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Song M, Tao Y, He K, Du M, Guo L, Hu C, Zhang W. Clear cell hepatocellular carcinoma: Gd-EOB-DTPA-enhanced MR imaging features and prognosis. Abdom Radiol (NY) 2024:10.1007/s00261-024-04263-2. [PMID: 38557768 DOI: 10.1007/s00261-024-04263-2] [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: 11/09/2023] [Revised: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE To investigate imaging findings on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) and prognosis of clear cell hepatocellular carcinoma (CCHCC) comparing with non-otherwise specified hepatocellular carcinoma (NOS-HCC). METHODS The clinical, pathological and MR imaging features of 42 patients with CCHCC and 84 age-matched patients with NOS-HCC were retrospectively analyzed from January 2015 to October 2021. Univariate and multivariate logistic regression and Cox regression analyses were performed to identify independent diagnostic and prognostic factors for CCHCC. Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan-Meier analysis. RESULTS CCHCC showed fat content more frequently (P < 0.001) and relatively higher Edmondson tumor grade (P = 0.001) compared with NOS-HCC. The lesion-to-muscle ratio (LMR) and lesion-to-liver ratio (LLR) of CCHCC on pre-enhancement T1-weighted imaging (pre-T1WI) (P = 0.001, P = 0.003) and hepatobiliary phase (HBP) (P = 0.007, P = 0.048) were significantly higher than those of NOS-HCC. The area under the curve (AUC) for fat content, LLR on pre-T1WI and their combination with better diagnostic performance in predicting CCHCC were 0.678, 0.666, and 0.750, respectively. There was no statistically significant difference in clinical outcomes between CCHCC and NOS-HCC. Multivariate Cox analysis confirmed that tumor size > 2 cm and enhancing capsule were independent prognostic factors for DFS and OS among CCHCC patients. CONCLUSION Fat content and adjusted lesion signal intensity on pre-T1WI and HBP could be used to differentiate CCHCC from NOS-HCC. CCHCC had similar prognosis with NOS-HCC.
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Affiliation(s)
- Mingyue Song
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215028, China
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yuhao Tao
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215028, China
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Kuang He
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Mingzhan Du
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Lingchuan Guo
- Department of Pathology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Weiguo Zhang
- Department of Radiology, The Fourth Affiliated Hospital of Soochow University, Suzhou, 215028, China.
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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Ai H, Gong T, Ma Y, Ma G, Zhao J, Zhao X. Primary hepatic adenosquamous carcinoma: a case report and review of the literature. Front Oncol 2023; 13:1328886. [PMID: 38162486 PMCID: PMC10757360 DOI: 10.3389/fonc.2023.1328886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
Primary hepatic adenosquamous carcinoma is considered a rare subtype of intrahepatic cholangiocarcinoma, with fewer than 100 domestic and international cases reported. This malignancy exhibits a high degree of malignancy, strong invasiveness, and an unfavorable prognosis due to its propensity for early lymph node and intrahepatic metastasis. The etiology of this disease remains uncertain, and preoperative diagnosis is exceedingly challenging owing to the nonspecific clinical features and lack of specificity in imaging studies. Radical surgical resection is the most effective treatment for non-metastatic tumors, while targeted adjuvant therapy administered postoperatively can enhance therapeutic efficacy and delay tumor recurrence. This article documents the diagnostic and therapeutic course of a case of primary hepatic adenosquamous carcinoma treated at our medical institution, along with a comprehensive synthesis of the clinical characteristics and advances in the diagnosis and treatment of this disease, aiming to augment understanding and serve as a reference for future clinical endeavors.
