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Lin H, Liu Y, Wei Y, Guan X, Yu S, Man Y, Deng D. Characteristics of imaging in hepatic inflammatory pseudotumors: a comparison between IgG4-related and IgG4-unrelated cases. Insights Imaging 2024; 15:203. [PMID: 39120829 PMCID: PMC11315856 DOI: 10.1186/s13244-024-01782-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 07/20/2024] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVES The objective of this study was to examine the imaging features of hepatic inflammatory pseudotumors (IPTs) associated with IgG4-related and IgG4-unrelated conditions and to enhance the approach toward distinguishing between these two types of IPTs. METHODS A retrospective study was conducted, involving 20 patients diagnosed with hepatic IPTs. Imaging procedures were conducted within a timeframe of 4 weeks prior to hepatectomy or biopsy. The imaging features were then analyzed and compared using chi-squared analysis. RESULTS Seventeen (81.0%) IPTs were located in the hepatic subcapsular area; six (66.7%) IgG4-related IPTs were distributed around the hepatic hilum; and eleven (91.7%) IgG4-unrelated and three (33.3%) IgG4-related IPTs had unclear boundaries. All lesions exhibited similar characteristics in CT scans, T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI), with the apparent diffusion coefficient (ADC) values slightly higher than the surrounding liver tissue. Delayed hypoenhancement, observed in five cases (55.6%), was exclusively present in IgG4-related IPTs. The remaining IPT lesions displayed progressive enhancement, septal and marginal enhancement, and persistent enhancement. Central enhancement was absent in three IgG4-related IPTs (33.3%) and ten IgG4-unrelated IPTs (83.3%). The duct-penetrating sign was identified in two IgG4-unrelated IPTs (16.7%) and seven IgG4-related IPTs (77.8%). Furthermore, seven patients with IgG4-related IPTs had additional lesions outside the liver. CONCLUSIONS IgG4-related lesions are frequently found in the vicinity of the hepatic hilum; they display the duct-penetrating sign and affect other organs as well. Both groups exhibited progressive or persistent contrast enhancement in typical IPT lesions, but delayed hypoenhancement was only observed in the IgG4-related IPT group. IgG4-unrelated IPT lesions often exhibited indistinct boundaries lacking central enhancement. CRITICAL RELEVANCE STATEMENT Differences in imaging features differentiate IgG4-related and -unrelated inflammatory pseudotumors (IPT). IgG4-related lesions are frequently near the hepatic hilum, display duct-penetrating sign, and affect other organs. Only the IgG4-related group demonstrated delayed hypoenhancement. IgG4-unrelated IPT lesions often exhibited indistinct boundaries lacking central enhancement. KEY POINTS Compared with IgG 4-unrelated IPTs, IgG4-related IPTs show delayed hypoenhancement and affect other organs. IgG4-unrelated IPTs have unclear boundaries and lack central enhancement. Improved IPT diagnostic capabilities can help minimize additional, potentially unnecessary, interventions.
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Affiliation(s)
- Hua Lin
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Ying Liu
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Youyong Wei
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Xiaohui Guan
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Shuilian Yu
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China
| | - Yuping Man
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China.
| | - Demao Deng
- Department of Radiology, the People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Science, Nanning, 530021, Guangxi, China.
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Patel A, Chen A, Lalos AT. Inflammatory pseudotumors in the liver associated with influenza: A case report. World J Hepatol 2023; 15:1164-1169. [PMID: 37970616 PMCID: PMC10642433 DOI: 10.4254/wjh.v15.i10.1164] [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: 08/14/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Inflammatory pseudotumor (IPT) is a rare and benign lesion that mimics malignancy and can develop in any part of the body. The pathophysiology and etiology of these quasineoplastic lesions remain unclear. CASE SUMMARY We report a case of a 65-year-old male who presented with fevers, night sweats, and unintentional weight loss following an influenza infection and was found to have multiple hepatic IPT's following an extensive work up. CONCLUSION Our case highlights the importance of considering hepatic IPT's in the differential in a patient who presents with symptoms and imaging findings mimicking malignancy shortly following a viral infection.
