Benign Liver Tumors Research Articles

Automatic Classification of Benign And Malignant Liver Tumors In Ultrasound Images

Introduction: Differentiation of benign and malignant liver tumors is very important for finding appropriate treatment procedure. Human eyes sometime are not able to diagnose the type of liver tumor. Texture analysis is considered as a suitable method to increase the diagnostic power of medical images. In this study texture analysis is employed in order to classification of benign and malignant liver tumors in ultrasound images. Materials and Methods: Our study was performed on 38 patients (25 malignant and 13benign). After selection of proper ROI, about 270 parameters were extracted from each ROI. Fisher algorithm was employed for selection of the best discriminating features. Three analysis methods (PCA, LDA and NDA) were performed at the last stage. Statistical analysis of data was performed by Receiver Operating Characteristic (ROC). Results: The result of our study was very plausive. The best discrimination result was belong to NDA with sensitivity and specificity of 100%. PCA and LDA also had good results (sensitivity of 97% and 98% respectively). Conclusion: This study show that texture analysis is able to classify benign and malignant liver tumors in US images with the high performance quality. Therefore, texture analysis may be a useful method for classification of benign and malignant liver tumors.

Contrast-Enhanced Ultrasound of Benign Focal LiverLesions.

The diagnostic handling of benign focal liver lesions (FLLs) is a challenge and it is difficult to avoid over- and underdiagnosis. Conventional B-mode ultrasound and contrast-enhanced ultrasound (CEUS) are the first-line imaging methods to detect and characterize FLLs. This CME article discusses the diagnostic workup of benign liver tumors.

A Case of Hepatic Adenoma With Imaging Suggestive of Fibrolamellar Hepatocellular Carcinoma

Introduction: Hepatic (Hepatocellular) adenomas are uncommon benign liver tumors that occur more in women of child-bearing age and are strongly associated with glycogen storage diseases, and intake of OCPs or anabolic steroids. Here, we report the case of a woman with a large hepatic adenoma and imaging findings mimicking fibrolamellar hepatocellular carcinoma. Case report: A 37 year-old female with a history of Protein C deficiency, and chronic lower extremity lymphedema presented with several weeks of intermittent right upper quadrant pain, described as dull and radiating to her back. Patient denied any history of liver disease, alcohol abuse or OCPs use. Clinical examination showed hepatomegaly with liver edge palpated at the level of umbilicus. Initial work up included complete blood count, electrolytes, urine analysis and liver function tests which were all within normal limits. Abdominal ultrasound showed a large liver mass. An MRI liver with gadolinium contrast showed the same mass with nonspecific imaging appearance. Triple-phase contrasted CT showed a heterogeneously arterial hyper-enhancing mass with portal venous and delayed washout centered within segments 4, 5 and 8 (images 1 and 2). Alpha fetoprotein was within the normal range, and viral hepatitis panel was negative. Patient underwent a right trisegmentectomy with Roux-en-Y hepaticojejunostomy. Discussion: Hepatic adenoma is a benign liver tumor seen predominantly in young women, with a small risk of malignant transformation. It is typically asymptomatic but can present with pain or a palpable mass, or with spontaneous rupture and hemorrhage. Long-term use of estrogen or androgens is the main risk factor for hepatic adenoma, and the yearly incidence varies from 1 per million in women not on OCPs to 3.4 per 100000 in those taking OCPs. The diagnosis is made based upon the combination of the clinical setting and imaging, or pathology. Adenomas typically show initial peripheral enhancement and subsequent centripetal enhancement on contrasted CT, but in this case CT findings described above in combination with patient's age and lack of preexisting liver disease suggested possible fibrolamellar hepatocellular carcinoma, a rare primary malignant liver tumor affecting young patients with a possible female predominance. In this case, given the lesion size and associated symptoms, surgery was performed, with pathology confirming the diagnosis of hepatic adenoma.2373_A Figure 1 No Caption available.2373_B Figure 2 No Caption available.

Hepatoblastoma misdiagnosed as infantile hemangioendothelioma in a child – a case report

Infantile hemangioendothelioma (IHH) is the most common benign tumor of the liver in children, which accounts for 12% of all pediatric liver tumors, and hepatoblastoma (HBL) is the most common malignant liver tumor in children. Although they share some clinical manifestations, the treatment strategies and prognoses are quite different. The most important alternative diagnosis to IHH in children is HBL. Histopathologic confirmation of a radiologically suspected hemangioendothelioma is often obtained before medical treatment is initiated. We are presenting here a case of HBL in a 2-year-male child misdiagnosed as having IHH on imaging studies.

The Comparison of the Effect of Mannitol and N Acetyl Cysteine on Liver Function in Partial Hepatectomy.

The alterations in liver function in patients after major liver resection are complex. Partial hepatectomy surgery is considered as a selective therapeutic approach in many benign and malignant liver tumors, secondary metastases, and liver trauma. According to surgical techniques most often based on vascular control and hepatic venous closure (Pringle maneuver), related complications such as ischemia and decreased venous return during and after surgery can be seen. In this study, the effects of Mannitol and N-acetylcysteine, on liver function, after hepatectomy surgery, were compared. This study was shown that infusion N-acetylcysteine next to mannitol, in partial hepatectomy surgeries, was not the significant difference to improve liver function, hemodynamic status, and laboratory tests.