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Affiliation(s)
- Haidong Ai
- Hepatobiliary and Pancreatic Medical Center, The First Affiliated Hospital of Weifang Medical College (Weifang People’s Hospital), Weifang, China
| | - Ting Gong
- Department of Ophthalmology, The First Affiliated Hospital of Weifang Medical College (Weifang People’s Hospital), Weifang, China
| | - Yongbiao Ma
- Hepatobiliary and Pancreatic Medical Center, The First Affiliated Hospital of Weifang Medical College (Weifang People’s Hospital), Weifang, China
| | - Guixu Ma
- Hepatobiliary and Pancreatic Medical Center, The First Affiliated Hospital of Weifang Medical College (Weifang People’s Hospital), Weifang, China
| | - Jingjing Zhao
- Hepatobiliary and Pancreatic Medical Center, The First Affiliated Hospital of Weifang Medical College (Weifang People’s Hospital), Weifang, China
| | - Xuelin Zhao
- Hepatobiliary and Pancreatic Medical Center, The First Affiliated Hospital of Weifang Medical College (Weifang People’s Hospital), Weifang, China
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Ben Ghashir N, Allawi L, Rathinavelu B, Al Harthi S. A case of clear cell-hepatocellular carcinoma accidentally found in the gallbladder wall after laparoscopic resection of gallbladder empyema: Beware of the liver bed. Int J Surg Case Rep 2023; 104:107933. [PMID: 36857801 PMCID: PMC9986511 DOI: 10.1016/j.ijscr.2023.107933] [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: 11/01/2022] [Revised: 01/24/2023] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Hepatocellular carcinoma (HCC) invading the gallbladder is a rare scenario, even in the context of an advanced tumor. The clear cell variant of HCC (CC-HCC) is also rare. However, CC-HCC is more frequent in women and those with liver cirrhosis, and the standard definition is the presence of transparent cytoplasm in at least 50 % of tumor cells. CASE PRESENTATION An accidental finding of HCC was made during histological examination of a gallbladder empyema specimen from a 74 year-old male patient. The tumor was found to be invading the wall of the gallbladder. On post-operative imaging, the HCC was identified in liver segments 4b, 5 and 6, with extensive portal vein thrombosis; without other distant spread. The tumor in our case was almost exclusively comprised of clear cells (>90 %); therefore, it was classified as CC-HCC. CLINICAL DISCUSSION Tumors are rarely discovered along with acute cholecystitis. Furthermore, HCC rarely invades the wall of the gallbladder. HCC with clear cell histology should be distinguished from other regional and metastatic tumors of similar morphology. CONCLUSION In this particular case, we provide an unusual circumstance in which HCC invaded the gallbladder wall and was found by chance in a specimen obtained after a cholecystectomy. Malignancy remains an under-recognized clinical scenario that is easily overlooked when assessing patients presenting with cholecystitis. We report our case with an additional focus on the findings of computed tomography (CT) as well as the clinicopathological characteristics pertinent to this distinctive histologic pattern of CC-HCC.
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Affiliation(s)
- Najla Ben Ghashir
- Pathology and Laboratory Medicine Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
| | - Luha Allawi
- Pathology Department, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
| | | | - Salem Al Harthi
- General Surgery Department, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates.
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Shi YJ, Yang X, Yan S, Li XT, Wei YY, Zhang XY, Sun YS. Primary malignant melanoma of the esophagus: differentiation from esophageal squamous cell carcinoma and leiomyoma using dynamic contrast-enhanced CT findings. Abdom Radiol (NY) 2022; 47:2747-2759. [PMID: 35668195 PMCID: PMC9300547 DOI: 10.1007/s00261-022-03556-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aimed to summarize the computed tomography (CT) findings of PMME and differentiate it from esophageal SCC and leiomyoma using CT analysis. METHODS This was a retrospective study including 23 patients with PMME, 69 patients with SCC, and 21 patients with leiomyoma in our hospital. Qualitative CT morphological characteristics of each lesion included the location, tumor range, ulcer, enhanced pattern, and so on. For quantitative CT analysis, thickness, length and area of tumor, size of largest lymph node, number of metastatic lymph node, and CT value of tumor in plain, arterial, and delayed phases were measured. The associated factors for differentiating PMME from SCC and leiomyoma were examined with univariate and multivariate analysis. Receive operating characteristic curve (ROC) was used to determine the performance of CT models in discriminating PMME from SCC and leiomyoma. RESULTS The thickness, mean CT value in arterial phase, and range of tumor were the independent factors for diagnosing PMME from SCC. These parameters were used to establish a diagnostic CT model with area under the ROC (AUC) of 0.969, and accuracy of 90.2%. In pathology, interstitial vessels in PMME were more abundant than that of SCC, and the stromal fibrosis was more obvious in SCC. PMME commonly exhibited intraluminal expansively growth pattern and SCC often showed infiltrative pattern. The postcontrast attenuation difference in maximum CT attenuation value between plain and arterial phases was the independent factor for diagnosing PMME from leiomyoma. This parameter was applied to differentiate PMME from leiomyoma with AUC of 0.929 and accuracy of 86.4%. CONCLUSION The qualitative and quantitative CT analysis had excellent performance for differentiating PMME from SCC and esophageal leiomyoma.
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Affiliation(s)
- Yan-Jie Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xin Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Pathology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Shuo Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xiao-Ting Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Yi-Yuan Wei
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Xiao-Yan Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China
| | - Ying-Shi Sun
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital & Institute, No. 52 Fu Cheng Road, Hai Dian District, Beijing, 100142, China.
