC7752610 DOI: 10.1002/ccr3.3201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/05/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
Intrahepatic cholangiocarcinoma masquerading as liver abscess, and presenting with fever, is a very rare situation and should be considered in nonresolving liver abscess. Only few cases were reported in the literature. This entity is characterized by late diagnosis and poor prognosis.
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Affiliation(s)
- Haythem Yacoub
- Gastroenterology B DepartmentLa Rabta Hospital TunisTunisTunisia
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
| | - Hajer Hassine
- Gastroenterology B DepartmentLa Rabta Hospital TunisTunisTunisia
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
| | - Seif Boukriba
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- Radiology DepartmentLa Rabta Hospital TunisTunisTunisia
| | - Slim Haouet
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- Pathology DepartmentLa Rabta Hospital TunisTunisTunisia
| | - Asma Ayari
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- Pathology DepartmentLa Rabta Hospital TunisTunisTunisia
| | - Hela Kchir
- Gastroenterology B DepartmentLa Rabta Hospital TunisTunisTunisia
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
| | - Nadia Maamouri
- Gastroenterology B DepartmentLa Rabta Hospital TunisTunisTunisia
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
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Rahman SU, Sana MK, Tahir Z, Ali A, Shah PA. Paraneoplastic syndromes in cholangiocarcinoma. World J Hepatol 2020; 12:897-907. [PMID: 33312417 PMCID: PMC7701960 DOI: 10.4254/wjh.v12.i11.897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/13/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023] Open
Abstract
Paraneoplastic syndromes are the symptoms or signs which result from damage to tissues that are distant from the site of malignancy, due to complex interactions between the body’s immune system and malignant neoplasm. Cholangiocarcinoma (CCA) is an aggressive epithelial malignancy of hepatobiliary tree and it is found to be associated with various paraneoplastic syndromes. These syndromes can present as dermatological, neurological, renal, hematological, or multi-systemic manifestations. Clinical suspicion and timely recognition of these syndromes can lead to early diagnosis of covert malignancies like CCA. The management plan remains the removal of the underlying cause which in this case is CCA.
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Affiliation(s)
- Saad Ur Rahman
- Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Muhammad Khawar Sana
- Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
| | - Zabreen Tahir
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA 02115, United States
| | - Aamir Ali
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States
| | - Pir Ahmad Shah
- Department of Medicine, University of Texas Health Science Center, San Antonio, TX 78229, United States
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Lee SC, Kim SJ, Yu MH, Lee KJ, Cha YS. Uses of Inflammatory Markers for Differentiation of Intrahepatic Mass-Forming Cholangiocarcinoma from Liver Abscess: Case-Control Study. J Clin Med 2020; 9:jcm9103194. [PMID: 33019760 PMCID: PMC7599997 DOI: 10.3390/jcm9103194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pyogenic liver abscess (LA) is difficult to distinguish from intrahepatic mass-forming cholangiocarcinoma (IMCC) in the emergency department (ED). We evaluated the predictive ability of white blood cells (WBC) and C-reactive protein (CRP) levels, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and delta neutrophil index (DNI) in LA and IMCC in the ED. METHODS Forty patients with IMCC between January 2011 and December 2018 were included in this study. For each patient with IMCC, two control patients with LA were enrolled based on matching age and sex,-i.e., 80 patients with LA. RESULTS Inflammatory markers, including WBC, PLR, NLR, DNI, and CRP were significantly higher in the LA group than in the IMCC group. For both groups, the area under the curve (AUC) of the initial CRP value was significantly higher (AUC: 0.909) than that of the initial serum WBC count, PLR, and DNI levels. On multivariable logistic regression analysis with inflammatory markers, serum CRP (odds ratio, 1.290; 95% confidence interval, 1.148-1.449, p < 0.001) was the only significant predictor for differentiation between the LA and IMCC groups. CONCLUSION Serum CRP may be a potential inflammatory marker to differentiate IMCC from LA in the ED.
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Affiliation(s)
- Sun Chul Lee
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (S.C.L.); (S.J.K)
| | - Sun Ju Kim
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (S.C.L.); (S.J.K)
| | - Min Heui Yu
- SENTINEL (Severance ENdocrinology daTa scIeNcE pLatform) Team, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Kyong Joo Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
- Correspondence: (K.J.L.); (Y.S.C.)
