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Li F, Liu Y, Xu K, Yao Q, Li Q, Wu H. Squamous cell lung carcinoma with gastrointestinal metastasis: a case report and review of literature. Front Oncol 2023; 13:1138871. [PMID: 37152036 PMCID: PMC10160372 DOI: 10.3389/fonc.2023.1138871] [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: 01/06/2023] [Accepted: 03/24/2023] [Indexed: 05/09/2023] Open
Abstract
Squamous cell lung carcinoma (LUSC) originates from squamous cells and has a high rate of metastasis and recurrence. The lack of effective genetic targets and specific therapies has resulted in a poor prognosis for patients with LUSC. Gastrointestinal metastasis of LUSC is a rare occurrence in clinical practice. Patients with gastrointestinal metastasis usually have worse overall survival and the process of diagnosis is more complicated than those with metastasis elsewhere. What's more, there are no helpful guidelines for treating patients with a clinically confirmed diagnosis of gastrointestinal metastasis, which means the treatment method is limited. Here, we review the clinical features, diagnosis, and treatment of LUSC patients with gastrointestinal metastasis and report a rare case of LUSC accompanied by gastrointestinal metastasis. The patient was admitted to the hospital with coughing and hemoptysis. A tumor was found in his lung, and lesions were initially controlled with standard treatment. The patient's tumor re-occurred again shortly for which treatment was lacking. Without effective treatment methods, the disease was difficult to control. Our learnings from the case demonstrate that LUSC metastasizes to secondary lymphoid organs of the gastrointestinal tract, usually with a poor prognosis.
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Affiliation(s)
- Feifei Li
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center, School of Medicine University of Electronic Science and Technology, Chengdu, Sichuan, China
- Collaborative Innovation Centre of Regenerative Medicine and Medical BioResource Development and Application Co-constructed by the Province and Ministry, Guangxi Medical University, Nanning, Guangxi, China
- Department of Oncology & Cancer Institute, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Department of Laboratory Medicine and Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Yiqiang Liu
- Department of Oncology & Cancer Institute, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Department of Laboratory Medicine and Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Ke Xu
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center, School of Medicine University of Electronic Science and Technology, Chengdu, Sichuan, China
| | - Quan Yao
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center, School of Medicine University of Electronic Science and Technology, Chengdu, Sichuan, China
| | - Qiang Li
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center, School of Medicine University of Electronic Science and Technology, Chengdu, Sichuan, China
- *Correspondence: Hong Wu, ; Qiang Li,
| | - Hong Wu
- Sichuan Cancer Hospital & Institute Sichuan Cancer Center, School of Medicine University of Electronic Science and Technology, Chengdu, Sichuan, China
- Department of Oncology & Cancer Institute, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Department of Laboratory Medicine and Sichuan Provincial Key Laboratory for Human Disease Gene Study, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- *Correspondence: Hong Wu, ; Qiang Li,
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Namikawa T, Yokota K, Yamaguchi S, Fukudome I, Munekage M, Uemura S, Maeda H, Kitagawa H, Mibu K, Kobayashi M, Hanazaki K. Spontaneous intra-abdominal hemorrhage of a well-differentiated, grade 3 gastric neuroendocrine tumor during drug-based treatment. Clin J Gastroenterol 2021; 14:1244-1249. [PMID: 33977396 DOI: 10.1007/s12328-021-01433-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/02/2021] [Indexed: 02/08/2023]
Abstract
Grade 3, well-differentiated, gastric neuroendocrine tumors (NET G3) are extremely rare. Herein, we report the case of a 64-year-old man with a grade 3 neuroendocrine tumor of the stomach who experienced intra-abdominal bleeding during the course of drug treatment. The patient was referred to our hospital for examination of a gastric tumor that was initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy revealed an elevated lesion with a central ulcer in the upper body of the stomach, and biopsy specimens confirmed the pathological diagnosis of NET G3. Abdominal contrast-enhanced computed tomography (CT) showed a 25-cm, well-defined mass lesion showing heterogeneous enhancement in the liver. A clinical diagnosis of NET G3 with multiple liver metastases was given, after which everolimus was administered in combination with a somatostatin analogue. However, the patient developed sudden-onset epigastric abdominal pain and general fatigue 2 months later, and emergency abdominal contrast-enhanced CT confirmed the presence of intra-abdominal hemorrhage. Following blood transfusion, the patient's symptoms and general condition improved. Although the patient was treated with streptozocin, abdominal CT indicated progression of the liver metastases. Unfortunately, despite receiving best supportive care, the patient died 8 months after the initial of the treatment. To the best of our knowledge, this is the first case of a patient who developed spontaneous hemoperitoneum during drug treatment for a NET G3 to be reported in the English literature. It is essential that additional data be obtained to determine the optimal treatment for this disease.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sachi Yamaguchi
