Isolated fat-containing pancreatic metastasis from hepatocellular carcinoma. Jpn J Radiol. 2013;31:408-411. [PMID: 23539254 DOI: 10.1007/s11604-013-0193-9]

Simultaneous gastric, pancreatic, and renal metastasis from poorly differentiated hepatocellular carcinoma

Common extrahepatic metastasis sites of hepatocellular carcinoma (HCC) are the lungs, adrenal glands, and bones. Herein, we report a rare case of metastatic gastric, pancreatic, and renal tumors from HCC simultaneously, and review the relevant literature. A 75-year-old woman presented with right hypochondralgia, appetite loss, and weight loss. Computed tomography revealed suspected metastatic liver, lung, and renal tumors. A blood test revealed a leukocyte count of 26,210/μL and a high inflammatory reaction. As sepsis was suspected, the patient was referred to our hospital. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging revealed a hypovascular liver tumor that was suspected to be metastatic. Upper gastrointestinal endoscopy revealed two suspected metastatic gastric tumors. Liver and gastric tumor biopsies revealed poor carcinoma in both. The patient's condition gradually worsened and she died on day 8 of the illness. Based on autopsy findings, the patient was finally diagnosed with metastatic gastric and renal tumors originating from HCC. Additionally, a metastatic pancreatic tumor originating from the HCC was identified during autopsy. The pathological diagnosis of the pulmonary lesion was primary lung adenocarcinoma. In conclusion, HCC should be suspected in cases with multiple metastases of unknown primary lesions.

Computed tomography and magnetic resonance imaging features of lipid-rich neuroendocrine tumors of the pancreas

AIM: To clarify the computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of lipid-rich pancreatic neuroendocrine tumors (PanNETs).

METHODS: Enhanced CT and MRI performed before pancreatectomy in 29 patients with 34 histologically-confirmed PanNETs was retrospectively reviewed. Tumor attenuation on CT and signal intensities on conventional (T1- and T2-weighted) and chemical shift MRI were qualitatively analyzed and compared alongside adipose differentiation-related protein (ADRP) immunostaining (ADRP-positive: lipid-rich; ADRP-negative: non-lipid-rich) results using Fisher’s exact test or the Mann-Whitney U test. Signal intensity index on chemical shift MRI was quantitatively assessed.

RESULTS: There were 15 lipid-rich PanNETs (44.1%) in 12 patients (41.4%). Tumor attenuation during the early, portal venous, and delayed phases of enhanced CT (P = 0.888, 0.443, and 0.359, respectively) and signal intensities on conventional MRI (P = 0.698 and 0.798, respectively) were not significantly different between lipid-rich and non-lipid-rich PanNETs. Four of the 15 lipid-rich PanNETs exhibited high signal intensity on subtraction chemical shift MRI, and the association of high signal intensity on subtraction imaging with lipid-rich PanNETs was significant (4 of 15 lipid-rich PanNETs, 26.73%, vs 0 of 19 non-lipid-rich PanNETs, 0%, P = 0.029). Lipid-rich PanNETs showed a significantly higher signal intensity index than non-lipid-rich PanNETs (0.6% ± 14.1% vs -10.4% ± 14.4%, P = 0.004). Eight of 15 lipid-rich PanNETs, vs 0 of 19 non-lipid-rich PanNETs, had positive signal intensity index values in concordance with lipid contents.

CONCLUSION: CT contrast enhancement and conventional MR signal intensities are similar in lipid-rich and non-lipid-rich PanNETs. Chemical shift MRI can demonstrate cytoplasmic lipids in PanNETs.