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea; (S.C.L.); (S.J.K)
- Correspondence: (K.J.L.); (Y.S.C.)
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Yang Z, Lv K, Zhao Y, Pan M, Zhang C, Wei S. Sarcomatoid hepatocellular carcinoma mimicking hepatic abscess: A case report. Medicine (Baltimore) 2020; 99:e22489. [PMID: 32991488 PMCID: PMC7523807 DOI: 10.1097/md.0000000000022489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
RATIONALE Primary sarcomatoid hepatocellular carcinoma (SHC) is a rare subtype of morphologic hepatocellular carcinoma reported on less than 1% of surgical pathology specimens. Herein, we report a rare case of SHC. The case in question was initially misdiagnosed as a liver abscess due to the clinical and radiological similarity between these 2 pathologies. Ultrasound(US)- and contrast-enhanced ultrasound (CEUS)- guided biopsies are helpful in making an accurate diagnosis under the appropriate biopsy area and angle of puncture. PATIENT CONCERNS A 56-year old male presented to our hospital with a 2-month history of dull, upper abdominal pain without radiation. DIAGNOSES Upon initial investigation with computed tomography, a cystic mass was found in the hepatic V segment and an infectious etiology was presumed. Further diagnostic examination with CEUS and magnetic resonance imaging suggested a hepatic abscess. However, a diagnosis of atypical intrahepatic cholangiocarcinoma was not excluded. The patient received the standard antibiotic treatment without alleviation of his symptoms. Through 3 diagnostic US-and CEUS-guided biopsies over a 3-month period, the pathological diagnosis of SHC was finally confirmed. INTERVENTIONS The patient was diagnosed by 3 diagnostic US-and CEUS-guided biopsies, the pathological diagnosis of SHC was finally confirmed. OUTCOMES Due to the delay in diagnosis, the patient was not a candidate for surgical resection, and showed dissemination of the lesion to the portal vein. Therefore, treatment with chemotherapy was initiated. After 4 courses of this regimen, tumor progression was found on enhanced magnetic resonance imaging. Therefore, the patient received immunotherapy and targeted therapy with limited response. The patient passed away 3 months later due to tumor progression. LESSONS A hepatic abscess should be considered as a malignant lesion when clinical symptoms do not resolve upon standard treatment. US- and CEUS- guided biopsies are helpful in making an accurate diagnosis under the appropriate biopsy area and angle of puncture.
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Affiliation(s)
| | | | | | | | | | - Shumei Wei
- Department of Pathology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Guo P, Pi C, Zhao S, Fu S, Yang H, Zheng X, Zhang X, Zhao L, Wei Y. Oral co-delivery nanoemulsion of 5-fluorouracil and curcumin for synergistic effects against liver cancer. Expert Opin Drug Deliv 2020; 17:1473-1484. [DOI: 10.1080/17425247.2020.1796629] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Pu Guo
- Department of Pharmaceutics, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China
| | - Chao Pi
- Department of Pharmaceutics, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China
| | - Shijie Zhao
- Department of Pharmaceutics, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China
| | - Shaozhi Fu
- Department of Oncology, the Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China
| | - Hongru Yang
- Department of Oncology, Luzhou People’s Hospital, Luzhou, Sichuan, 646000, P.R. China
| | - Xiaoli Zheng
- Basic Medical College, Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China
| | - Xiaomei Zhang
- Institute of Medicinal Chemistry of Chinese Medicine, Chongqing Academy of Chinese Materia Medica, Chongqing, 400065, P.R. China
| | - Ling Zhao
- Department of Pharmaceutics, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China
| | - Yumeng Wei
- Department of Pharmaceutics, School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, 646000, P.R. China
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Gong ZJ, Cheng JW, Gao PT, Huang A, Sun YF, Zhou KQ, Hu B, Qiu SJ, Zhou J, Fan J, Yang XR. Clinical Characteristics and Prognostic Factors of Patients with Intrahepatic Cholangiocarcinoma with Fever: A Propensity Score Matching Analysis. Oncologist 2019; 24:997-1007. [PMID: 30910867 DOI: 10.1634/theoncologist.2018-0268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 02/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with intrahepatic cholangiocarcinoma (ICC) rarely present fever as the initial symptom. We aimed to identify clinical characteristics and prognostic factors for these feverish patients. SUBJECTS, MATERIALS, AND METHODS This study retrospectively reviewed 31 patients with