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Cross-Sectional Imaging Findings of Atypical Liver Malignancies and Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:775-794. [DOI: 10.1016/j.rcl.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Wei D, Lu L, Ying C, Qingsong K, Dongbo L, Feibo L. Primary hepatic adenosquamous carcinoma: A rare case report. INDIAN J PATHOL MICR 2021; 64:S140-S142. [PMID: 34135156 DOI: 10.4103/ijpm.ijpm_785_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Primary hepatic adenosquamous carcinoma (ASC) is an extremely rare primary hepatic malignant tumor, which is easily misdiagnosed as hepatocellular carcinoma before surgery. It has both the histologic features-adenocarcinoma and squamous cell carcinoma. Primary hepatic ASC incidence rate in intrahepatic cholangiocarcinoma is 2% to 3%.[1] Patients with hepatic ASC may experience recurrence or metastasis after surgery. The epidemiology, clinical diagnosis, etiology, and treatment of the disease remain challenging. It is important to improve the recognition of hepatic ASC because of its bad prognosis. Here, we report a man who had complained of an upper stomachache for 2 months and was diagnosed with primary hepatic ASC by histology and immunohistochemistry (IHC) after laparoscopic hepatectomy. The patient remained asymptomatic and survived well for 2 years post surgery and long-term follow-up was continued till now. In addition, we offer a brief discussion about the histopathological features, clinical behavior, and treatment of hepatic ASC and review the relevant literature.
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Affiliation(s)
- Dong Wei
- Department of General Surgery, Zhejiang Putuo Hospital, Zhoushan, China
| | - Liu Lu
- Department of Endocrinology, Zhejiang Putuo Hospital, Zhoushan, China
| | - Chen Ying
- Department of General Surgery, Zhejiang Putuo Hospital, Zhoushan, China
| | - Kang Qingsong
- Department of General Surgery, Zhejiang Putuo Hospital, Zhoushan, China
| | - Li Dongbo
- Department of Endocrinology, Zhejiang Putuo Hospital, Zhoushan, China
| | - Li Feibo
- Department of General Surgery, Zhejiang Putuo Hospital, Zhoushan, China
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7
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Shi D, Sun J, Ma L, Chang J, Li H. Clinical and imaging characteristics of primary hepatic sarcomatoid carcinoma and sarcoma: a comparative study. BMC Cancer 2020; 20:977. [PMID: 33036589 PMCID: PMC7547477 DOI: 10.1186/s12885-020-07475-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/30/2020] [Indexed: 12/29/2022] Open
Abstract
Background Primary hepatic sarcomatous carcinoma (PHSC) and primary hepatic sarcoma (PHS) are rare malignancies with frequent overlap in both the clinic and radiology. No comparative study of these tumors for the restricted cases has previously been undertaken. The purpose of our study was to analyze the clinical and imaging features of PHSCs and PHSs, with an emphasis on particularities and similarities through a comparison of the two tumors. Methods We retrospectively analyzed the clinical and imaging features of 39 patients with pathologically proven PHSCs (n = 23) and PHSs (n = 16) from four university centers over a 9-year period from 2010 to 2019. Univariate analyses were performed to determine the consistent and distinctive features. Results The background of chronic hepatitis or cirrhosis was observed with a high frequency in both of PHSCs (73.7%) and PHSs (62.5%). Tumors with a diameter greater than 10 cm were significantly more common in PHSs than PHSCs (p = 0.043) and cystic masses were more detected in PHSs (P = 0.041). Both PHSCs and PHSs mainly presented hypovascularity (78.3% vs 81.3%). The ring hyper enhancement on the arterial phase (AP) and wash out were more frequently seen in PHSCs and the iso-hypo enhancement on the AP followed persistent or progressive enhancement was more commonly detected in PHSs (all, p < 0.05). Conclusion PHSC and PHS generally present as mass lesions with hypovascularity. The ring hyper enhancement on the AP and wash out favor the diagnosis of PHSC. The large size greater than 10 cm, cystic lesion, iso-hypo persistent or progressive enhancement pattern might suggest the possibility of PHSs.
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Affiliation(s)
- Dongli Shi
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, You'anmen wai, Fengtai District, Beijing, 100069, China
| | - Jun Sun
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, You'anmen wai, Fengtai District, Beijing, 100069, China
| | - Liang Ma
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, You'anmen wai, Beijing, 100069, Fengtai District, China
| | - Jing Chang
- Department of pathology, Beijing You' an Hospital, Capital Medical University, No.8, Xi Tou Tiao, You'anmen wai, Beijing, 100069, Fengtai District, China
| | - Hongjun Li
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, You'anmen wai, Fengtai District, Beijing, 100069, China.