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Affiliation(s)
- Ankoor Patel
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States.
| | - Alexander Chen
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
| | - Alexander T Lalos
- Department of Gastroenterology and Hepatology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States
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3
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Focal Benign Liver Lesions and Their Diagnostic Pitfalls. Radiol Clin North Am 2022; 60:755-773. [DOI: 10.1016/j.rcl.2022.05.005] [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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Calistri L, Maraghelli D, Nardi C, Vidali S, Rastrelli V, Crocetti L, Grazioli L, Colagrande S. Magnetic resonance imaging of inflammatory pseudotumor of the liver: a 2021 systematic literature update and series presentation. Abdom Radiol (NY) 2022; 47:2795-2810. [PMID: 35648207 PMCID: PMC9300573 DOI: 10.1007/s00261-022-03555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE Inflammatory pseudotumors of the liver (IPTL) are not exceptional benign lesions with various etiologies, histology, and imaging appearances. The incomplete knowledge of this pathology and the wide polymorphism sometimes resembling malignancy often induce long and expensive diagnostic flow, biopsy and occasionally unnecessary surgery. We propose a systematic revision of MRI literature data (2000-2021) with some narrative inserts and 10 new complete MRI cases, with the aim of organizing the data about IPTL and identifying some typical features able to improve its diagnosis from imaging. METHODS We performed a systematic revision of literature from 2000 to 2021 to obtain MRI features, epidemiological, and clinical data of IPTL. The basic online search algorithm on the PubMed database was "(pseudotumor) AND (liver) AND (imaging)." Quality assessment was performed using both scales by Moola for case report studies and by Munn for cross-sectional studies reporting prevalence data. A case-based retrospective study by collecting patients diagnosed with IPTL from three different university hospitals from 2015 to 2021 was done as well. Only cases with MR examinations complete with T1/T2/contrast-enhanced T1/Diffusion-Weighted (W) images and pathology-proven IPTL were selected. RESULTS After screening/selection 38 articles were included for a total of 114 patients. In our experience we selected 10 cases for a total of 16 IPTLs; 8 out of 10 patients underwent at least 1 MRI follow-up. Some reproducible and rather typical imaging findings for IPTL were found. The targetoid aspect of IPTL is very frequent in our experience (75% on T1W, 44% on T2W, 81% on contrast-enhanced T1W (at least one phase), 100% on Diffusion-W images) but is also recurrent in the literature (6% on T1W, 31% on T2W, 51% on CE-T1W (at least one phase), 18% on Diffusion-W images, and 67% on hepatobiliary phase). In our experience, Apparent Diffusion Coefficient map values were always equal to or higher than those of the surrounding parenchyma, and at MRI follow-up, nodule/s disappeared at first/second control, in six patients, while in the remaining 2, lesions persisted with tendency to dehydration. CONCLUSION A targetoid-like aspect of a focal liver lesion must raise diagnostic suspicion, especially if IgG4-positive plasma is detected. MRI follow-up mainly shows the disappearance of the lesion or its reduction with dehydration.