ICC with fever (≥38.0°C) treated at our hospital between January 2002 and December 2014. A propensity score was used to match patients with and without fever at a ratio of 1:2. RESULTS Patients with ICC with fever had higher serum γ-glutamyl transferase and carcinoembryonic antigen levels, larger tumors, poorer tumor differentiation, and worse prognosis (all p < .05) than those without fever. This was supported by propensity score matching (PSM) analysis. Univariate and multivariate analyses indicated that microvascular invasion, hilar lymph node metastasis, and temperature ≥ 38.6°C were related to prognosis. Patients with ICC with fever had higher levels of leucocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in peripheral blood before and after PSM analysis. Body temperature positively correlated with leucocytes (r = 0.599, p < .001), neutrophils (r = 0.644, p < .001), NLR (r = 0.681, p < .001), and PLR (r = 0.457, p = .010). CONCLUSION Patients with ICC with fever ≥38.0°C and ≥38.6°C had poor and extremely poor prognosis, respectively. Radical surgical treatment may improve the prognosis of patients with ICC with fever <38.6°C. However, systemic therapy (e.g., anti-inflammatory and immune therapy) may be preferable to surgery for these patients with fever ≥38.6°C. IMPLICATIONS FOR PRACTICE Patients with intrahepatic cholangiocarcinoma (ICC) with fever (≥38.0°C) as the initial symptom are extremely rare. Because their symptoms are similar to those of liver abscess, diagnosis is challenging, and most of these patients are already at an advanced stage at the time of diagnosis. Patients with ICC with fever had different clinical characteristics and worse prognosis than those without fever. The prognosis of those with temperature <38.6°C would be improved by timely surgical intervention. Those with fever ≥38.6°C had an extremely dismal outcome, although they all received radical surgical treatment. New therapeutic strategies are needed to improve survival for patients with ICC with temperature ≥38.6°C.
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Affiliation(s)
- Zi-Jun Gong
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
- Department of General Surgery, Zhongshan Hospital, Biliary Tract Diseases Institute, Fudan University, Shanghai, People's Republic of China
| | - Jian-Wen Cheng
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Pin-Ting Gao
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Ao Huang
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Yun-Fan Sun
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Kai-Qian Zhou
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Bo Hu
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Shuang-Jian Qiu
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
| | - Jian Zhou
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
| | - Jia Fan
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
- Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
| | - Xin-Rong Yang
- Department of Liver Surgery & Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, and Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, People's Republic of China
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Gowarty J, Ghauri A, Martinez G, Birdwell AL. Hepatocellular carcinoma disguised as liver abscesses. Proc (Bayl Univ Med Cent) 2018; 31:222-223. [PMID: 29706827 DOI: 10.1080/08998280.2018.1444252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 10/17/2022] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is growing rapidly in the United States. Nonalcoholic fatty liver disease and nonalcoholic steatohepatitis are being increasingly recognized as known risk factors for the development of HCC. However, this risk seems to be associated with their progression to cirrhosis. This case demonstrates an unusual initial presentation of HCC masquerading as liver abscesses in a previously healthy woman with nonalcoholic fatty liver disease without cirrhosis. Our patient's clinical presentation was suspicious for an infectious etiology due to her ongoing fever in the setting of possible zoonotic transmission, because she had just acquired two unvaccinated kittens. Abscess-like clinical presentation can be seen in HCC and is due to neoplasm-associated granulocytosis. Fever is due to pyrogen production by malignant tumor cells or by macrophages. Therefore, HCC can be difficult to differentiate from a hepatic abscess, and aspiration of malignant cells may be needed for an accurate diagnosis. Although the incidence of HCC in nonalcoholic fatty liver disease without cirrhosis is low or unknown, surveillance for HCC should be considered due to the higher prevalence of nonalcoholic fatty liver disease in the developed world and its potential risk for HCC.