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8
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Mamone G, Di Piazza A, Carollo V, Crinò F, Vella S, Cortis K, Miraglia R. Imaging of primary malignant tumors in non-cirrhotic liver. Diagn Interv Imaging 2020; 101:519-535. [DOI: 10.1016/j.diii.2020.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
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9
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The multidisciplinary team for gastroenteropancreatic neuroendocrine tumours: the radiologist's challenge. Radiol Oncol 2019; 53:373-387. [PMID: 31652122 PMCID: PMC6884929 DOI: 10.2478/raon-2019-0040] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are a heterogeneous group of tumours. An effective diagnosis requires a multimodal approach that combines evaluation of clinical symptoms, hormonelevels, radiological and nuclear imaging, and histological confirmation. Imaging plays a critical role in NETs diagnosis, prognosis and management, so the radiologists are important members of the multidisciplinary team. During diagnostic work-up two critical issues are present: firstly the need to identify tumor presence and secondly to define the primary site and assess regional and distant metastases. Conclusions The most appropriate imaging technique depends on the type of neuroendocrine tumour and the availability of specialized imaging techniques and expertise. There is no general consensus on the most efficient imaging pathway, reflecting the challenge in reliably detection of these tumours.
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A case of primary clear cell hepatocellular carcinoma comprised mostly of clear cells. Radiol Case Rep 2019; 14:1377-1381. [PMID: 31695824 PMCID: PMC6823767 DOI: 10.1016/j.radcr.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 01/26/2023] Open
Abstract
Clear cell hepatocellular carcinoma (CHCC) is defined as a tumor which contains more than 50% of clear cells. However, CHCC with more than 90% of clear cells are extremely rare. We report a case of a 65-year-old woman who was found to have a solitary mass, which was histologically diagnosed as clear cell hepatocellular carcinoma composed of 90% or more clear cells. The tumor presented rim arterial phase hyperenhancement in computed tomography, magnetic resonance imaging, and computed tomography during hepatic arteriography, and was classified as LR-M category according to The Liver Imaging Reporting and Data System version 2018(LI-RADS v2018). This tumor may mimic other tumors with similar radiographic features, such as intrahepatic cholangiocellular carcinoma and metastatic tumor.
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11
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Romano F, Altiero M, Laccetti E, Calise F, D'Avino R, Benincasa G, Scaglione M. MRI and CT findings of a primary malignant fibrous hystiocitoma presenting as a huge glissonian mass; imaging findings with surgical and histological correlations. BJR Case Rep 2019; 5:20180055. [PMID: 31131128 PMCID: PMC6519500 DOI: 10.1259/bjrcr.20180055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/14/2018] [Accepted: 07/24/2018] [Indexed: 11/05/2022] Open
Abstract
The present case report describes imaging findings (CT and MRI features) of a primary malignant fibrous hystiocitoma, presenting as a dual stage lesion, completely exophytic along liver surface with surgical and histological correlations. Imaging characteristics suggested the nature of the lesion (mesenchymal) and the behavior (expansile growth pattern) which addressed surgeons to a conservative excision.
