Benign Liver Tumors Research Articles

Applications of molecular barcode sequencing for the detection of low-frequency variants in circulating tumour DNA from hepatocellular carcinoma.

Liquid biopsy has emerged as a promising tool for minimally invasive and accurate detection of various malignancies. We aimed to apply molecular barcode sequencing to circulating tumour DNA (ctDNA) from liquid biopsies of hepatocellular carcinoma (HCC). Patients with HCC or benign liver disease were enrolled between 2017 and 2018. Matched tissue and serum samples were obtained from these patients. Plasma cell-free DNA was extracted and subjected to targeted sequencing with ultra-high coverage and molecular barcoding. The study included 143 patients: 102 with HCC, 7 with benign liver tumours and 34 with chronic liver disease. No tier 1/2 or oncogenic mutations were detected in patients with benign liver disease. Among the HCC patients, 49 (48%) had tier 1/2 mutations in at least one gene; detection rates were higher in advanced stages (75%) than in early stages (26%-33%). TERT was the most frequently mutated gene (30%), followed by TP53 (16%), CTNNB1 (14%), ARID2 (5%), ARID1A (4%), NFE2L2 (4%), AXIN1 (3%) and KRAS (1%). Survival among patients with TP53 mutations was significantly worse (p=0.007) than among patients without these mutations, whereas CTNNB1 and TERT mutations did not affect survival. ctDNA testing combined with α-fetoprotein and prothrombin induced by vitamin K absence-II analyses improved HCC detection, even in early stages. ctDNA detection using molecular barcoding technology offers dynamic and personalized information concerning tumour biology, such information can guide clinical diagnosis and management. This detection also has the potential as a minimally invasive approach for prognostic stratification and post-therapeutic monitoring.

Benign liver tumours: understanding molecular physiology to adapt clinical management.

Improvements in understanding the pathophysiology of the different benign liver nodules have refined their nosological classification. New criteria have been identified using imaging, histology and molecular analyses for a precise diagnosis of these tumours. Improvement in the classification of liver tumours provides a more accurate prediction of disease progression and has modified patient management. Haemangioma and focal nodular hyperplasia, the most common benign liver tumours that develop in the absence of chronic liver disease, are usually easy to diagnose on imaging and do not require specific treatment. However, hepatocellular adenomas and cirrhotic macronodules can be difficult to discriminate from hepatocellular carcinoma. The molecular subtyping of hepatocellular adenomas in five major subgroups defined by HNF1A inactivation, β-catenin mutation in exon 3 or exon 7/8, and activation of inflammatory or Hedgehog pathways helps to identify the tumours at risk of malignant transformation or bleeding. New clinical, biological and molecular tools have gradually been included in diagnostic and treatment algorithms to classify benign liver tumours and improve patient management. This Review aims to explain the main pathogenic mechanisms of benign liver tumours and how this knowledge could influence clinical practice.

Rare benign liver tumors that require differentiation from hepatocellular carcinoma: focus on diagnosis and treatment.

Recently, an increase in the number of asymptomatic rare benign liver tumors (BLTs) has been reported during health check-ups. It is difficult to determine the nature of partial rare BLTs and not easy to distinguish from malignant liver tumors. This study aimed to analysis clinical features, diagnosis and treatment of rare BLTs to reduce misdiagnosis and provide reference for clinical practice. From January 2012 to January 2021, we treated 112 rare BLTs by hepatectomy, including 54 focal nodular hyperplasias, 14 hepatocellular adenomas, 28 hepatic angiomyolipomas, 3 hepatic granulomas, 2 inflammatory pseudotumors of the liver, 2 nodular regenerative hyperplasia, 2 hepatic lipomas, 1 solitary fibrous tumor of the liver, 1 hepatic schwannoma and 1 hepatic myelolipoma. The majority of patients were middle-aged female and asymptomatic. Single tumors were dominant. The diagnostic accuracies of computed tomography (CT) and magnetic resonance imaging (MRI) were 32.5% and 44.2%, respectively. The majority of tumors were likely to be misdiagnosed as hepatocellular carcinoma (HCC) or difficult to distinguish from HCC. All patients underwent surgical treatment. Postoperative pathological and immunohistochemical examination can confirm the diagnosis. No patients without tumor recurrence or metastasis during follow-up period. Altogether, the clinical symptoms of rare BLTs lack specificity, and their preoperative diagnosis largely depends on imaging examination, with a low diagnostic accuracy rate and high chances of misdiagnosis as HCC. Diagnosis is confirmed by pathological and immunohistochemical examination. Surgical resection for rare BLT is safe and effective, regular postoperative follow-up is necessary.