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Affiliation(s)
- Jasmine Gowarty
- Department of Internal Medicine, Baylor Scott and White-Texas A&M Health Science Center, Temple, Texas
| | - Arshad Ghauri
- Department of Internal Medicine and Clinical Informatics, Central Texas Veterans Health Care System, Temple, Texas
| | - George Martinez
- Department of Internal Medicine, Central Texas Veterans Health Care System, Temple, Texas
| | - Angela L Birdwell
- Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas
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Chu CS, Lin CC, Peng CY, Chuang PH, Su WP, Lai SW, Chen HJ, Chung CJ, Lai HC. Does pyogenic liver abscess increase the risk of delayed-onset primary liver cancer?: Evidence from a nationwide cohort study. Medicine (Baltimore) 2017; 96:e7785. [PMID: 28834881 PMCID: PMC5572003 DOI: 10.1097/md.0000000000007785] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Delayed-onset primary liver cancer (PLC) including hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) in patients with pyogenic liver abscess (PLA) is not common. The relationship between PLA and delayed-onset PLC is unclear. We investigated the association in a nationwide cohort study.From Taiwan National Health Insurance claims data, a cohort of 17,531 patients with PLA was generated after excluding patients with a history of cancer (n = 2034) and those diagnosed with PLC (n = 572) and other cancers (n = 627) within 1 year of a diagnosis of PLA. An age-, sex-, index year-, and diabetes mellitus (DM)-matched control cohort of 70,124 persons without PLA was selected from the same dataset. Both cohorts were followed up until the end of 2011. The risk of PLC was estimated for both cohorts.The incidence of PLC was nearly 2-fold greater in the PLA group than in the control cohort (29.3 per 10,000 person-years vs. 16.2 per 10,000 person-years). The incidences of HCC and ICC were 1.5- (22.1 per 10,000 person-years vs. 15.0 per 10,000 person-years) and 11-fold greater (6.73 per 10,000 person-years vs. 0.62 per 10,000 person-years), respectively, in the PLA group than in the control cohort. The PLA cohort also had high risks of PLC (adjusted hazard ratio [aHR] = 1.56; 95% confidence interval [CI] = 1.35-1.81), HCC (aHR = 1.34; 95% CI = 1.15-1.57), and ICC (aHR = 6.94; 95% CI = 4.23-11.57).In conclusion, in this nationwide cohort study, PLA increased the risk of delayed-onset PLC.
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Affiliation(s)
- Chia-Sheng Chu
- School of Chinese Medicine, China Medical University
- Division of Hepatogastroenterology, Department of Internal Medicine
| | - Che-Chen Lin
- Management Office for Health Data, China Medical University Hospital
- School of Medicine, China Medical University
| | - Cheng-Yuan Peng
- Division of Hepatogastroenterology, Department of Internal Medicine
- School of Medicine, China Medical University
| | - Po-Heng Chuang
- Division of Hepatogastroenterology, Department of Internal Medicine
- School of Medicine, China Medical University
| | - Wen-Pang Su
- Division of Hepatogastroenterology, Department of Internal Medicine
- School of Medicine, China Medical University
| | - Shih-Wei Lai
- School of Medicine, China Medical University
- Department of Family Medicine
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital
- School of Medicine, China Medical University
| | - Chi-Jung Chung
- Department of Medical Research, China Medical University Hospital
- Department of Health Risk Management, China Medical University, Taichung, Taiwan
| | - Hsueh-Chou Lai
- School of Chinese Medicine, China Medical University
- Division of Hepatogastroenterology, Department of Internal Medicine
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Wu XM, Wang JF, Ji JS, Chen MG, Song JG. Evaluation of efficacy of transcatheter arterial chemoembolization for hepatocellular carcinoma using magnetic resonance diffusion-weighted imaging. Onco Targets Ther 2017; 10:1637-1643. [PMID: 28352195 PMCID: PMC5360395 DOI: 10.2147/ott.s115568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Although the efficacy of transcatheter arterial chemoembolization (TACE) has been recommended as first-line therapy for nonsurgical patients with hepatocellular carcinoma (HCC), it is difficult to accurately predict the efficacy of TACE. Therefore, this study evaluated the efficacy of TACE for HCC using magnetic resonance (MR) diffusion-weighted imaging (DWI). A total of 84 HCC patients who received initial TACE were selected and assigned to the stable group (n=39) and the progressive group (n=45). Before TACE treatment, a contrast-enhanced MR scan and DWI (b=300, 600, and 800 s/mm2) were performed on all patients. The modified response evaluation criteria in solid tumors were used for evaluation of tumor response. Receiver operating characteristic curve was employed to predict the value of apparent diffusion coefficient (ADC) for TACE efficacy. The ADC values of HCC patients in the progressive group were higher than those in the stable group at different b-values (b=300, 600, and 800 s/mm2) before TACE treatment. The area under the curve of ADC values with b-values of 300, 600, and 800 s/mm2 were 0.693, 0.724, and 0.746; the threshold values were 1.94×10-3 mm2/s, 1.28×10-3 mm2/s, and 1.20×10-3 mm2/s; the sensitivity values were 55.6%, 77.8%, and 73.3%; and the specificity values were 82.1%, 61.5%, and 71.8%, respectively. Our findings indicate that the ADC values of MR-DWI may accurately predict the efficacy of TACE in the treatment of HCC patients.