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Affiliation(s)
- Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Davide Maraghelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Cosimo Nardi
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Sofia Vidali
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Vieri Rastrelli
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
| | - Laura Crocetti
- Clinical and Translational Science Research Department - Division of Interventional Radiology, Cisanello University Hospital, Bldg 30, Via Paradisa 2, 56124 Pisa, Italy
| | - Luigi Grazioli
- Department of Radiology, University of Brescia “Spedali Civili”, P. le Spedali Civili 1, Brescia, Italy
| | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence - Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50134 Florence, Italy
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Guo Y, Qin X, Chen S, Liu X, Gu P. Diagnosis efficacy of CEUS for hepatic inflammatory lesions. J Clin Lab Anal 2020; 34:e23231. [PMID: 32017229 PMCID: PMC7307339 DOI: 10.1002/jcla.23231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose In this study, the efficacy of US/CEUS and clinicopathologic parameters in differential diagnosis of hepatic inflammatory lesions were evaluated. Methods This was a retrospective study in which CEUS imaging was performed on 182 patients. Among these patients, 44 patients had hepatic inflammatory lesions and 138 patients had malignant lesions. The ultrasound (US), CEUS, and clinicopathologic parameters with respect to differential diagnosis of hepatic inflammatory lesions were analyzed. Results Irregular lesion shape and unclear margin were commonly seen in hepatic inflammatory lesions by US/CEUS examination. Hypoenhancement in arterial phase (AP) and portal venous phase (PVP), and isoenhancement in delayed phase (DP) were more commonly found in inflammatory lesions rather than malignant lesions [9% (4/44), 68% (30/44), and 16% (7/44) vs 2% (3/138), 11% (15/138), 1% (1/138), respectively; P < .05]. The enhancement coverage was also a significant indicator for the differentiation of inflammatory lesions and malignant lesions (P < .05). History of hepatitis or cirrhosis, and higher serum alpha‐fetoprotein (AFP) level were indicators for malignant lesions, while liver parasites and higher body temperature were indicators for inflammatory lesions. When the US/CEUS findings were combined with clinicopathologic parameters, the diagnostic accuracy of inflammatory lesions could reach 93.3%, with sensitivity, specificity, positive predictive value, and negative predictive value of 63.64%, 96.03%, 84.85%, and 88.32%, respectively. Conclusion The US/CEUS findings combined with clinical characteristics can accurately differentiate hepatic inflammatory lesions and malignant lesions. The results of study will improve the diagnostic confidence for hepatic inflammatory lesions.
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Affiliation(s)
- Yuanyuan Guo
- Department of Gynaecology and ObstetricsAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
| | - Xiachuan Qin
- Department of UltrasoundNanchong Central HospitalSichuanChina
| | - Shaoxian Chen
- Radiology DepartmentGaoping District People Hospital of NanchongNanchongChina
| | - Xuebin Liu
- Department of UltrasoundNanchong Central HospitalSichuanChina
| | - Peng Gu
- Department of UltrasoundAffiliated Hospital of North Sichuan Medical CollegeNanchongChina
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Yang HK, Burns PN, Jang HJ, Kono Y, Khalili K, Wilson SR, Kim TK. Contrast-enhanced ultrasound approach to the diagnosis of focal liver lesions: the importance of washout. Ultrasonography 2019; 38:289-301. [PMID: 31311068 PMCID: PMC6769186 DOI: 10.14366/usg.19006] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/17/2019] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) is a powerful technique for differentiating focal liver lesions (FLLs) without the risks of potential nephrotoxicity or ionizing radiation. In the diagnostic algorithm for FLLs on CEUS, washout is an important feature, as its presence is highly suggestive of malignancy and its characteristics are useful in distinguishing hepatocellular from nonhepatocellular malignancies. Interpreting washout on CEUS requires an understanding that microbubble contrast agents are strictly intravascular, unlike computed tomography or magnetic resonance imaging contrast agents. This review explains the definition and types of washout on CEUS in accordance with the 2017 version of the CEUS Liver Imaging Reporting and Data System and presents their applications to differential diagnosis with illustrative examples. Additionally, we propose potential mechanisms of rapid washout and describe the washout phenomenon in benign entities.