Digital Staging of Hepatic Hemangiomas Reveals Spatial Heterogeneity in Endothelial Cell Composition and Vascular Senescence.

Hepatic hemangioma (HH) is the most common benign primary liver tumor; however, despite its high prevalence, a stage-specific classification of this tumor is currently missing. For a spatial stage-specific classification, a tissue microarray (TMA) consisting of 98 HHs and 80 hemangioma margins and 78 distant liver tissues was digitally analyzed for the expression of 16 functional and vascular niche-specific markers. For cross-correlation of histopathology and functional characteristics, computed tomography/MRI imaging data of 28 patients were analyzed. Functional and morphological analyses revealed a high level of intra- and interpatient heterogeneity, and morphological heterogeneity was observed with regard to cellularity, vascular diameter, and endothelial cell subtype composition. While regressed hemangiomas were characterized by low blood vessel density, low beta-catenin levels, and a microvascular phenotype, non-regressed HHs showed a pronounced cellular and architectural heterogeneity. Functionally, cellular senescence-associated p16 expression identified an HH subgroup with high vascular density and increased lymphatic endothelial cell content. Histological HH regions may be grouped into spatially defined morphological compartments that may reflect the current region-specific disease stage. The stage-specific classification of HHs with signs of regression and vascular senescence may allow a better disease course-based and cell state-based subtyping of these benign vascular lesions.

P-227 Overexpression of survivin-1, TAG-72 and HERC5 in patients diagnosed with hepatocellular carcinoma in the Black Sea Coast geographical area

Epidemiological data regarding hepatocellular carcinoma (HCC) report unsatisfactory morbimortality rates despite the global efforts to decrease the incidence and prolong patient survival. Current guidelines lack diagnostic biomarkers to better characterize patients with HCC. We aimed to validate the overexpression of Survivin-1, tumor-associated glyocoprotein 72 (Tag-72), and HECT and RLD domain containing E3 ubiquitin protein ligase 5 (HERC5) as tissue biomarkers for HCC characterization in patients from our geographical area and to standardize a local biomarker panel to be introduced in the current management guideline. Thirty liver specimens of HCC and a similar number of liver tissue specimens of benign liver tumors were selected from the Gastroenterology file database and Pathology Clinic registries from St. Apostle Andrew Emergency Clinical Hospital, Constanta and Fundeni Institute, Bucharest and compared in terms of Survivin-1, Tag-72, and HERC5 overexpression. The morphological features of the tumors were noted based on the WHO Histological Classification for digestive tumors. Demographic data of all patients providing the liver specimens, as well as liver diseases background like chronic viral infections, other co-morbidities and laboratory parameters recorded at the time of hospital admission were noted. For the IHC assessment, the representative samples were chosen, and 4-μm sections of formalin-fixed, paraffin-embedded tissue blocks were obtained for each case enrolled. Epitope retrieval was conducted prior to incubation of tissue sections with a panel of three primary antibodies (ready-to-use) from Novus Biological: survivin-1 (NB100-911 clone), Tag-72 (CC49 clone), and HERC5 (NBP-91985 clone). The immunostaining protocol for each antibody used was provided by the manufacturer. As chromogen, we used 3,3'diaminobenzidine (DAB), and brown staining was obtained. The final step was represented by counterstaining all slides with Mayer's Hematoxylin. Comparisons of the studied biomarker overexpression from HCC tissue samples with a matched non-HCC group of normal liver tissue specimens were made.Student t-test, Mann-Whitney U-test and Chi-square test were used to find differences between the two studied groups and to compare the categorical variables. The discriminative power of Survivin -1, Tag-72, and HERC5 overexpression was assessed using ROC curves. The multivariate linear regression analysis revealed that Survivin-1, Tag-72, and HERC5 were significantly overexpressed upon IHC analysis in HCC samples in patients older than 50 years (P=0.003, P=0.006, P=0.004), male gender (P=0.031, P=0.004, P=0.020), patients with increased AFP over 180 ng/dl (P=0.012, P=0.004, P=0.029), with low serum albumin < 3 mg/dl (P=0.031, P=0.021, P=0.003, respectively), with imaging features of portal thrombosis (P=0.004, P=0.020, P=0.004, respectively), ascites (P=0.002, P=0.004, P=0.019, respectively) and in BCLC B and C classes patients (P=0.045, P=0.036, P=0.045, and P=0.033, P=0.001, P=0.027, respectively). The diagnostic performance of Survivin-1, Tag-72 and HER-C5 tissue biomarkers for HCC characterization was superior to that of AFP, considered the gold standard biomarker used in clinical guidelines (Survivin-1: Z statistic=2.911, P=0.0039; Tag-72: Z statistic=2.789, P=0.0049, respectively; HERC5: Z statistic=2.844, P=0.0043) and AFP assay alone (Z statistic=5.022, P < 0.0001). Our study results validate the overexpression of Survivin-1, Tag-72, and HERC5 as tissue biomarkers for HCC characterization in patients from our geographical region and could be standardized in the current HCC management guideline.