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Affiliation(s)
- Xiao-Ming Wu
- Department of Radiology, Jinhua People's Hospital, Jinhua
| | - Jun-Feng Wang
- Department of Radiology, Jinhua People's Hospital, Jinhua
| | - Jian-Song Ji
- Department of Radiology, Lishui Municipal Center Hospital, Lishui, People's Republic of China
| | - Ming-Gao Chen
- Department of Radiology, Jinhua People's Hospital, Jinhua
| | - Jian-Gang Song
- Department of Radiology, Jinhua People's Hospital, Jinhua
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Commander SJ, Goss M, Shi Y, Finegold M, Heczey A, Kukreja K, Masand P, Vasudevan S. Liver abscesses secondary to Escherichia coli infection mimicking multifocal hepatoblastoma: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Ma KW, Cheung TT. Surgical resection of localized hepatocellular carcinoma: patient selection and special consideration. J Hepatocell Carcinoma 2016; 4:1-9. [PMID: 28097107 PMCID: PMC5207474 DOI: 10.2147/jhc.s96085] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Localized hepatocellular carcinoma (HCC) refers to a solitary or few tumors located within either the left or right hemiliver without evidence of bilobar or extrahepatic spread. This term encompasses a heterogeneous morphology with no regard to stage of prognosis of the disease. Surgical resection remains the mainstay of curative treatment for the localized HCC. Various biochemical and radiological tests constitute an indispensible part of preoperative assessment. Emergence of laparoscopic hepatectomy has brought liver resection into a new era. Improved understanding of the pathophysiology of HCC allows more aggressive surgical resection without compromising outcomes. New insights into the management of special situations, such as ruptured HCC, pyogenic transformation of HCC, and HCC with portal vein tumor thrombus, rekindle the hopes of curative resection in these terminal events. Amalgamating salvage liver transplantation into the surgical management of resectable HCC has revolutionized the treatment paradigm of this deadly disease.
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Affiliation(s)
- Ka Wing Ma
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Tan To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong
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18
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Gong ZJ, Guo W, Sun YF, Zhang X, Qiu SJ, Zhou J, Fan J, Yang XR. Prognostic value of fever grade combined with neutrophil percentage in hepatocellular carcinoma patients presenting fever as the initial manifestation. Onco Targets Ther 2016; 9:6281-6290. [PMID: 27789960 PMCID: PMC5072517 DOI: 10.2147/ott.s109023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) patients with fever as the initial presentation are extremely rare. Our aim was to investigate the clinical characteristics and prognosis of patients with this disease. Patients and methods The clinical features were analyzed in a retrospective study of 63 HCC patients with fever as the first manifestation and 300 HCC patients without fever as the control group. Results HCC patients with fever had a higher neutrophil percentage, larger tumor size, worse tumor differentiation, advanced Barcelona Clinic Liver Cancer stage, and more hilar lymph node metastasis than HCC patients without fever (all P<0.05). Compared with HCC patients without fever, patients presenting with fever had shorter overall survival (OS, median: 13 months, P<0.001) and time to recurrence (TTR, median: 7.5 months, P<0.001). In addition, HCC patients with fever also had shorter OS and TTR than those without fever in all clinical subgroups with aggressive features (all P<0.05). Multivariate analysis showed that neutrophil percentage >70%, fever grade ≥38.5°C, tumor size >5 cm, and hilar lymph node metastasis were independent factors for OS and TTR. A positive correlation was observed between body temperature and serum neutrophil percentage (r=0.527, P<0.001). Patients with a fever grade ≥38.5°C had more incomplete encapsulation and larger tumor size, while those with a neutrophil percentage >70% presented with more incomplete encapsulation, vascular invasion, and worse tumor differentiation. Patients with a fever grade ≥38.5°C combined with a neutrophil percentage >70% had worse OS and TTR than other groups. Conclusion HCC patients presenting with fever have poorer prognosis than those without fever; however, their prognosis could be improved by timely surgical intervention. Patients with a neutrophil percentage >70% and a fever grade ≥38.5°C represent a rare HCC subgroup with an extremely dismal outcome and more aggressive clinical course.