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kiyo Mibu
- Nursing Department, Kochi Medical School Hospital, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Goto Y, Tobino K, Yoshimine K, Sueyasu T, Okahisa M, Sakabe M, Tsuruno K. An autopsy case of ruptured liver metastases from small cell lung cancer: A case report and literature review. Respir Med Case Rep 2020; 30:101039. [PMID: 32257791 PMCID: PMC7097517 DOI: 10.1016/j.rmcr.2020.101039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/15/2020] [Indexed: 01/04/2023] Open
Abstract
A 50-year-old male presented to our hospital complaining of dry cough and slight fever. A chest CT scan showed a mass in the right upper lung lobe, pleural effusion on both sides, and multiple liver tumors. He was diagnosed with small cell lung cancer (SCLC), and then antitumor chemotherapy was started. Thereafter, his condition deteriorated rapidly, and died 2 days later. An autopsy revealed that the cause of death was ruptured liver metastases. SCLC is a highly invasive disease and often metastasizes to the liver, but the rupture of liver metastases is rare. Clinical features and imaging findings were of a great help in diagnosing ruptured hepatic metastasis. Physicians need to pay attention to this condition, especially after chemotherapy has initiated.
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Affiliation(s)
- Yuki Goto
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
- Corresponding author.
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo; Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kohei Yoshimine
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Masanobu Okahisa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Mitsukuni Sakabe
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
| | - Kosuke Tsuruno
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-0018, Japan
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Hatanaka T, Naganuma A, Saito T, Hoshino T, Kakizaki S, Kumasaka T, Takamoto T, Makuuchi M. Intratumoral Hemorrhage of Liver Metastasis from a Rectal Neuroendocrine Tumor. Intern Med 2019; 58:217-223. [PMID: 30210114 PMCID: PMC6378148 DOI: 10.2169/internalmedicine.1140-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A 56-year-old healthy woman was referred to our hospital for abdominal pain. Contrast-enhanced computed tomography (CT) showed a 14-cm-diameter liver tumor with intratumoral hemorrhage. We performed emergent transcatheter arterial embolization. She was referred to hepatic surgeon (M.M.) for resection. Preoperative colonoscopy showed an elevated lesion measuring 2 cm in diameter that was pathologically diagnosed as a rectal neuroendocrine tumor (NET). We performed low anterior resection of the rectum, followed by extended right hepatectomy for all hepatic lesions. Intratumoral hematoma was observed in the largest hepatic lesion (size: 150 mm×100 mm). Microscopy also indicated NET G2. We pathologically diagnosed a liver tumor from a rectal NET that bled spontaneously.
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Affiliation(s)
- Takeshi Hatanaka
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Japan
| | - Atsushi Naganuma
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Japan
| | - Takahiro Saito
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Japan
| | - Takashi Hoshino
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Japan
| | - Satoru Kakizaki
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Japan
| | - Toshio Kumasaka
- Department of Pathology, Japanese Red Cross Medical Center, Japan
| | - Takeshi Takamoto
- Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation, Japanese Red Cross Medical Center, Japan
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5
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Mochimaru T, Minematsu N, Ohsawa K, Tomomatsu K, Miura H, Betsuyaku T, Murakami M. Hemoperitoneum Secondary to Rupture of a Hepatic Metastasis from Small Cell Lung Cancer during Chemotherapy: A Case with a Literature Review. Intern Med 2017; 56:695-699. [PMID: 28321073 PMCID: PMC5410483 DOI: 10.2169/internalmedicine.56.6828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 65-year-old man was diagnosed with small cell lung cancer with multiple liver metastases. Three days after initiating chemotherapy, he experienced abdominal discomfort with hypotension. Computed tomography revealed a ruptured liver metastasis and the presence of hemorrhagic ascites. Transcatheter arterial embolization to the appropriate hepatic artery in concomitant with supportive therapies successfully stabilized his condition. Unlike with hepatocellular carcinoma, the rupture of a liver metastasis and associated hemoperitoneum is very rare in patients with lung cancer. We comprehensively reviewed the literature and found 10 similar cases with this serious condition. Physicians should therefore be aware of the risk of hemoperitoneum caused by ruptured liver metastases in patients with lung cancer.