Combined surgical treatment of giant cavernous hepatic hemangioma: A case report.

Introduction and importanceHepatic hemangiomas are the most common benign liver tumors, which in most cases are small in size and do not require specific treatment. Giant hepatic hemangiomas are a rare pathology. The purpose of this report is to demonstrate the case of combined treatment of giant hepatic hemangioma.Case presentationA man of the Caucasian race, 37 years old, appealed to the clinic with a complaint about the presence of palpable abdominal mass. During the examination a giant cavernous hemangioma of the left lobe of the liver with a vertical size of up to 210 mm was discovered. Endovascular transarterial embolization (ETE) of tumor-feeding hepatic artery followed by radical surgery on mass removal is performed.Clinical discussionGiant hemangiomas often cause compression of nearby structures and cause symptoms such as pain, abdominal discomfort, nausea, early food saturation, etc. Cases of spontaneous rupture of cavernous hemangioma, including fatal outcome, are also described. We suggest that some patients should go through surgical treatment even if they do not have any complaint.ConclusionsOur experience shows that endovascular embolization of the hepatic arteries can be effectively applied as a pre-surgical preparation method in order to reduce hemangioma size and blood loss volume during surgical intervention.

Spontaneous evolution patterns of focal congenital hepatic hemangiomas: a case series of 25 patients.

Hepatic hemangiomas are the most common benign liver tumors of infancy. They are termed congenital if fully developed at birth or infantile if they appear in the first weeks of life. Previous studies suggested that most focal hepatic hemangiomas are congenital in nature, exhibit no postnatal growth and have an evolution that parallels their cutaneous counterparts. They are subdivided by pattern of involution, whether rapidly involuting (RICH), partially involuting (PICH) or non-involuting (NICH) congenital hemangiomas. In our experience, some focal hepatic hemangiomas show postnatal growth, behaving like infantile forms. To analyze the spontaneous evolution of focal congenital hepatic hemangiomas with quantification of tumor volume changes over time and to identify initial postnatal ultrasound (US) imaging biomarkers predictive of their evolution pattern. A retrospective review of clinical, imaging and pathology data of children diagnosed with focal congenital hepatic hemangioma (prenatal diagnosis or age at diagnosis <7days and/or glucose transporter protein 1 [GLUT1]-negative tumor) diagnosed between 2000 and 2018 was performed with analysis of tumor volume changes over time. Exclusion criteria were treatment inducing a tumor volume change (hepatic artery embolization, propranolol, or corticosteroids), imaging follow-up less than 1month or fewer than two US examinations. Volumetric analysis was based on US and cross-sectional imaging. Lesion volumes were estimated using the standard ellipsoid formula. A 35% margin of error was assumed for tumor volume variation to account for variability in measurements. Imaging studies, including US, computed tomography, and magnetic resonance imaging, were reviewed and initial postnatal US features were correlated with evolution pattern. Twenty-five patients with focal congenital hepatic hemangiomas were included. The median follow-up time was 46.5months (range: 4-144months). Eight (32%) lesions showed postnatal growth before involuting, without signs of intralesional hemorrhage, as do cutaneous infantile hemangiomas. The other 17 (68%) lesions exhibited a strict decrease in volume with age, of which 15 underwent complete involution (8 before age 18months and 7 after age 18months) and 2 underwent partial involution. The different evolution patterns of focal congenital hepatic hemangiomas showed overlapping imaging features and we found no initial US feature to be significantly associated with postnatal growth. However, large vascular spaces with marked vascularity at US were noted in three of the eight rapidly involuting lesions. Focal congenital hepatic hemangiomas are not the equivalent of cutaneous RICH, as some may increase in size and tumor regression may be rapid or slow. The different evolution patterns of focal congenital hepatic hemangiomas show overlapping US features.

