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Agnello F, Rabiolo L, Midiri F, Lo Re G, Grassedonio E, La Grutta L, Buscemi S, Agrusa A, Galia M. Focal hepatic intrinsically hyperattenuating lesions at unenhanced CT: Not always calcifications. Clin Imaging 2021; 80:304-314. [PMID: 34482241 DOI: 10.1016/j.clinimag.2021.08.020] [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: 05/20/2021] [Revised: 07/26/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
Due to the growing use of CT, there has been an increase in the frequency of detecting focal liver lesions. Intrinsically hyperattenuating hepatic lesions or pseudolesions are not uncommon at unenhanced CT. Hyperattenuating hepatic lesions can be divided into non-calcified and calcified. Causes of intrinsic hyperattenuation include hemorrhage, thrombosis, and calcifications. Focal liver lesions can show hyperattenuation on unenhanced CT in case of severe liver steatosis. Recognition of etiologies associated with hyperattenuation on unenhanced CT can help the radiologist in characterizing focal liver lesions and pseudolesions. In this paper, we describe the spectrum of intrinsically hyperattenuating focal liver lesions and pseudolesions at unenhanced CT.
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Affiliation(s)
- Francesco Agnello
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Lidia Rabiolo
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Federico Midiri
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Giuseppe Lo Re
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Emanuele Grassedonio
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Ludovico La Grutta
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Massimo Galia
- Section of Radiological Sciences, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Palermo, Italy.
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Matsunaga Y, Ariizumi S, Shibuya G, Uemura S, Kato T, Yazawa T, Yamashita S, Omori A, Higuchi R, Takahashi Y, Kotera Y, Egawa H, Yamamoto M. Hepatocellular carcinoma with ring calcification mimicking hydatid disease: a case report. Surg Case Rep 2020; 6:171. [PMID: 32661725 PMCID: PMC7359204 DOI: 10.1186/s40792-020-00927-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/26/2020] [Indexed: 01/23/2023] Open
Abstract
Background Ring calcification in hepatocellular carcinoma is extremely rare. Untreated hepatocellular carcinoma occasionally includes calcified lesions. Here, we report a case of ring-calcified hepatocellular carcinoma. Case presentation A 60-year-old man with a hepatic tumor was referred to Tokyo Women’s Medical University Hospital. He had a history of chronic hepatitis C. Computed tomography showed a liver tumor 20 mm in diameter in segment 6 of the Couinaud classification, with ring calcification. Based on this uncommon imaging presentation and the patient’s past exposure to the definitive hosts of Echinococcus multilocularis, he was preoperatively diagnosed with echinococcosis. Partial hepatectomy was performed as a radical treatment for echinococcosis. A final diagnosis of hepatocellular carcinoma was confirmed based on pathological findings. The patient was discharged uneventfully. Conclusion The presentation of an extremely rare hepatocellular carcinoma with ring calcification may be disguised as hydatid disease.
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Affiliation(s)
- Yutaro Matsunaga
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Shunichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Go Shibuya
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Shuichiro Uemura
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Takaaki Kato
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Shingo Yamashita
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Akiko Omori
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yutaka Takahashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Yoshihito Kotera
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1Kawada-cho, Shinjuku-ku, Tokyo, Japan.
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Pattarapanawan M, Uemura M, Miyazaki N, Takami S, Tomiyasu H, Tsunekawa N, Hirate Y, Fujishiro J, Kurohmaru M, Kanai-Azuma M, Higashiyama H, Kanai Y. Anatomical and histological characteristics of the hepatobiliary system in adult Sox17 heterozygote mice. Anat Rec (Hoboken) 2020; 303:3096-3107. [PMID: 32478476 DOI: 10.1002/ar.24466] [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] [Received: 07/25/2019] [Revised: 04/04/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
Biliary atresia (BA) is a rare neonatal disease characterized by inflammation and obstruction of the extrahepatic bile ducts (EHBDs). The Sox17-haploinsufficient (Sox17+/- ) mouse is an animal model of BA that encompasses bile duct injury and subsequent BA-like inflammation by the neonatal stage. Most Sox17+/- neonates die soon after birth, but some Sox17+/- pups reach adulthood and have a normal life span, unlike human BA. However, the phenotype and BA-derived scars in the hepatobiliary organs of surviving Sox17+/- mice are unknown. Here, we examined the phenotypes of the hepatobiliary organs in post-weaning and young adult Sox17+/- mice. The results confirmed the significant reduction in liver weight, together with peripheral calcinosis and aberrant vasculature in the hepatic lobule, in surviving Sox17+/- mice as compared with their wild-type (WT) littermates. Such hepatic phenotypes may be sequelae of hepatobiliary damage at the fetal and neonatal stages, a notion supported by the slight, but significant, increases in the levels of serum markers of liver damage in adult Sox17+/- mice. The surviving Sox17+/- mice had a shorter gallbladder in which ectopic hepatic ducts were more frequent compared to WT mice. Also, the surviving Sox17+/- mice showed neither obstruction of the EHBDs nor atrophy or inflammation of hepatocytes or the intrahepatic ducts. These data suggest that some Sox17+/- pups with BA naturally escape lethality and recover from fetal hepatobiliary damages during the perinatal period, highlighting the usefulness of the in vivo model in understanding the hepatobiliary healing processes after surgical restoration of bile flow in human BA.