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Affiliation(s)
- Takao Mochimaru
- Department of Internal Medicine, Hino Municipal Hospital, Japan
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Fred HL. A Life-Saving Cancer: More on the Double Whammy. Tex Heart Inst J 2016; 43:110-1. [DOI: 10.14503/thij-16-5728] [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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Duan YF, Tan Y, Yuan B, Zhu F. Spontaneous rupture of hepatic metastasis from small cell neuroendocrine carcinoma of maxillary sinus. World J Surg Oncol 2014; 12:126. [PMID: 24767405 PMCID: PMC4006448 DOI: 10.1186/1477-7819-12-126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 04/20/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Small cell neuroendocrine carcinoma of the maxillary sinus, a rare malignant tumor, has a poor prognosis because of its high incidence of metastasis. Moreover, metastatic cancer-induced hepatic rupture, characterized by hemoperitoneum, is infrequent, although several lines of evidences have reported that a wide variety of other neoplasms can cause this usually fatal manifestation. CASE PRESENTATION We now present the first case of a 49-year-old man with spontaneous rupture of hepatic metastasis from small cell neuroendocrine carcinoma of the maxillary sinus and ultimately resulted in massive intraperitoneal bleeding, which was successfully controlled by subsequent surgery (partial hepatectomy). The postoperative clinical manifestation of the patient was uneventful. He was discharged on the 16th day after operation and without any complication. CONCLUSIONS Small cell neuroendocrine carcinoma of the maxillary sinus is very scarce and unfortunately has a poor prognosis. It has potential to cause spontaneous metastatic rupture which can elicit fatal hemorrhage. Emergency surgery is effective, although the long-term outcome is still unsatisfactory.
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Affiliation(s)
| | | | | | - Feng Zhu
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, Changzhou, Jiangsu 213003, China.
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Liu YH, Ma HX, Ji B, Cao DB. Spontaneous hemoperitoneum from hepatic metastatic trophoblastic tumor. World J Gastroenterol 2012; 18:4237-40. [PMID: 22919261 PMCID: PMC3422809 DOI: 10.3748/wjg.v18.i31.4237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/25/2012] [Accepted: 05/26/2012] [Indexed: 02/06/2023] Open
Abstract
Spontaneous hemoperitoneum (SP) is defined as the presence of blood within the peritoneal cavity that is unrelated to trauma. Although there is a vast array of etiologies for SP, primary hepatocellular carcinoma and hepatic adenoma are considered to be the most common causes. Hepatic metastatic tumor associated with spontaneous rupture is rare. SP from hepatic metastatic trophoblastic tumor may initially present with a sudden onset of abdominal pain. Abdominal computed tomography (CT) plays an important role in establishing the diagnosis of SP, indicating its origin and etiology, and determining subsequent management. Herein, we report an uncommon case of hemoperitoneum from spontaneous rupture of a hepatic metastatic trophoblastic tumor in a young female patient. Interestingly, the contrast-enhanced CT findings demonstrated hypervascular hepatic masses with persistent enhancement at all phases, which were completely different from the common appearances of hepatic metastases. For SP resulting from hepatic metastatic tumors, surgical intervention is still the predominant therapeutic method, but the prognosis is very poor.
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Abstract
A variety of abdominal and pelvic tumors can present with rupture leading to hemoperitoneum/hemoretroperitoneum or peritonitis. Imaging plays an important role in the diagnosis of hemorrhage or peritonitis as well as in the detection of ruptured tumors or organs. In this article, we illustrate the imaging findings of ruptured tumors arising in the abdominal and pelvic organs while excluding those of ruptured tumors arising in the stomach and intestines. It is important for the radiologists to understand the mechanisms involved in tumor rupture and recognize the imaging features of ruptured tumors according to the organs involved because this will permit the exact diagnosis of ruptured tumors, thereby facilitating prompt and effective treatment.