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Affiliation(s)
- Zi-Jun Gong
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China
| | - Wei Guo
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China; Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yun-Fan Sun
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China
| | - Xin Zhang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China
| | - Shuang-Jian Qiu
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China
| | - Jian Zhou
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China; Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
| | - Jia Fan
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China; Institutes of Biomedical Sciences, Fudan University, Shanghai, People's Republic of China
| | - Xin-Rong Yang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China; Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, People's Republic of China
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Liver Resection for De Novo Hepatocellular Carcinoma Complicated by Pyogenic Liver Abscess: A Clinical Challenge. World J Surg 2016; 40:412-8. [PMID: 26316116 DOI: 10.1007/s00268-015-3239-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND De novo hepatocellular carcinoma (HCC) complicated by pyogenic liver abscess is rare, and the standard of care for this disease has yet been defined. This study assesses whether liver resection can be recommended as its standard treatment. METHODS This retrospective study reviewed the prospectively collected data of the 1725 patients who underwent primary liver resection for HCC at our hospital during the period from December 1989 to December 2012. Outcomes were compared between patients with and without liver abscess. RESULTS Twenty-two (1.28 %) patients had HCC and liver abscess. Fourteen of them received preoperative drainage. Patients with and without abscess had similar tumor characteristics, but patients with abscess had more operative blood loss (2.2 vs. 0.8 L; p < 0.0001) and more of them needed blood transfusion (63.6 vs. 23.1 %; p < 0.0001). They also had a longer hospital stay (38.5 vs. 10 days; p < 0.0001), a higher hospital mortality (40.9 vs. 2.8 %; p < 0.001), a higher postoperative complication rate (100 vs. 25.9 %; p < 0.0001), and poorer 1, 3, and 5-years disease-free survival rates (p = 0.023). CONCLUSIONS The post-resection mortality of the patients with de novo HCC complicated by pyogenic liver abscess was so high that liver resection is not recommended as the standard treatment. More research is needed to determine the best therapy for this rare disease.
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20
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Yang X, Miao R, Yang H, Chi T, Jiang C, Wan X, Xu Y, Xu H, Du S, Lu X, Mao Y, Zhong S, Zhao H, Sang X. Retrospective and comparative study of inflammatory myofibroblastic tumor of the liver. J Gastroenterol Hepatol 2015; 30:885-90. [PMID: 25387431 DOI: 10.1111/jgh.12846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Inflammatory myofibroblastic tumor of the liver (IMTL) is a very rare benign disease with a good prognosis. The study aims to determine the clinical, radiological, and pathological characteristics of IMTL. The diagnosis and treatment strategies were discussed. METHODS A total of 11 patients with pathologically confirmed IMTL receiving treatment over a 15-year period were reviewed retrospectively. The analysis included demographics information and pertinent clinical data. Results obtained from patients with hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (IHCC), and metastatic liver cancer (MLC) receiving surgical resection were compared. RESULTS In comparison to HCC, IHCC, and MLC, IMTL has an earlier onset (P < 0.001). IMTL patients had significantly lower aspartate aminotransferase (P = 0.003) and higher alkaline phosphatase (P = 0.034) than HCC patients, and higher gamma-glutamyl transpeptidase (P = 0.010) than MLC patients. Increased serum α-fetoprotein level was detected in only one patient. Serum α-fetoprotein was significantly lower in patients with IMTL (P = 0.000) than in those with HCC but not IHCC (P = 0.558) or MLC (P = 0.514). In contrast to elevated serum CA19-9 in patients with HCC/IHCC/MLC, the serum CA19-9 in IMTL cases was generally normal (vs HCC P = 0.008; vs IHCC P = 0.000; vs MLC P = 0.022). In nine IMTL patients, the tumor appeared as a hypoechogenic solid mass on the ultrasonography. In contrast, most patients with HCC, IHCC, or MLC showed hybrid echo. In contrast computed tomography and magnetic resonance imaging, the lesion of IMTL and MLC appeared as peripheral enhancement. CONCLUSION Lab tests, imaging features, and patient history are helpful in the differential diagnosis of IMTL from HCC/IHCC/MLC. Surgical resection is curative for IMTL.