Medicolegal Sidebar: Are Implant Sales Reps in the Operating Room Legally Untouchable?

Medicolegal Sidebar: Are Implant Sales Reps in the Operating Room Legally Untouchable?

An Extreme Case of Liver Adenomatosis: Are They All the Same?

Hepatocellular adenoma (HCA) is a rare and benign liver tumor that affects predominantly young and middle-aged women, especially between 30–40 years old. Liver adenomatosis (LA) is defined as the presence of 10 or more HCA. There are authors that report eight different subtypes of HCA, that correlates with clinical and histopathological features, being the inflammatory subtype the most common. We present a case of a 32-year-old Caucasian woman with a history of self-limited episodes of right abdominal pain and an abdominal ultrasound with multiple hypoechogenic liver nodules, suspected of metastasis. She was taking combined oral contraceptive for 6 years. Magnetic Resonance Imaging (MRI) disclosed around 40 nodules, suggestive of HCA. Liver biopsy confirmed HCA, inflammatory subtype. Oral contraceptive was stopped and control MRI 6 months later disclosed reduction of nodules’ dimensions. Management of patients with LA should be based on the size of the largest tumor, as clinical presentation and risk of bleeding or malignancy do not differ between patients with single or multiple HCAs. However, even with biopsy, there is a risk of missampling, raising concern about the real risk of bleeding and malignant potential in patients with different subtypes coexisting in the same liver.

Cost analysis of robotic versus open hepatectomy: Is the robotic platform more expensive?

The robotic platform is perceived to be more expensive when compared to laparoscopic and open operations. We aimed to compare the perioperative costs of robotic vs. open hepatectomy for the treatment of liver tumors at our facility. We followed 370 patients undergoing robotic and open hepatectomy for benign and malignant liver tumors. Demographic, perioperative, cost and payment data were collected and analyzed. For illustrative purposes, the data were presented as median (mean ± SD). Two hundred sixty-seven robotic and 104 open hepatectomies were analyzed. There were no significant differences in perioperative variables between the two cohorts. The robotic group had a significantly lower estimated blood loss (EBL) (135 [208 ± 244.8] vs 300 [427 ± 502.5] ml, p < 0.0001), smaller lesion size (4 [5 ± 3.6] vs 5[6 ± 4.9] cm, p = 0.0052), shorter length of stay (LOS) (4 [4 ± 3.4] vs 6[8 ± 5.7] days, p < 0.0001) and decreased 90-day mortality (3 vs 7 p = 0.0028). There were no significant differences between the two groups any cost variable. The open group received significantly higher reimbursement ($29,297 [62,962 ± 75,377.96] vs $19,102 [38,975 ± 39,362.11], p < 0.001) and profit ($5005 [30,981 ± 79,541.09] vs $- 6682 [6146 ± 40,949.65], p < 0.001). Robotic hepatectomy is associated with lower EBL, shorter LOS and less mortality. There was no greater cost associated with the robotic platform despite a reduced reimbursement and profit.

