Ultrasonography of necrotic hepatic metastases

A case of hemorrhage of hepatocellular carcinoma resembling a hepatic cyst arising from non-cirrhotic steatohepatitis

A 70-year-old female was found to have multiple hepatic cysts at her annual checkup. In the posterior segment of the right lobe of the liver, an 81 × 67 mm circular cystic lesion was detected by contrast-enhanced computed tomography (CT). Magnetic resonance imaging (MRI) of the cyst revealed a solid component. The cyst had a capsule-like structure and non-uniform fluid accumulation suggested bleeding. Since the lesion was enlarged and malignancy could not be ruled out, it was surgically resected. Histopathologically, reticular fibers of the liver were seen in necrotic tissue and the lesion was diagnosed as a bleeding hepatocellular carcinoma (HCC). The non-cancerous liver tissue showed non-cirrhotic steatohepatitis. This was an unusual presentation of HCC.

Ultrasound Diagnosis of Liver Hydatid Disease

A clinical study of 42 patients with hydatid disease was carried out using a real-time gray scale B-scanner. All cases were confirmed surgically. The ultrasound characteristics of the hydatid cysts were classified into three groups: Type I, simple hydatid cyst (19 of the 42 cases), type II, hydatid cyst with a disrupted wall and septa (14 cases), and type III, hydatid cyst with a heterogeneous echo pattern (9 cases). It was concluded that ultrasound classification of the cysts increases diagnostic accuracy. However, if a hydatid cyst becomes secondarily infected these typical changes are lost and the ultrasound diagnosis may then become more difficult. Periodic examinations should be performed with ultrasound after surgery.

Cystic liver metastases from colorectal cancer

BACKGROUND AND OBJECTIVES

Cystic liver metastases from colorectal cancer are rarely reported.

METHODS

Clinicopathological and radiological analyses were performed on six cases of cystic liver metastases from colorectal cancer.

RESULTS

Computed tomography or ultrasound findings for the tumors were atypical for metastases of colorectal cancer, and the lesions needed to be differentiated from cystadenocarcinoma and benign tumors. The histological findings were peculiar: the central portions of the tumors contained necrotic tissue or areas of hemorrhage, and adenocarcinoma cells were found predominantly outside well-developed fibrous capsules.

CONCLUSIONS

Clinicopathological observations suggested that these metastatic tumors had the potential to grow rapidly, but, unexpectedly, the patients had favorable prognoses.

The prevalence and characterization of simple hepatic cysts by ultrasound examination

To help assess the significance of liver cysts we have prospectively documented their prevalence and characteristics within a general population being referred for ultrasound. Simple hepatic cysts occur in 2.5% of the population, becoming increasingly common with age. They show a preference for women, the right lobe of the liver and are occasionally multiple. The differential diagnosis is discussed.

Attenuation estimation in reflection: progress and prospects

This monograph presents a tutorial review of the current state-of-the-art in ultrasonic attenuation estimation in reflection. Clinical indications which provide the motivation for attempting in vivo attenuation estimation are discussed. Frequency and time domain techniques and their respective tradeoffs and problems are presented. Finally, current clinical results obtained with the various techniques are summarized and further areas of study are suggested.

Evaluation of biliary cystadenoma and cystadenocarcinoma

Biliary cystadenomas and cystadenocarcinomas are among the rare neoplasms of the biliary ductal system. This article presents 3 adult patients in whom such large multiloculated biliary tumors were diagnosed. The characteristic features noted on ultrasonography, computed tomography, and angiography of the liver are illustrated and the literature is reviewed.

Comparison of ultrasound and CT images of liver metastases

The US and CT images of liver metastases in 42 patients were systematically compared. Based on the US image the lesions were classified as non-echogenic, slightly echogenic, and markedly echogenic lesions, target lesions and lesions with diffuse alteration of structure. There was often discrepancy between the appearance of the US and CT images. The discrepancy was increased after contrast enhancement in non-echogenic and in slightly echogenic metastases and in metastases with diffuse alteration of echo structure and diminished in target lesions. The possible reasons for these differences are discussed.

Ultrasound and computed tomography of small asymptomatic haemangiomas of the liver

Gray-scale ultrasound examinations were performed in 13 patients with 18 small asymptomatic haemangiomas of the liver and computed tomography in 10 of these patients. Different types of ultrasound images were found. One of them appeared as a well-demarcated area of increased echoes with an echo-free halo consisting of vessels, is probably characteristic for haemangioma. The other types of images are considered non-specific. The native CT scans demonstrated a well-demarcated spherical area with low attenuation in 8 cases and an area with attenuation similar to the liver in 4. After contrast medium injection, areas with lower attenuation were found in 7 cases, with irregular accumulation of contrast medium in the periphery in 4, and with distinct vessels in the periphery in one case, 2 haemangiomas had the same attenuation as the liver parenchyma.