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Affiliation(s)
- Xiaobo Yang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS and PUMC), Beijing, China
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Shah V, Arora A, Tyagi P, Sharma P, Bansal N, Singla V, Bansal RK, Gupta V, Kumar A. Intrahepatic cholangiocarcinoma masquerading as liver abscess. J Clin Exp Hepatol 2015; 5:89-92. [PMID: 25941437 PMCID: PMC4415198 DOI: 10.1016/j.jceh.2014.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 12/31/2014] [Indexed: 12/12/2022] Open
Abstract
Malignancy masquerading as liver abscess, and presenting with fever, is mainly described in patients with colorectal cancers with liver metastasis. Primary liver tumors such as hepatocellular carcinoma or intrahepatic cholangiocarcinoma presenting as non-resolving liver abscess is extremely uncommon and carries a dismal prognosis. We present a rare case of non-resolving liver abscess as a presenting manifestation of intrahepatic cholangiocarcinoma.
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Key Words
- AFP, alphafetoprotein
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- CA 19-9, cancer antigen 19-9
- CEA, carcinoembryonic antigen
- CECT, contrast enhanced computerized tomography
- CK, cytokeratin
- CT, computerized tomography
- ESR, erythrocyte sedimentation rate
- FDG, fludeoxyglucose
- FNAC, fine needle aspiration cytology
- GGT, gamma-glutamyl transpeptidase
- HBV, hepatitis B virus
- HCC, hepatocellular carcinoma
- HCV, hepatitis C virus
- HIV, human immunodeficiency virus
- Hb, hemoglobin
- IU, international units
- IVC, inferior vena cava
- PET, positron emission tomography
- RHV, right hepatic vein
- SAP, serum alkaline phosphatase
- UGI, upper gastrointestinal
- USG, ultrasonography
- WBC, white blood count
- cholangicarcinoma
- hepatocellular carcinoma
- liver abscess
- liver cancer
- liver tumor
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Affiliation(s)
| | - Anil Arora
- Address for correspondence: Prof. Anil Arora, Chairman, Department of Gastroenterology & Hepatology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110 060, India.
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Ham H, Kim HY, Seo KJ, Lee SL, Kim CW. Cholangiocarcinoma with a paraneoplastic leukemoid reaction mimicking a pyogenic liver abscess. Korean J Intern Med 2015; 30:110-3. [PMID: 25589843 PMCID: PMC4293549 DOI: 10.3904/kjim.2015.30.1.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/20/2014] [Accepted: 09/11/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hyoju Ham
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hee Yeon Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Jin Seo
- Department of Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su Lim Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Huang WK, Lin YC, Chiou MJ, Yang TS, Chang JWC, Yu KH, Kuo CF, See LC. Pyogenic liver abscess as a warning sign for primary liver cancer: a nationwide population-based study. Asian Pac J Cancer Prev 2014; 14:4727-31. [PMID: 24083734 DOI: 10.7314/apjcp.2013.14.8.4727] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There have been no large-scale population-based studies to estimate the subsequent risk of primary liver cancer (PLC) among patients with pyogenic liver abscess (PLA). This study aimed to provide relevant data. MATERIALS AND METHODS The Taiwan Longitudinal Health Insurance Database for the years 2000 and 2005 was used. The PLA group were adult inpatients who were newly diagnosed with PLA from 2000 to 2008. The control group was randomly selected and matched with the PLA group in terms of age, sex, and date in which medical treatment was sought other than for PLA. RESULTS There were 1,987 patients each in the PLA and control groups. In total, 56 had PLC, 48 (2.4%, 601.5 per 100,000 person-years) from the PLA group, and 8 from the control group. After adjusting for potential covariates, the hazard ratio of PLC for the PLA group was 3.4 times that of the control group (95% confidence interval = 1.6-7.3, p <0.001). The PLC risk for the PLA group was significantly higher within the first year after PLA diagnosis (hazard ratio: 35.4) as compared with the control group and became insignificant (hazard ratio: 2.0, 95% confidence interval = 0.8-4.9) more than one year after PLA diagnosis. CONCLUSIONS Patients with PLA have a higher rate of PLC than matched controls, especially within the first year after the diagnosis of PLA, suggesting PLA is a warning sign for PLC.