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Affiliation(s)
- Sang Won Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyun Cheol Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Dal Mo Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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10
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Seetho IW, Stinchcombe S, Rizeq MM. Bleeding from ruptured hepatic metastases as a cause of syncope in an octogenarian: a case report. J Med Case Rep 2010; 4:194. [PMID: 20579390 PMCID: PMC2905431 DOI: 10.1186/1752-1947-4-194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 06/26/2010] [Indexed: 01/11/2023] Open
Abstract
Introduction Acute hemoperitoneum as a result of hemorrhage from liver metastases is an uncommon but serious condition. The use of appropriate imaging is important in the diagnosis and can have a profound impact on subsequent management. This case is important because the presentation was of recurrent syncopal episodes with an unusual underlying cause. This case highlights the need to consider this diagnosis in the differential in patients presenting with collapse in the acute setting. Case presentation We present the case of an 85-year-old Caucasian man who was admitted following a collapse episode and was found to be persistently hypotensive despite aggressive resuscitation. An acute intra-peritoneal bleed originating from hepatic metastases from an unknown primary was identified promptly with computed tomography imaging and was subsequently managed conservatively. Conclusions This case aims to convey key teaching points: (A) the need to consider intra-abdominal hemorrhage in the differential diagnosis when assessing patients with collapse; and (B) the use of appropriate imaging such as computed tomography can facilitate a prompt diagnosis and appropriate management steps can then be taken accordingly.
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Affiliation(s)
- Ian W Seetho
- Department of Stroke Medicine and Medicine for the Elderly, King's Mill Hospital, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Nottingham NG17 4JL, UK.
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[Hemoperitoneum secondary to spontaneous rupture of metastatic liver of a testicular germ cell tumor]. ACTA ACUST UNITED AC 2008; 31:1150-2. [PMID: 18176377 DOI: 10.1016/s0399-8320(07)78355-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a case of hemoperitoneum secondary to a spontaneous rupture of liver metastases of a testicular germ cell cancer. In clinical practice, some aetiologies must be considered in case of spontaneous hemoperitoneum, mainly rupture of liver tumors: hepatocellular carcinoma or unfrequently benign tumors; the rupture of a metastase is very uncommon. The main interest of this case report is to point to the possibility of curative option in some cases of metastatic diseases.
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Sala Llinàs M, Pagés M, Solé M. [A 73-year-old male with multiple hepatic lesions]. Med Clin (Barc) 2007; 129:551-6. [PMID: 17983535 DOI: 10.1157/13111423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Naganuma H, Funaoka M, Fujimori S, Niwa M, Hirano H, Ishida H, Komatsuda T, Yamada M. Rupture of liver metastasis: report of a case with an emphasis on contrast-enhanced US. J Med Ultrason (2001) 2007; 34:113-6. [PMID: 27278295 DOI: 10.1007/s10396-007-0140-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Accepted: 03/07/2007] [Indexed: 12/15/2022]
Abstract
We present a case of liver metastasis from an uterine leiomyosarcoma in which contrast-enhanced ultrasonography (CEUS) helped determine the bleeding point and prevented a delay in devising diagnostic and therapeutic strategies. CEUS allowed us to differentiate active from nonactive bleeding on the basis of presence or absence of contrast extravasation in the ascites. CEUS is the first examination performed when liver tumor rupture is suspected. Reference to the preangiographic CEUS results is expected to provide a road map for angiography.
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Affiliation(s)
- Hiroko Naganuma
- Department of Internal Medicine, Yokote Municipal Hospital, 5-31 Negishi-cho, Yokote, Akita, 013-8602, Japan.
| | - Masato Funaoka
- Department of Internal Medicine, Yokote Municipal Hospital, 5-31 Negishi-cho, Yokote, Akita, 013-8602, Japan
| | - Shusei Fujimori
- Department of Internal Medicine, Yokote Municipal Hospital, 5-31 Negishi-cho, Yokote, Akita, 013-8602, Japan
| | - Makoto Niwa
- Department of Surgery, Yokote Municipal Hospital, Akita, Japan
| | - Hiroko Hirano
- Department of Radiology, Yokote Municipal Hospital, Akita, Japan
| | - Hideaki Ishida
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita, Japan
| | - Tomoya Komatsuda
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita, Japan
| | - Mamiko Yamada
- Center of Diagnostic Ultrasound, Akita Red Cross Hospital, Akita, Japan
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