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Affiliation(s)
- Federica Romano
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Michele Altiero
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Ettore Laccetti
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Fulvio Calise
- Department of Surgery, Pineta Grande Hospital, Castel Volturno, Italy
| | - Raffaele D'Avino
- Department of Surgery, Pineta Grande Hospital, Castel Volturno, Italy
| | - Giulio Benincasa
- Department of Pathology, Pineta Grande Hospital, Castel Volturno, Italy
| | - Mariano Scaglione
- Department of Radiology, Pineta Grande Hospital, Castel Volturno, Italy
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12
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Kim MJ, Lee S, An C. Problematic lesions in cirrhotic liver mimicking hepatocellular carcinoma. Eur Radiol 2019; 29:5101-5110. [DOI: 10.1007/s00330-019-06030-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/21/2018] [Accepted: 01/22/2019] [Indexed: 12/19/2022]
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13
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Semelka RC, Nimojan N, Chandana S, Ramalho M, Palmer SL, DeMulder D, Parada Villavicencio C, Woosley J, Garon BL, Jha RC, Miller FH, Altun E. MRI features of primary rare malignancies of the liver: A report from four university centres. Eur Radiol 2017; 28:1529-1539. [PMID: 29079914 DOI: 10.1007/s00330-017-5102-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 09/12/2017] [Accepted: 09/27/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine if rare primary malignancies of the liver may have consistent features on magnetic resonance imaging (MRI). MATERIALS AND METHODS This IRB-compliant retrospective study reviewed the records from the pathology departments of four university centres over an 11-year period from 2005-2016 to identify rare primary malignant tumours, which were cross-referenced with MRI records. MRI studies of these patients were reviewed to determine if these tumours exhibited consistent and distinctive features. RESULTS Sixty patients were identified with rare primary liver tumours. The following distinctive features and frequency of occurrence were observed: mixed hepatocellular carcinoma-cholangiocarcinoma showed regions of wash-out in 7/19 of patients; 6/6 of fibrolamellar carcinomas demonstrated large heterogeneous lesions with large heterogeneous central scars; epithelioid haemangioendothelioma larger than 2 cm showed target-like enhancement in late-phase enhancement in 9/13; sarcomas excluding angiosarcoma had central necrosis in 3/9 and haemorrhage in 5/9; angiosarcomas showed centripedal progressive nodular enhancement in 3/6 and showed regions of haemorrhage in 3/6; and 7/7 of primary hepatic lymphomas showed encasement of vessels. CONCLUSION Although helpful features for the differentiation of rare primary malignancies of the liver are identified, no MRI features appear to be specific and therefore histopathological confirmation is usually required for definitive diagnosis. KEY POINTS • No MRI features appear to be specific for rare primary liver malignancies. • Haemorrhage is a helpful sign in diagnosis of primary hepatic sarcomas. • Angiosarcomas may show progressive nodular enhancement towards the centre mimicking haemangioma. • Vessel encasement is a helpful sign in diagnosis of primary hepatic lymphoma.
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Affiliation(s)
- Richard C Semelka
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Nadesan Nimojan
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Saman Chandana
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Suzanne L Palmer
- Department of Radiology, University of South California, Los Angeles, CA, USA
| | | | | | - John Woosley
- Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bonnie L Garon
- Department of Radiology, University of South California, Los Angeles, CA, USA
| | - Reena C Jha
- Department of Radiology, Georgetown University, Washington, DC, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Ersan Altun
- Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Drive, Chapel Hill, NC, 27514, USA.
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Alexander LF, Harri P, Little B, Moreno CC, Mittal PK. Magnetic Resonance Imaging of Primary Hepatic Malignancies in Patients With and Without Chronic Liver Disease: A Pictorial Review. Cureus 2017; 9:e1539. [PMID: 28989828 PMCID: PMC5628780 DOI: 10.7759/cureus.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Primary hepatic malignancies are less common than metastatic diseases, but a recognition of these lesions is important for diagnosis and treatment planning. Magnetic resonance imaging (MRI) provides the most imaging information to diagnose lesions noninvasively and to narrow differential diagnoses. This paper reviews the imaging findings of chronic liver disease and primary hepatic malignancies, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CCA), epithelioid hemangioendothelioma, hepatic angiosarcoma, and primary hepatic lymphoma. Clinical and MRI features are reviewed to improve the readers’ recognition of these tumors, allowing for a narrower differential diagnosis when liver masses are encountered on abdominal imaging.
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Affiliation(s)
- Lauren F Alexander
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Peter Harri
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Brent Little
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
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15
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Tong Y, Yu H, Shen B, Feng X, Wang G, Cai X. Primary hepatic malignant fibrous histiocytoma combined with invasion of inferior vena cava: A case report and literature review. Medicine (Baltimore) 2017; 96:e7110. [PMID: 28591058 PMCID: PMC5466236 DOI: 10.1097/md.0000000000007110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Malignant fibrous histiocytoma (MFH), primary presented in liver, was very rare and displayed a poor prognosis because of high aggression. As a few of cases had been reported merely, we shared the case of primary hepatic MFH combined with invasion of inferior vena cava (IVC). PATIENTS CONCERNS A 69-year-old women presented with abdominal pain. DIAGNOSES Abdominal computed tomography and magnetic resonance imaging indicated a soft mass about 5.4 × 4.2 cm in the caudate lobe, accompanied with IVC invaded. INTERVENTIONS After the multidisciplinary consultation, laparotomy was performed, followed by chemotherapy and radiotherapy. Primary hepatic MFH was demonstrated pathologically. Till now, the patient was alive for >22 months after surgery and no evidence of recurrence or distant metastasis was suspected. OUTCOMES We discussed the integrated procedure of diagnosis and treatment, combined with data from literature review. LESSONS To our knowledge, the primary hepatic MFH combined with invasion of IVC was hardly reported. Despite the poor prognosis, the comprehensive treatment integrating the surgery, chemotherapy, and radiotherapy showed the satisfactory disease-free and overall survival. However, further investigations are definitely warranted.