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Affiliation(s)
| | - Mami Uemura
- Department of Veterinary Anatomy, The University of Tokyo, Tokyo, Japan
| | - Nanae Miyazaki
- Department of Veterinary Anatomy, The University of Tokyo, Tokyo, Japan
| | - Shohei Takami
- Department of Veterinary Anatomy, The University of Tokyo, Tokyo, Japan.,Department of Pediatric Surgery, The University of Tokyo, Tokyo, Japan
| | - Hirotaka Tomiyasu
- Department of Veterinary Internal Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoki Tsunekawa
- Department of Veterinary Anatomy, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Hirate
- Center of Experimental Animal, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Masami Kanai-Azuma
- Center of Experimental Animal, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Higashiyama
- Department of Physiological Chemistry and Metabolism, The University of Tokyo, Tokyo, Japan
| | - Yoshiakira Kanai
- Department of Veterinary Anatomy, The University of Tokyo, Tokyo, Japan
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Zulfiqar M, Shetty A, Tsai R, Gagnon MH, Balfe DM, Mellnick VM. Diagnostic Approach to Benign and Malignant Calcifications in the Abdomen and Pelvis. Radiographics 2020; 40:731-753. [DOI: 10.1148/rg.2020190152] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Anup Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Richard Tsai
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Marie-Helene Gagnon
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Dennis M. Balfe
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
| | - Vincent M. Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110
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Genain MA, Barbosa A, Herrtage M, Watson P. Clinical relevance of radiographic linear branching mineral opacities in the canine liver. J Small Anim Pract 2017; 59:432-437. [PMID: 29210091 DOI: 10.1111/jsap.12797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/17/2017] [Accepted: 09/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the prevalence, clinical significance and breed distribution of linear branching mineralisation superimposed on the hepatic radiographic silhouette in dogs. MATERIALS AND METHODS Retrospective review of radiographs or ultrasound images of dogs showing branching mineralisation in the liver. RESULTS Over the 30-year review period, 17 cases were identified and the mineralisation had a predominantly ventral distribution. Seven of the 17 were cavalier King Charles spaniels, and four of the total 17 dogs were diagnosed with hepatobiliary system disease. Five dogs had repeat radiographs, of which four showed no change in the pattern and one developed the pattern 6 years after being diagnosed with cholangiohepatitis. Serum calcium concentrations were normal in all patients. Liver enzymes were markedly elevated only in the dog diagnosed with cholangiohepatitis. Histology performed on three patients showed no convincing evidence of primary liver disease. CLINICAL SIGNIFICANCE Branching mineralisation in the liver parenchyma is a rare finding in dogs with little or no clinical significance and cavalier King Charles spaniels may be predisposed. Biopsy of the liver of affected dogs with no clinical or clinicopathological evidence of liver disease is unlikely to be helpful in these cases.
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Affiliation(s)
- M-A Genain
- Department of Veterinary Medicine, CB3 0ES, Cambridge, UK
| | - A Barbosa
- Clínica Veterinária de Serralves, 4150-353, Porto, Portugal
| | - M Herrtage
- Department of Veterinary Medicine, CB3 0ES, Cambridge, UK
| | - P Watson
- Department of Veterinary Medicine, CB3 0ES, Cambridge, UK
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Yasutake T, Kiryu S, Akai H, Watadani T, Akahane M, Tomizawa N, Gonoi W, Ikemura M, Takahashi M, Matsuoka Y, Ohtomo K. MR imaging of carcinosarcoma of the liver using Gd-EOB-DTPA. Magn Reson Med Sci 2014; 13:117-21. [PMID: 24769633 DOI: 10.2463/mrms.2013-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We present a case of a 69-year-old man with primary hepatic carcinosarcoma who underwent computed tomography that revealed a hypervascular hepatic tumor with local dense calcification. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging revealed hyperintense lesions in the hepatobiliary phase that indicated hepatocellular carcinoma with bile production. The patient underwent right lobectomy, and the presence of a sarcoma component within the tumor on histopathology confirmed liver carcinosarcoma that included hepatocellular carcinoma. In cases with atypical images that resemble this case, the hyperintensity of a lesion in the hepatobiliary phase aids differential diagnosis.
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Affiliation(s)
- Tsuyoshi Yasutake
- Department of Radiology, Graduate School of Medicine, University of Tokyo
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Abstract
The authors report a 74-year-old man with chronic hepatitis C-related cirrhosis and end-stage renal disease undergoing maintenance haemodialysis who was diagnosed with hepatoma. The hepatoma spontaneously regressed with significantly decreased serum alpha-fetoprotein level without any treatment during the subsequent 4-year follow-up period. However, recurrent hepatomas over bilateral hepatic lobes were evident thereafter, and the patient died later due to hepatic failure. Hepatoma with ring calcification is extremely rare and considered poor differentiation with high risk for recurrence. Spontaneous regression of hepatoma is also rare, while spontaneous regression occurring in a hepatoma with ring calcification is never reported. The definite mechanisms causing spontaneous regression of hepatomas remain unclear, but an immune response toward hepatoma induced by alpha-fetoprotein might play an important role.
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