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Affiliation(s)
- Hyun Kyung Yang
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Peter N Burns
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Toronto, Canada
| | - Hyun-Jung Jang
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Yuko Kono
- Departments of Medicine and Radiology, University of California, San Diego, CA, USA
| | - Korosh Khalili
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Stephanie R Wilson
- Diagnostic Imaging, Department of Radiology, University of Calgary, Calgary, Canada
| | - Tae Kyoung Kim
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
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Sheng RF, Zhai CW, Ji Y, Chen CZ, Yang L, Zeng MS. Role of MR in the differentiation of IgG4-related from non-IgG4-related hepatic inflammatory pseudotumor. Hepatobiliary Pancreat Dis Int 2017; 16:631-637. [PMID: 29291783 DOI: 10.1016/s1499-3872(17)60062-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 05/16/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hepatic inflammatory pseudotumor (IPT) is classified into 2 types based on IgG4 stain: IgG4-related and non-IgG4-related; the two types differ not only in their pathological characteristics, but also in the clinical features. This study aimed to investigate the MR character of hepatic IPT, and differentiate the IgG4-related IPT from the non-IgG4-related IPT. METHODS Twenty-five patients with 27 histologically proven hepatic IPTs were retrospectively analyzed. Ten lesions were diagnosed as IgG4-related IPT, and the other 17 as non-IgG4-related IPT. The MR signal features on T1, T2-weighted, dynamic-enhanced, and diffusion-weighted imaging were evaluated and compared. RESULTS The dominant lesions were subcapsularly distributed (n=17, 63.0%) with clear boundary (n=20, 74.1%), and showed progressive enhancement pattern (n=21, 77.8%) with diffuse homogeneous (n=12, 44.4%) or heterogeneous (n=8, 29.6%) hyperintensity, accompanied by delayed capsule-like enhancement (n=17, 63.0%) and central nonenhanced areas (n=18, 66.7%). Morphological features (P>0.05) were not sufficient to differentiate IgG4-related IPT from non-IgG4-related IPT; the wash-out pattern was only found in 2 IgG4-related IPT, while the progressive enhancement pattern was more common in the non-IgG4-related lesions (n=16) (P=0.022). During portal and delayed phases, iso-/hypoenhanced lesions were only seen in 3 IgG4-related IPT, and circular-enhanced lesions (n=5) existed exceptionally in the non-IgG4-related group with significant differences (P=0.029 and 0.027). Most IgG4-related IPTs had lower apparent diffusion coefficient compared with the liver parenchyma (n=6), while most non-IgG4-related IPTs had higher apparent diffusion coefficient value (n=13) (P=0.046). CONCLUSIONS Although MR images of hepatic IPT have certain characteristics, they are not enough to differentiate IgG4-related IPT from non-IgG4-related IPT. The enhancement pattern, signal features on portal and delayed phases, and the apparent diffusion coefficient value of the lesion may be helpful for the diagnosis.
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Affiliation(s)
- Ruo-Fan Sheng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Chang-Wen Zhai
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Yuan Ji
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Cai-Zhong Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Li Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Meng-Su Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, No. 180 Fenglin Road, Xuhui District, Shanghai 200032, China.
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Shang J, Wang YY, Dang Y, Zhang XJ, Song Y, Ruan LT. An inflammatory myofibroblastic tumor in the transplanted liver displaying quick wash-in and wash-out on contrast-enhanced ultrasound: A case report. Medicine (Baltimore) 2017; 96:e9024. [PMID: 29245287 PMCID: PMC5728902 DOI: 10.1097/md.0000000000009024] [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: 01/12/2023] Open
Abstract
RATIONALE Inflammatory myofibroblastic tumor (IMT) is an uncommon mesenchymal neoplasm, and its presence in a grafted liver is exceedingly rare. PATIENT CONCERNS A 54-year-old woman was admitted to our hospital with a half-month history of intermittent melena. She had undergone deceased-donor liver transplantation (LT) for hepatitis B virus related liver cirrhosis without hepatocellular carcinoma 5 months previously. DIAGNOSIS Laboratory examination showed impaired liver and renal functions and Epstein-Barr virus (EBV) infection, but tumor markers within normal ranges. Gastroscopy showed esophageal varices. Ultrasound and computed tomography angiography revealed an ill-defined and irregular solitary lesion in the porta hepatis, encasing both the portal vein and the hepatic artery. The lesion was characterized by arterial hyper-enhancement and hypo-enhancement in the remaining phases with contrast-enhanced ultrasound (CEUS). The lesion was finally confirmed as an IMT by ultrasound-guided biopsy. INTERVENTION The patient received conservative treatment, including immunosuppression, endoscopic variceal ligation, antibiotics, steroids, and antiviral agents. OUTCOME The patient's gastrointestinal bleeding was controlled, but the symptoms associated with portal hypertension worsened. Attempts to perform a transjugular intrahepatic portosystemic shunt were unsuccessful, and she unfortunately died soon after. LESSONS A differential diagnosis of IMT should be considered in LT recipients presenting with EBV infection, normal tumor markers, and a de novo hepatic lesion with quick wash-in and wash-out on CEUS. Ultrasound is associated with the advantages of convenience and nonionizing radiation, and should thus be the priority approach for monitoring transplanted liver.