Ultrasonographic patterns in hepatic hemangiomas

Twenty-one cases of hepatic hemangioma were examined by ultrasound, and three main sonographic patterns were identified. In 14 cases hyperechoic focal areas were observed, in five cases larger hemangiomas exhibited a complex pattern, and in two cases hemangiomas appeared as rounded sonolucent areas with distal enhancement mimicking cysts. Hemangiomas may have significantly variable ultrasonographic features. According to the authors' experience, only in cases of hyperechoic well-defined lesions in asymptomatic patients can a definite diagnosis of hemangioma be made.

Echographic aspects of hepatic metastases of nephroblastomas

We report a retrospective study of 293 cases of nephroblastoma treated at the Gustave Roussy Institute (I.G.R.) from 1971 to 1980, and 39 similar cases treated at the Curie Institute (I.C), from June 1977 to June 1981. Twenty-two cases of hepatic metastases were found. We were primarily interested in the echographic aspects of the lesions and particularly in their evolution. Despite the fact that the patients came from different centers with varying types of work-up, ten cases were fully documented and are presented in detail. They show the use to which ultrasound may be put.

Ultrasonically guided fine-needle biopsies in neoplastic liver disease: cytohistologic diagnoses and echo pattern of lesions

Sixty consecutive percutaneous fine-needle aspiration biopsies guided by ultrasound were performed without complications in patients with ultrasonically suspected focal or diffuse neoplastic liver disease. Evaluations of aspirated samples were based on cytologic examination of smear preparations (100%) combined with histologic examination of serial sectioned tissue fragments (81.7%). The overall accuracy rate of cytohistologic evaluations was 91.6% with a sensitivity of 92.2%, a specificity of 88.9%, and a high predictive value of positive results (cytology; 97.8%; histology, 100%). Percutaneous fine-needle aspiration biopsy guided by sonography proved to be a safe, useful, and highly accurate technique for making cytohistologic diagnoses of hepatic masses suspected of being malignant. No relationship was found between the various echo patterns of intrahepatic neoplastic lesions and cell type or primary site of tumor origin.

Sonographic features of gastrointestinal leiomyosarcoma

Five cases of gastrointestinal leiomyosarcoma were studied by ultrasound. Sonographic features of a huge mass with a thick echogenic rim and central sonolucent cavitation were seen in four cases with presenting symptoms of an abdominal mass. In a fifth case necrotic metastasis was seen in the liver after removal of a leiomyosarcoma. Although not pathognomonic, such features should strongly suggest the diagnosis of leiomyosarcoma.

The role of vascularization in the formation of echographic patterns of hepatic metastases: microangiographic and echographic study

An experimental microangiograhic and echographic study was carried out on metastatic autopsy livers which were also examined histologically. Relationships between the echographic pattern and vascularization are explored. In most cases, hypervascular lesions correspond to hyperechogenic patterns, while hypovascular lesions furnish hypoechogenic images.

Intratumor gas--an ultrasound sign of tumour necrosis

The ultrasound appearances of primary liver tumour in three patients are described. Changes in these appearances following devascularisation of the tumour by transcatheter embolisation are demonstrated. A possible mechanism for the change in appearances is suggested and is discussed in the light of plain radiographic and computerised tomographic findings.

Ultrasonographic-pathologic correlation of malignant hepatic masses

Characterization of the source of hepatic malignancy would be useful in directing a patient's workup, saving time and expense. We attempted to correlate the echographic appearance of malignant hepatic masses with the pathologic (44 patients) or clinical (1 patient) diagnosis in 45 consecutive patients scanned to evaluate this problem. In 31 patients the lesions were hyperechoic (28) or predominantly hyperechoic with central lucency. Of these lesions, 25 represented metastases from adenocarcinoma of the colon (17), pancreas (6), or unknown origin (2). Six patients with metastatic adenocarcinoma had predominantly echolucent lesions. Of the 14 malignancies of other histologic types, 6 were largely hyperechoic and could not be distinguished from adenocarcinoma metastases. No correlations could be drawn between the ultrasound patterns and the tumor source in this diverse group fo malignancies. In eight patients receiving chemotherapy, sequential examinations failed to reveal any alteration in the echographic patterns of their lesions. These results indicate that the ultrasound appearance of hepatic malignancy lacks specificity in defining the organ of origin. Such factors as homogeneity, vascularity, or desmoplastic response may be more important than cell type in producing the echographic pattern.