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Affiliation(s)
| | - Hong Yu
- Department of General Surgery
| | - Bo Shen
- Department of General Surgery
| | - Xu Feng
- Department of General Surgery
| | - Guanglan Wang
- Department of Pathology, Sir Run Run Shaw Hospital Affiliated to Zhejiang University, Hangzhou, China
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16
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Imaging of Rare Primary Malignant Hepatic Tumors in Adults With Histopathological Correlation. J Comput Assist Tomogr 2017; 40:452-62. [PMID: 26938690 DOI: 10.1097/rct.0000000000000382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatocellular carcinoma and cholangiocarcinoma are the most common primary liver malignancies in adults (comprising >85%); however, liver is also host to some unusual primary malignant tumors. Some of these tumors show distinct demographic, clinicopathologic, and imaging features. Imaging features of these uncommon primary malignant liver tumors are presented with an attempt to correlate them with histopathology.
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17
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Techavichit P, Masand PM, Himes RW, Abbas R, Goss JA, Vasudevan SA, Finegold MJ, Heczey A. Undifferentiated Embryonal Sarcoma of the Liver (UESL): A Single-Center Experience and Review of the Literature. J Pediatr Hematol Oncol 2016; 38:261-8. [PMID: 26925712 DOI: 10.1097/mph.0000000000000529] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare and aggressive pediatric malignancy. The purpose of this study was to review the clinical, radiologic, and pathologic features and outcome of children with UESL at our institution, in the United Network of Organ Sharing database and to review the existing literature to define the state of the art for children with UESL. Six children were diagnosed with UESL at the Texas Children's Cancer Center between 1993 and 2014, 12 children underwent liver transplantation registered in the United Network of Organ Sharing database, and 198 children with UESL were described in 23 case series during 1978 to 2014. Patients were treated with multimodal treatment approaches including primary surgical resection, neoadjuvant and/or adjuvant chemotherapy, and liver transplantation resulting in overall survival reported between 20% and 100% with significant improvement over the recent years. We show that complete tumor removal remains the key element of treatment and our single-institutional experience and data in the published literature suggest that combination chemotherapy with ifosfamide and doxorubicin to facilitate complete surgical resection is an effective approach to cure children with UESL.
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Affiliation(s)
- Piti Techavichit
- *Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Departments of †Radiology ‡Pediatrics, Section Gastroenterology §Surgery ∥Pathology ¶Pediatrics, Section Hematology and Oncology, Baylor College of Medicine, Houston, TX
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18
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Abstract
The liver normally produces a large amount of lymph. It is estimated that between 25% and 50% of the lymph received by the thoracic duct comes from the liver. In normal conditions, hepatic lymphatics are not depicted on cross-sectional imaging. They are divided in lymphatics of deep system (lymphatics following the hepatic veins and the portal tract) and those of superficial system (convex surface and inferior surface). A variety of diseases may affect hepatic lymphatics and in general they manifest as lymphedema, lymphatic mass, or cystic lesions. Abnormal distended lymphatics are especially seen in periportal spaces as linear hypoattenuations on CT or strong linear hyperintensities on heavily T2-weighted MR imaging. Lymphatic tumor spread as in lymphoma and lymphangitic carcinomatosis manifests as periportal masses and regional lymph node enlargement. Lymphatic disruption after trauma or surgery is depicted as perihepatic fluid collections of lymph (lymphocele). Lymphatic malformation such as lymphangioma is seen on imaging as cystic spaces of variable size.
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Rajesh S, Bansal K, Sureka B, Patidar Y, Bihari C, Arora A. The imaging conundrum of hepatic lymphoma revisited. Insights Imaging 2015; 6:679-92. [PMID: 26443451 PMCID: PMC4656246 DOI: 10.1007/s13244-015-0437-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/09/2015] [Accepted: 09/22/2015] [Indexed: 12/14/2022] Open
Abstract
Abstract The imaging manifestations of hepatic lymphoma, both in its primary and secondary form, are extremely variable and overlap with a number of other more common hepatic diseases. However, in the appropriate clinical context, combining the imaging and laboratory features can aid in making the correct diagnosis. Since the management and prognosis of lymphomas are significantly different from other malignancies, early diagnosis and prompt commencement of therapy is of paramount importance. The various morphological appearances of hepatic lymphoma on imaging have been described here along with their possible differentials. Teaching points • Primary hepatic lymphoma is extremely rare. • Secondary liver involvement occurs in 50 % of patients with non-Hodgkin lymphoma. • The imaging manifestations of hepatic lymphoma are largely non-specific. • Some imaging features may be helpful in the appropriate clinical setting. • Management and prognosis of lymphoma is significantly different from other malignancies.