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Affiliation(s)
| | | | | | - Xin-juan Zhang
- Department of Pathological Diagnosis, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yan Song
- Department of Ultrasound Medicine
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Gesualdo A, Tamburrano R, Gentile A, Giannini A, Palasciano G, Palmieri VO. A Diagnosis of Inflammatory Pseudotumor of the Liver by Contrast Enhaced Ultrasound and Fine-Needle Biopsy: A Case Report. Eur J Case Rep Intern Med 2017; 4:000495. [PMID: 30755918 PMCID: PMC6346893 DOI: 10.12890/2016_000495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/30/2016] [Indexed: 12/21/2022] Open
Abstract
Inflammatory pseudotumor (IPT) of the liver is a rare, benign lesion of unclear etiology, which may be misdiagnosed as hepatocellular carcinoma, cholangiocarcinoma, secondary tumor or abscess, because of its non-specific clinical, biochemical and radiologic findings. We present the case of a 48-old-year male in whom diagnosis of liver IPT was suspected by contrast enhanced ultrasound (CEUS) and confirmed by fine-needle liver biopsy. The diagnosis is in contrast to most of the literature reports in which the diagnosis was made only based on a surgical specimen.
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Affiliation(s)
- Annamaria Gesualdo
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico, Bari, Italy
| | - Rossana Tamburrano
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico, Bari, Italy
| | - Antonia Gentile
- Department of Emergency and Transplantation, Pathology Section, University of Bari, Policlinico, Bari, Italy
| | | | - Giuseppe Palasciano
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico, Bari, Italy
| | - Vincenzo O Palmieri
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari, Policlinico, Bari, Italy
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Dong Y, Wang WP, Mao F, Fan M, Ignee A, Serra C, Sparchez Z, Sporea I, Braden B, Dietrich CF. Contrast enhanced ultrasound features of hepatic cystadenoma and hepatic cystadenocarcinoma. Scand J Gastroenterol 2017; 52:365-372. [PMID: 27887203 DOI: 10.1080/00365521.2016.1259652] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Hepatic (biliary) cystic tumor (HBCT) is a rare focal cystic liver lesion, which has been rarely described in the literature. In our current multicenter, retrospective study, we aimed to analyze contrast enhanced ultrasound (CEUS) features and its diagnostic performance in histologically proved HBCT. MATERIAL AND METHODS Twenty-three patients with single HBCT were retrospectively analyzed. Histologically, 17 (73.9%) were benign hepatic (biliary) cystadenoma (HBCA), 6 (26.1%) were hepatic (biliary) cystadenocarcinoma (HBCAC). All CEUS examinations were assessed by two independent radiologists in consensus. Criteria of CEUS imaging evaluation included the contrast enhancement pattern of lesion (hypoenhancing, hyperenhancing, isoenhancing in comparison to the surrounding liver parenchyma) during the arterial, portal venous and late phases. RESULTS After injection of ultrasound contrast agents, most of the HBCTs (78.3%, 18/23) had typical honeycomb enhancement pattern of the cystic wall, septa or mural nodules. Comparing between HBCA and HBCAC, hyperenhancement of the honeycomb septa during the arterial phase was more common in HBCA (p = .047). However, hypoenhancement during the portal venous and late phases was the characteristic of HBCAC (p = .041). CONCLUSIONS The EFSUMB algorithm for CEUS for characterization of solid focal liver lesions is also applicable to HBCT. CEUS evaluation can avoid further diagnostic investigations or invasive biopsy procedure.