Benign Hepatic Tumors and Liver Transplantation: A Literature Review.

Management of benign liver tumors represents still an open debate, with no clear guidelines for patient selection,treatment options, and indications to surgical intervention. Usually, most of these diseases are conservatively treated, in view of their low potential malignancy and incidental diagnosis. However, when the lesions are symptomatic, with a major hepatic parenchyma involvement or life-threatening complications, liver transplant represents the only curative option. The scope of this review is to present an up-to-date state of the art of transplantable benign hepatic neoplasms.

Study Protocol for a Multicenter Nationwide Prospective Cohort Study to Investigate the Natural Course and Clinical Outcome in Benign Liver Tumors and Cysts in The Netherlands: The BELIVER Study

Introduction: Benign liver tumours and cysts (BLTCs) comprise a heterogeneous group of cystic and solid lesions, including hepatic hemangioma, focal nodular hyperplasia and hepatocellular adenoma. Some BLTCs, for example (large) hepatocellular adenoma, are at risk of complications. Incidence of malignant degeneration or hemorrhage is low in most other BLTCs. Nevertheless, the diagnosis BLTC may carry a substantial burden and patients may be symptomatic, necessitating treatment. The indications for interventions remain matter of debate. The primary study aim is to investigate patient reported outcomes (PROs) of patients with BLTCs, with special regard to the influence of invasive treatment as compared to the natural course of the disease. Methods and analysis: A nationwide observational cohort study of BLTC patients will be performed between August 2021 and August 2026. Inclusion will be open from August 2021 until August 2025. During surveillance, a questionnaire regarding symptoms and their impact will be sent to participants on a biannual basis and more often in case of invasive intervention. The questionnaire was previously developed based on patient reported outcomes (PROs) considered relevant to patients with BLTCs and their caregivers. Most questionnaires will be administered by computerized adaptive testing through the Patient-Reported Outcomes Measurement Information System (PROMIS). Data, such as treatment outcomes, will be extracted from electronic patient files. Multivariable analysis will be performed to identify patient and tumour characteristics associated with significant improvement in PROs or a complicated postoperative course.

Relief of Symptoms and Quality of Life after Conservative versus Surgical Treatment of Benign Liver Tumors (CONSULT): A Retrospective Propensity Score Matched Study

Introduction: Surgery can be considered for patients with benign liver tumours (BLTs) with risk of malignancy, complications, or severe symptoms. The effect of surgery on symptoms and quality of life (QoL) remains debatable. The aim of this study was to compare symptoms and QoL after surgical or conservative management of BLTs. Methods: In this dual-site retrospective study, adult patients with hepatocellular adenoma, focal nodular hyperplasia, or haemangioma diagnosed between 2000 and 2019 were included. SumScores and general QoL scores at follow-up were compared between propensity-score matched, surgically and conservatively managed patients. Higher scores indicate more symptoms and a higher QoL, respectively. Results: Among 221 included patients, 50 (22.6%) were treated surgically and 171 (78.4%) conservatively. Surgical patients were younger, with lower baseline QoL, and more often had left-sided and larger tumours. At follow-up, median 91-100 months after diagnosis, surgical patients had higher SumScores (mean difference 9.2, 95%CI 1.0-17.4, p=0.028) but not higher general QoL scores (p=0.331) than their propensity-score matched, conservatively treated counterparts. Surgical patients also had higher emotional (p=0.010) and cognitive (p=0.009) functioning scores, less insomnia (p=0.026), less appetite loss (p=0.012), less bloating (p=0.006), less weight gain (p=0.035) and less pain (p=0.027). Most reported stable, improved or disappearance of symptoms (41/47 patients) and would undergo surgery again (44/47 patients). Conclusion: More than seven years after diagnosis, surgical patients had less symptoms than conservatively managed patients, although QoL was not significantly different. These results may support currently available recommendations and further guide treatment selection.