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Affiliation(s)
- S Rajesh
- Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India.
| | - Kalpana Bansal
- Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India.
| | - Binit Sureka
- Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India.
| | - Yashwant Patidar
- Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India.
| | - Chhagan Bihari
- Department of Pathology, Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India.
| | - Ankur Arora
- Department of Radiology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, 110070, India.
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20
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Abe H, Kamimura K, Kawai H, Kamimura H, Domori K, Kobayashi Y, Nomoto M, Aoyagi Y. Diagnostic imaging of hepatic lymphoma. Clin Res Hepatol Gastroenterol 2015; 39:435-42. [PMID: 25541481 DOI: 10.1016/j.clinre.2014.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/10/2014] [Accepted: 11/03/2014] [Indexed: 02/06/2023]
Abstract
Hepatic lymphoma is a rare disease with poor prognosis because of delayed diagnosis. The disease comprises primary, metastatic, and intravascular hepatic lymphomas. The pathological characteristics of lymphomas differ contributing to difficulty in early diagnosis. Early diagnosis and appropriate treatment result in improved prognosis; therefore, diagnostic radiology and its development with various contrast agents are critical for improving disease outcomes. Herein, we review hepatic lymphomas and summarize the results of imaging studies in correlation with pathological characteristics. The information provided will help physicians in early diagnosis and thereby improving prognosis.
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Affiliation(s)
- Hiroyuki Abe
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan.
| | - Hirokazu Kawai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Koji Domori
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Yuji Kobayashi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Minoru Nomoto
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
| | - Yutaka Aoyagi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, 951-8510, Japan
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Pedrassa BC, da Rocha EL, Kierzenbaum ML, Bormann RL, Francisc VV, D'Ippolito G. Uncommon hepatic tumors: iconographic essay - Part 2. Radiol Bras 2015; 47:374-9. [PMID: 25741121 PMCID: PMC4341376 DOI: 10.1590/0100-3984.2013.1761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 10/14/2013] [Indexed: 12/16/2022] Open
Abstract
In cases where typical aspects are shown, the diagnosis of most frequent hepatic lesions can be made with some safety by means of several imaging methods; on the other hand, uncommon lesions generally represent a diagnostic challenge for the radiologist. In the present second part of the study, the authors describe four rare hepatic lesions, as follows: primary hepatic lymphoma, myofibroblastic tumor, primary hepatic neuroendocrine tumor and desmoplastic small round cell tumor, approaching their main characteristics and imaging findings with emphasis on computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Bruno Cheregati Pedrassa
- MDs, Radiologists, Fellows at Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Eduardo Lima da Rocha
- MDs, Radiologists, Fellows at Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Marcelo Longo Kierzenbaum
- MDs, Radiologists, Fellows at Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Renata Lilian Bormann
- MDs, Radiologists, Fellows at Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Viviane Vieira Francisc
- PhD, MD, Radiologist, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Giuseppe D'Ippolito
- Associate Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Yan L, Xie F, Yang C, Yu L, Zheng T, Fu J, Yang J. The comparison of surgical patients with primary hepatic squamous cell carcinoma or adenosquamous carcinoma and surgical patients with hepatocellular carcinoma. World J Surg Oncol 2015; 13:90. [PMID: 25890009 PMCID: PMC4358902 DOI: 10.1186/s12957-015-0464-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 01/17/2015] [Indexed: 12/11/2022] Open
Abstract
Background There are still several controversies and ambiguities in the aspects of primary hepatic squamous cell carcinoma and primary hepatic adenosquamous carcinoma. To further clarify the specific features of these two infrequent diseases and provide beneficial propose for clinical decision, we did this retrospective study. Methods We reviewed the clinical features and outcomes of three primary hepatic squamous cell carcinoma (SCC) patients and six primary hepatic adenosquamous carcinoma (ASC) patients from January 1998 to December 2011 in Eastern Hepatobiliary Surgery Hospital in China. Meanwhile, 40 hepatocellular carcinoma (HCC) patients and 26 metastatic hepatic SCC or ASC patients who were hospitalized in the same period were also reviewed to make a comparison. In order to find out the definite survival information of SCC and ASC patients, 30 previous studies containing 37 primary hepatic SCC (16) and ASC (21) patients were reviewed, and their information of survival was analyzed together with the included patients in our hospital. Results Serum tumor markers showed significant differences between primary hepatic SCC/ASC and HCC patients, especially for serum alpha fetal protein (AFP) level and carbohydrate antigen 19-9 (CA 19-9). On the pathologic performance, primary SCC/ASC tumor was rarely accompanied with tumor capsule. They presented peripheral hepatic lymph node metastasis more likely and showed low proportion of microvascular invasion. The median survival time of primary hepatic SCC/ASC patients after liver resection (LR) was 15 months. And the 1-, 3-, 5-year survival rates after LR were 60%, 24%, and 12%, respectively. Significant difference was not discovered when SCC and ASC patients were compared with HCC patients (P = 0.294). The median survival time after LR for primary SCC and ASC patients was respectively 23 months and 13 months. Conclusions The comprehensive application of some clinical characteristics, histopathologic features, and imaging findings may be useful for us in making definite diagnoses for primary hepatic SCC and ASC patients preoperatively. And the treatment of liver resection was effective for those patients who met the selection criteria for liver resection.