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Affiliation(s)
- Yi Dong
- a Department of Ultrasound , Zhongshan Hospital, Fudan University , Shanghai , China.,b Med. Klinik 2, Caritas-Krankenhaus Bad Mergentheim , Bad Mergentheim , Germany
| | - Wen-Ping Wang
- a Department of Ultrasound , Zhongshan Hospital, Fudan University , Shanghai , China
| | - Feng Mao
- a Department of Ultrasound , Zhongshan Hospital, Fudan University , Shanghai , China
| | - Mei Fan
- c Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
| | - Andre Ignee
- b Med. Klinik 2, Caritas-Krankenhaus Bad Mergentheim , Bad Mergentheim , Germany
| | - Carla Serra
- d Diagnostic and Interventional Ultrasound Unit, Department of Organ Failure and Transplantation , S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Zeno Sparchez
- e 3rd Medical Department, Institute for Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy , Cluj-Napoca, Romania
| | - Ioan Sporea
- f Department of Gastroenterology and Hepatology , University of Medicine and Pharmacy Victor Babes , Timisoara , Romania
| | - Barbara Braden
- g Translational Gastroenterology Unit, Headley Way, Oxford University Hospitals NHS Foundation Trust , Oxford , UK
| | - Christoph F Dietrich
- b Med. Klinik 2, Caritas-Krankenhaus Bad Mergentheim , Bad Mergentheim , Germany.,c Sino-German Research Center of Ultrasound in Medicine, The First Affiliated Hospital of Zhengzhou University , Zhengzhou, China
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Bartolotta TV, Vernuccio F, Taibbi A, Lagalla R. Contrast-Enhanced Ultrasound in Focal Liver Lesions: Where Do We Stand? Semin Ultrasound CT MR 2016; 37:573-586. [PMID: 27986175 DOI: 10.1053/j.sult.2016.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in sonography, and it is being increasingly used for the evaluation of focal liver lesions (FLLs). Currently, CEUS is included as a part of the suggested diagnostic workup of FLLs, resulting in a better patient management and delivering cost-effective therapy. After a brief technical note, contrast-enhancement patterns of different types of benign and malignant FLLs, along with hepatic pseudolesions, are described and discussed based on our experience and literature data. At the same time, the most recent concepts and the use of CEUS in different clinical settings are presented.
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Affiliation(s)
| | - Federica Vernuccio
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Adele Taibbi
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
| | - Roberto Lagalla
- Section of Radiology, DIBIMED, University Hospital "Paolo Giaccone", Palermo, Italy
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Fu J, Yang W, Wang S, Bai J, Wu H, Wang H, Yan K, Chen M. Clinical value of contrast-enhanced ultrasound in improving diagnostic accuracy rate of transthoracic biopsy of anterior-medial mediastinal lesions. Chin J Cancer Res 2016; 28:617-625. [PMID: 28174490 PMCID: PMC5242449 DOI: 10.21147/j.issn.1000-9604.2016.06.08] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in transthoracic biopsy of anterior-medial mediastinal lesions. Methods A total of 123 patients with anterior or middle mediastinum lesions required ultrasound guided transthoracic biopsy for pathological diagnosis. Among them, 72 patients received CEUS examinations before biopsy. After CEUS, 8 patients were excluded from biopsy and the rest 64 patients underwent biopsy (CEUS group). During the same period, 51 patients received biopsy without CEUS examination (US group). The ultrasonography characteristics, the number of biopsy puncture attempts, diagnostic accuracy rate and the incidence of complications were recorded and compared between the two groups. Results A large portion of necrosis area or superficial large vessels was found in 8 patients, so the biopsy was cancelled. The internal necrosis was demonstrated in 43.8% of the lesions in CEUS group and in 11.8% of US group (P>0.001). For thymic carcinoma, CEUS increased the detection rate of internal necrosis and pericardial effusion than conventional ultrasound (62.5% vs. 18.8%, P=0.012; 56.3% vs. 12.5%, P=0.023). The average number of punctures in CEUS group and US group was 2.36±0.70 and 2.21±0.51 times, respectively (P>0.05). The diagnostic accuracy rate of biopsy in CEUS group (96.9%, 62/64) was significantly higher than that in US group (84.3%, 43/51) (P=0.022). In US group, 2 patients suffered from mediastinal bleeding (3.9%), while no major complications occurred in CEUS group.