Infantile hepatic hemangioma complicated consumptive hypothyroidism

Infantile hepatic hemangioma (IHH) is the most common benign liver tumor in infancy, some life-threatening complications like abdominal compartment syndrome, consumptive hypothyroidism and cardiac failure may occur in these patients. Hypothyroidism should be focused on and managed earlier to prevent intellectual and growth retardation. We described a 4 months old infant complaint of progressive abdominal distention, who was diagnosed with diffuse hepatic hemangiomas by ultrasonography and MRI, treated successfully with propranolol and levothyroxine for consumptive hypothyroidism. At 8 months old levothyroxine was stopped, she grew up with a normal growth trajectory and neurodevelopment at her last follow-up at the age of 13 months. Our study suggests that thyroid function should be evaluated even though negative neonatal screen and propranolol should be first-line agent for diffuse IHH. It is instrumental that simultaneous anti-tumor and thyroid replacement make diffuse IHH patients with consumptive hypothyroidism recovery better.

Liver transplantation for benign liver tumors.

Benign liver tumors are common lesions that are usually asymptomatic and are often found incidentally due to recent advances in imaging techniques and their widespread use. Although most of these tumors can be managed conservatively or treated by surgical resection, liver transplantation (LT) is the only treatment option in selected patients. LT is usually indicated in patients that present with life-threatening complications, when the lesions are diffuse in the hepatic parenchyma or when malignant transformation cannot be ruled out. However, due to the significant postoperative morbidity of the procedure, scarcity of available donor liver grafts, and the benign course of the disease, the indications for LT are still not standardized. Hepatic adenoma and adenomatosis, hepatic hemangioma, and hepatic epithelioid hemangioendothelioma are among the most common benign liver tumors treated by LT. This article reviews the role of LT in patients with benign liver tumors. The indications for LT and long-term outcomes of LT are presented.

Artificial intelligence for hepatitis evaluation.

Recently, increasing attention has been paid to the application of artificial intelligence (AI) to the diagnosis of diverse hepatic diseases, which comprises traditional machine learning and deep learning. Recent studies have shown the possible value of AI based data mining in predicting the incidence of hepatitis, classifying the different stages of hepatitis, diagnosing or screening for hepatitis, forecasting the progression of hepatitis, and predicting response to antiviral drugs in chronic hepatitis C patients. More importantly, AI based on radiology has been proven to be useful in predicting hepatitis and liver fibrosis as well as grading hepatocellular carcinoma (HCC) and differentiating it from benign liver tumors. It can predict the risk of vascular invasion of HCC, the risk of hepatic encephalopathy secondary to hepatitis B related cirrhosis, and the risk of liver failure after hepatectomy in HCC patients. In this review, we summarize the application of AI in hepatitis, and identify the challenges and future perspectives.

Hepatocellular Adenoma Risk Factors of Hemorrhage: Size Is Not the Only Concern!: Single-center Retrospective Experience of 261 Patients.

Our aim was to determine independent risk factors of clinical bleeding of hepatocellular adenoma (HCA) to define a better management strategy. HCA is a rare benign liver tumor with severe complications: malignant transformation that is rare (5%-8%) and more often, hemorrhage (20%-27%). To date, only size > 5 cm and histological subtype (possibly sonic hedgehog) are associated with bleeding, but these criteria are not clearly established. We retrospectively collected data from a cohort of 268 patients with HCA managed in our tertiary center, from 1984 to 2020 and focused on clinical bleeding. Hemorrhage was considered severe when it required intensive care and moderate when bleeding symptoms required a hospitalization. We included 261 patients, of whom 130 (49.8%) had multiple HCAs or liver adenomatosis. All surgical specimen and liver biopsy were reviewed by an experienced liver pathologist and reclassified in the light of the current immunohistochemistry. Mean duration of follow-up was 93.3 months (range 1-363). We analyzed type, frequency, consequences of bleeding, and risk factors among clinical data and HCA characteristics. Eighty-three HCA (31.8%) were hemorrhagic. There were 4 pregnant women with 1 newborn death. One patient died before treatment. Surgery was performed in 78 (94.0%) patients. Mortality was nil and severe complications occurred in 11.5%. Multivariate analysis identified size (OR 1.02 [1.01-1.02], P < 0.001), shHCA (OR 21.02 [5.05-87.52], P < 0.001), b-catenin mutation on exon 7/8 (OR 6.47 [1.78-23.55], P = 0.0046), chronic alcohol consumption (OR 9.16 [2.47-34.01], P < 0.001) as independent risk factors of clinical bleeding. This series, focused on the hemorrhagic risk of HCA, shows that size, but rather more molecular subtype is determinant in the natural history of HCA.