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Affiliation(s)
- Long Yan
- Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Hospital, the Second Military Medical University, 255 Changhai Road, Shanghai, 200438, China.
| | - Feng Xie
- Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Hospital, the Second Military Medical University, 255 Changhai Road, Shanghai, 200438, China.
| | - Cheng Yang
- Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Hospital, the Second Military Medical University, 255 Changhai Road, Shanghai, 200438, China.
| | - Lihan Yu
- Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Hospital, the Second Military Medical University, 255 Changhai Road, Shanghai, 200438, China.
| | - Tao Zheng
- Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Hospital, the Second Military Medical University, 255 Changhai Road, Shanghai, 200438, China.
| | - Jun Fu
- Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Hospital, the Second Military Medical University, 255 Changhai Road, Shanghai, 200438, China.
| | - Jiamei Yang
- Department of Special Treatment and Liver Transplantation, Eastern Hepatobiliary Hospital, the Second Military Medical University, 255 Changhai Road, Shanghai, 200438, China.
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Wang H, Tan B, Zhao B, Gong G, Xu Z. CT findings of primary clear cell carcinoma of liver: with analysis of 19 cases and review of the literature. ACTA ACUST UNITED AC 2014; 39:736-43. [PMID: 24549879 DOI: 10.1007/s00261-014-0104-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To analyze CT characteristics of primary clear cell carcinoma of the liver (PCCCL) and improve the current understanding and diagnose accuracy of the tumor. METHODS Pre- and post-contrast CT images of 19 patients with pathology proven PCCCL were retrospectively analyzed. The clinical data and CT findings as well as relevant literature reports were reviewed. RESULTS Thirteen patients were tested positive for HBsAg, and two patients were positive for HCVAb. The serum alpha-fetoprotein (AFP) levels of most tumors (14/19) were ≤20 ng/ml with 14 cases were associated with liver cirrhosis. All lesions were solitary intraparenchymal mass lesions which have well-defined boarders. On pre-contrast CT scans, 15 lesions appeared as hypo-attenuation and four lesions appeared as isointensity to the adjacent liver parenchyma. On post-contrast CT scans, 16 lesions showed avid enhancement on the hepatic arterial phase, of which 6 lesions were hypo-attenuation, and 10 lesions remained slightly hyper-attenuation or iso-attenuation on the portal venous phase images. Three lesions showed only mild enhancement on the hepatic arterial phase and hypo-attenuation on the portal venous phase. All lesions demonstrated hypointensity on the equilibrium phase. There are 12 lesions showed pseudocapsules. None of patients showed signs of portal vein thrombosis. There was no distal metastasis except only one patient had lymph node metastasis. CONCLUSION The characteristics of CT imaging of PCCCL, such as tend to form pseudocapsules and less involved with vascular invasion, could be useful in differentiating from common type hepatocellular carcinoma (CHCC). Some CT imaging characteristics of PCCCL are similar to CHCC, such as prone to occur in patients with liver cirrhosis and early enhancement pattern on the hepatic arterial phase as well as hypo-attenuation on the equilibrium phase. Those features could be useful in differentiating PCCCL from other liver tumors, such as hemangioma and hepatic metastases.
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Affiliation(s)
- Haiyan Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jingwu Road No.324, Jinan, People's Republic of China, 250021
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