Conclusions CEUS examination provided important information before transthoracic mediastinum biopsy and improved diagnostic accuracy rate in biopsy of anterior and middle mediastinum lesions than conventional ultrasound.
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Affiliation(s)
- Jingjing Fu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Song Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Jing Bai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Haiyue Wang
- Department of Pathology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Kun Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
| | - Minhua Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing),1Department of Ultrasound
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13
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Yang W, Yan K, Wang S, Dai Y, Wu W, Yin SS, Chen MH. Differential Diagnosis of Arterial Phase Enhanced Hepatic Inflammatory Lesions and Hepatocellular Carcinomas with Contrast-enhanced Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:82-91. [PMID: 26456578 DOI: 10.1016/j.ultrasmedbio.2015.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 07/09/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
We aimed to investigate the enhancement patterns of contrast-enhanced ultrasound (CEUS) with SonoVue and determine the utility of this method for differential diagnosis between hepatic inflammatory lesions with arterial phase enhancement and hepatocellular carcinomas (HCC). Twenty-three patients with arterial-enhanced inflammatory liver lesions and 46 HCC patients were included. These lesions had been subjected to CEUS examination and confirmed by pathologic results or imaging follow-up for at least 1 y. In the arterial phase of CEUS, 65.2% of the inflammatory lesions showed patchy (slight enhancement with poorly defined margins) or centripetal enhancement, whereas 89.1% of the HCC lesions showed homogeneous or heterogeneous enhancement (p < 0.001). Moreover, 82.6% of the inflammatory lesions had poorly defined margins, and 78.3% were irregular in shape at the peak, whereas 87.0% of the HCC lesions had well-defined margins and 76.1% were regular (both p < 0.001). Feeding vessels were more frequently visualized in HCCs (71.7%) than in inflammatory lesions (26.1%, p < 0.001). Additionally, 88.2% of the internal non-perfused areas in inflammatory lesions were regular in shape, while 68.0% of these areas in HCCs had an irregular shape (p < 0.001). CEUS pattern analysis provides important information for differentiating inflammatory liver lesions and HCCs and is helpful for improving diagnostic accuracy.
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Affiliation(s)
- Wei Yang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Song Wang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Ying Dai
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Wei Wu
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Shan-Shan Yin
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Min-Hua Chen
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China.
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14
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Kondo T, Maruyama H, Kiyono S, Sekimoto T, Shimada T, Takahashi M, Ogasawara S, Suzuki E, Ooka Y, Tawada A, Chiba T, Kanai F, Yokosuka O. Intensity-Based Assessment of Microbubble-Enhanced Ultrasonography: Phase-Related Diagnostic Ability for Cellular Differentiation of Hepatocellular Carcinoma. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:3079-3087. [PMID: 26371403 DOI: 10.1016/j.ultrasmedbio.2015.07.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 07/28/2015] [Accepted: 07/30/2015] [Indexed: 06/05/2023]
Abstract
This prospective study aimed to elucidate the effect of phase-related quantitative parameters of contrast-enhanced ultrasound (CEUS) with perflubutane microbubble agent to assess the cellular differentiation of hepatocellular carcinoma (HCC). Intensity was analyzed in 94 lesions (19.4 ± 4.9 mm, 86 patients), 47 well-differentiated HCCs (wHCCs) and 47 moderately-differentiated HCCs (mHCCs): I(e) (early phase) = I(te) (tumor) - I(le) (liver), I(p) (post-vascular phase) = I(tp) (tumor) - I(lp) (liver), I(ep) = I(e) - I(p). The area under the receiver operating characteristic curve with the best cutoff value (I(e), 13.2, I(p), -4.5, I(ep), 21.3) for discriminating between wHCC and mHCC was 0.6922 for Ie, 0.7680 for Ip and 0.7925 for Iep, which indicated a significantly greater ability to differentiate between wHCC and mHCC compared with visual/qualitative assessment (early phase, 0.6170, p = 0.04; post-vascular phase, 0.6702, p = 0.01; both phases, 0.7021, p = 0.04). In conclusion, I(ep) was found to have the highest diagnostic ability, suggesting it is a promising parameter for the cellular differentiation of HCCs with CEUS.