Contrast-Enhanced Ultrasound in the Diagnosis of Ocular Pathology: Application Prospects

Contrast-enhanced ultrasound is a highly informative method for the differential diagnosis of focal changes in various organs and tissues, which allows to visualize vascular structures and obtain new previously unavailable information when using standard b-scan. At the beginning of the 21st century after the development of a new generation of contrast agents consisting of microbubbles with inert gas contrast-enhanced ultrasound became widely used to improve visual assessment of small-caliber vessels in the diagnosis of the abdominal cavity and retroperitoneal space pathology: benign and malignant liver formations, spleen pathology, inflammatory diseases and tumors of the pancreas, defects in renal perfusion, tumor and cystic lesions of the kidneys. Assessment of intraocular tumors microcirculation and diagnosis of vitreoretinal pathology are still two main directions of using contrast-enhanced ultrasound in ophthalmology. In recent years, there has been a growing interest in the use of contrast-enhanced ultrasound in the study of perfusion of different types of uveal melanoma in an animal experiment. A promising direction in the field of genetic engineering is the use of local contrast-enhanced ultrasound exposure on retinal cells (retinal ganglion cells, retinal pigment epithelium) to promote gene transfection (non-viral nucleic acid delivery into the DNA of a cell), which is an important part of gene therapy. Despite the successes achieved in the study of contrast-enhanced ultrasound effectiveness in medicine, further research is needed to increase the informative value of this method in the diagnosis of ophthalmopathology.

Imaging Characteristics and Management of Infected Hepatic Hemangioma: Case-in Discussion

AbstractHepatic hemangiomas are the most common type of benign liver tumors. We present a case of an infected hepatic hemangioma, which posed a diagnostic challenge. A 43-year-old female presented with right upper quadrant pain after blunt force trauma and intentional weight loss. CT and MRI were done, showing a posterior right lobe liver mass. Imaging characteristics were thought to be suggestive of metastatic disease, with a differential diagnosis of abscess. Drainage and biopsy of the mass revealed Streptococcus sp. infection, and pathology showed a cavernous hemangioma with inflammation. Patients presenting with systemic symptoms and an indeterminate liver mass on imaging should be evaluated for infected hepatic hemangiomas. Biopsy may be needed to rule out cancer. Management may include surgical resection; however, antibiotics and percutaneous drainage can suffice, as in this case.

466 Resection or Enucleation for Extremely Giant Hepatic Haemangiomata? A Case Report and Review of The Literature

Abstract Background Cavernous hepatic haemangiomas are benign liver tumours and although common when small, giant haemangiomas (usually accepted as being greater than 10cm) are infrequent. Treatment is indicated in patients who are symptomatic or if diagnosis is unclear, although with giant haemangiomas, many support expectant management of asymptomatic lesions due to the risk of major complications. Traditionally hepatic resection has been the primary treatment option for these lesions, but a variety of other techniques, including enucleation, have been described as safe and effective alternatives. There remains equipoise in respect of the best management of giant haemangiomas above 10cm. Cases of such size are rare and so there is a paucity of data available. Case presentation We present a case of a 65-year-old male who underwent successful anatomical liver resection for a 5kg giant cavernous haemangioma of 26cm diameter following its incidental identification during an ultrasound scan. We also discuss and compare the role of resection and enucleation for the treatment of haemangiomata greater than 20cm in diameter. Conclusions This case demonstrates successful resection of an unusually giant haemangioma which, in contrast to the majority of literature, provides a valuable addition to the limited evidence base for management of this condition by anatomical resection.