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Affiliation(s)
- Wen-Kuan Huang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan E-mail :
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Pujahari AK. The symposium on hepatic abscess: Controversy, analysis and addendum. Med J Armed Forces India 2014; 69:98.e1-2. [PMID: 24532951 DOI: 10.1016/j.mjafi.2012.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Gupta M, Sharma A, Singh R, Lehl SS. Citrobacter koseri: an unusual cause of pyogenic liver abscess. BMJ Case Rep 2013; 2013:bcr-2013-008974. [PMID: 23505286 DOI: 10.1136/bcr-2013-008974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Liver abscess is a common pathology in the Indian subcontinent and usually results from amoebic or bacterial infection. Pyogenic abscesses usually occur in those with underlying predisposing factors like intra-abdominal infections, biliary infections or comorbidities like malignancy, immunosuppression, diabetes mellitus and previous biliary surgery or interventional endoscopy. Citrobacter is an unusual cause of pyogenic liver abscess and may occur in the setting of underlying comorbidities. We report a 56-year-old man with diabetes (operated for periampullary carcinoma 20 years ago), who presented with a history of fever for 1 week and on evaluation was found to have Citrobacter koseri-related hepatic abscess. The patient was managed with parenteral antibiotics, repeated aspiration of liver abscess and pigtail drainage.
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Affiliation(s)
- Monica Gupta
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India.
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26
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Multicystic hepatocarcinoma mimicking liver abscess. Case Rep Surg 2013; 2013:374905. [PMID: 23365779 PMCID: PMC3556838 DOI: 10.1155/2013/374905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/25/2012] [Indexed: 11/29/2022] Open
Abstract
The diagnosis of hepatocellular carcinoma (HCC) became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Multicystic HCC mimicking a liver abscess associated with septic-type fever and leukocytosis is rare, has a poor prognosis, and poses diagnostic and therapeutic dilemmas. We present the case of an 80-year-old patient, who presented with fever, leukocytosis, and large cystic masses involving right and left lobes of the liver initially considered abscesses and finally diagnosed as HCC after open drainage and liver biopsy. Although the patient died on the tenth postoperative day due to pulmonary oedema, the authors emphasize the high index of suspicion needed in the diagnosis of this unusual presentation of HCC.
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Kao WY, Hwang CY, Chang YT, Su CW, Hou MC, Lin HC, Lee FY, Lee SD, Wu JC. Cancer risk in patients with pyogenic liver abscess: a nationwide cohort study. Aliment Pharmacol Ther 2012; 36:467-76. [PMID: 22779737 DOI: 10.1111/j.1365-2036.2012.05212.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Revised: 04/04/2012] [Accepted: 06/20/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND There has been no large-scale population-based study on the relationship between pyogenic liver abscesses (PLA) and subsequent cancer risk. AIM To estimate all cancer risk following a diagnosis of PLA. METHODS Based on Taiwan's National Health Insurance Research Database, 1257 patients with PLA without prior cancers in the period 1996-2008 were identified and followed-up. The standard incidence ratio (SIR) of each cancer was calculated as the number of observed cancer cases arising among the PLA patients divided by the expected case number of cancer cases according to the national cancer rates. RESULTS Of the 1257 PLA patients identified, 598 (47.6%) had diabetes mellitus. After a median (±s.d.) follow-up of 3.33 ± 3.45 years, 186 were diagnosed with cancers, including 56 liver cancer, 22 biliary tract cancer and 40 colorectal cancer patients. Patients with PLA had a higher risk of all cancers (SIR, 3.83; 95% CI, 3.30-4.42), liver cancer (SIR, 7.87; 95% CI, 5.94-10.21), biliary tract cancer (SIR, 34.58; 95% CI, 21.67-52.36) and colorectal cancer (SIR, 5.27; 95% CI, 3.76-7.18). The highest SIRs of all cancers, liver cancer, biliary tract cancer and colorectal cancer occurred within 90 days of follow-up (360.82; 95% CI, 278.46-459.91, 257.28; 95% CI, 186.17-346.56, 1153.38; 95% CI 694.08-1801.24, and 52.63; 95% CI 25.2-96.8 respectively). CONCLUSIONS Pyogenic liver abscesses may herald the onset of cancer, especially hepato-biliary and colon cancer. Further surveys should be conducted for the detection of occult cancers in such patients.
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Affiliation(s)
- W-Y Kao
- Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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