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Affiliation(s)
- Takayuki Kondo
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Hitoshi Maruyama
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan.
| | - Soichiro Kiyono
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Tadashi Sekimoto
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Taro Shimada
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Masanori Takahashi
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Sadahisa Ogasawara
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Eiichiro Suzuki
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Yoshihiko Ooka
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Akinobu Tawada
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Fumihiko Kanai
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Chiba University Graduate School of Medicine, Chuou-ku, Chiba, Japan
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15
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Hepatic inflammatory pseudotumor: educational value of an incorrect diagnosis at contrast-enhanced ultrasound. J Med Ultrason (2001) 2015; 42:547-52. [PMID: 26576980 DOI: 10.1007/s10396-015-0624-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/06/2015] [Indexed: 12/16/2022]
Abstract
Hepatic inflammatory pseudotumor (IPT) is a rare lesion that is frequently confused with malignant tumors. According to the latest guidelines on contrast-enhanced ultrasound, hypoenhancement of solid lesions in the portal and late phases corresponds to the wash-out phenomenon that characterizes malignancies. IPT may show rapid arterial enhancement and portal or late phase hypoenhancement, falsely suggesting malignancy. We report a case of a diagnostic error in which a multifocal IPT was misdiagnosed as hepatic metastases. The IPT developed after an endoscopic retrograde cholangiography was investigated by close follow-up with CEUS and contrast-enhanced CT.
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Liang YR, Huang SH, Bao SY, Guo Z, Zhong JH, Jiang JH, Zeng LX, Qin X, Xiang BD. Hepatic inflammatory myofibroblastic tumors: Analysis of 24 cases. Shijie Huaren Xiaohua Zazhi 2014; 22:2952-2956. [DOI: 10.11569/wcjd.v22.i20.2952] [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] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical characteristics, diagnosis and treatment of hepatic inflammatory myofibroblastic tumors (HIMTs).
METHODS: Clinical data for 24 patients with HIMT who were treated at Guangxi Tumor Hospital during the recent 10 years were analyzed retrospectively.
RESULTS: The cause of HIMT is still unclear now. Right upper abdomen pain and fever are common symptoms. Preoperative laboratory examinations showed that alpha fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), and cancer antigen 125 (CA125) were normal. HBsAg positivity was found only in 11 patients. In dynamic enhanced computed tomography (CT) or magnetic resonance imaging (MRI) scans, most tumor lesions demonstrated peripheral enhancement or septal enhancement during the delayed phase. Pathological examination showed fusiform cells arranged in fascicles in the collagen matrix with lymphocytes and plasma cells infiltrating. Immunohistochemistry showed that the spindle cells expressed Vimentin (8/8) and smooth muscle actin (8/8). Fifteen cases underwent complete tumor resection, and 9 cases only underwent biopsy. The median follow-up duration was 46 months. Five patients were lost during follow-up, and 19 patients are still alive.
CONCLUSION: HIMTs have nonspecific clinical manifestations. Dynamic enhanced CT or MRI can reveal their histopathologic characteristics and be of great value in diagnosis. Surgical resection is recommended when the diagnosis is in doubt or if a malignant tumor cannot be excluded.
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