Outcomes of laparoscopic and open surgery for benign liver tumours, with emphasis on symptoms and quality of life. a systematic review

Background: Symptomatic benign liver tumours (BLT) may be an indication for surgery. Surgical treatment exists of laparoscopic and open liver resection. However, surgical outcomes have never been compared before in a systematic review, as well as the influence of type of surgery on relief of symptoms and quality of life (QOL). Methods: Two independent reviewers performed a systematic literature search in Pubmed and Embase. All articles on surgery for symptomatic BLT were abstracted. Methodological quality was evaluated using the MINORS tool. Outcomes were divided in open and laparoscopic. Results: A total of 69 articles were analysed, including 4913 patients receiving surgery for BLT. 3749 patients received open surgery and 1164 laparoscopic. A total of 1022 major resections were performed: 581 open and 33 laparoscopic. Blood loss, operative time and length of hospital stay were respectively 457ml, 183min and 8,2days for open surgery, versus 124ml, 146 min and 6,4days for laparoscopic. The most common indication for surgery was symptoms: 61,9%. Overall, symptoms decreased from 69% preoperative to 16% postoperative. 2 out of 14 studies using a validated QOL questionnaire reported an advantage for laparoscopy, 12 didn't report differences. A total of 309 complications were reported: (7,2%) open and (3,7%) laparoscopic. Conclusion: Blood loss, operative time, length of hospital stay and complications were less for laparoscopic surgery, which can be explained by the majority of minor resections. However, as the percentages of complications are still far apart, it could be considered to perform more extensive laparoscopic surgery for BLT in selected patients.

Molecular and clinical characterization of citrin deficiency in a cohort of Chinese patients in Hong Kong

Background and objectives: This retrospective study analysed a case series of subjects with citrin deficiency, and aims to present the molecular and clinical characterization of this disease in the Hong Kong Chinese population for the first time. Patients and Methods: Data from medical records of eighteen patients with citrin deficiency (years 2006–2015) were retrieved. Demographic data, biochemical parameters, radiological results, genetic testing results, management, and clinical outcome were collected and analysed. Results: Eighteen patients with diagnosis of citrin deficiency were recruited. All 18 patients carried at least one common pathogenic variant c.852_855delTATG in SLC25A13. Prolonged jaundice (neonatal intrahepatic cholestasis caused by citrin deficiency, NICCD) was the most common presenting symptom, in conjunction with elevated plasma citrulline, threonine, alkaline phosphatase, and alpha-fetoprotein levels. The abnormal biochemical parameters including liver derangement returned to normal range in most of the cases by 6 months of age after the introduction of a lactose-free formula. There were a few cases with atypical presentations. Two subjects did not present with NICCD, and were subsequently diagnosed later in life after their siblings presented with symptoms of citrin deficiency at one month of age and subsequently received a molecular diagnosis. One patient with citrin deficiency also exhibited multiple liver hemangioendotheliomas, which subsided gradually after introduction of a lactose-free formula. Only one patient from this cohort was offered expanded metabolic screening at birth. She was not ascertained by conducted newborn screening and was diagnosed upon presentation with cholestatic jaundice by 1 month of age. Conclusion: This is the first report of the clinical and molecular characterization of a large cohort of patients with citrin deficiency in Hong Kong. The presentation of this cohort of patients expands the clinical phenotypic spectrum of NICCD. Benign liver tumors such as hemangioendotheliomas may be associated with citrin deficiency in addition to the well-known association with hepatocellular carcinoma. Citrin deficiency may manifest in later infancy period with an NICCD-like phenotype. Furthermore, this condition is not always ascertained by expanded newborn metabolic screening testing.

Benign liver tumors. New approach and experience in 145 patients

Benign liver tumors. New approach and experience in 145 patients

Liver resection for benign solid liver tumors: patient characteristics, indications and outcomes

Liver resection for benign solid liver tumors: patient characteristics, indications and outcomes

Incidental intraoperative multiple bile duct adenomas found in conjunction with hepatocellular carcinoma

Literature reviews from 1999-2016 determined bile duct adenoma (BDA) to be a very rare benign tumor. BDA usually presents as a single nodular lesion, most often found incidentally and is very difficult to distinguish from hepatocellular carcinoma (HCC) on imaging. We present a case of multiple BDAs in a patient with a known HCC. Patient is a 65-year-old male, non-cirrhotic, cured hepatitis C after Harvoni treatment, with one 4.0 cm lesion found on CT in segment 6. Due to the difficulty of diagnosis based on CT and MRI, biopsy was performed and confirmed HCC. Intra-operatively four other nodular lesions, in addition to the 4.0 cm HCC, were found involving both lobes of the liver surface. Sizes varied from 3 to 7 mm, intraoperative ultrasound did not view other lesions. Intraoperative diagnosis was one HCC with four other small HCCs, possible HCC intrahepatic metastasis. Partial liver resection with several liver wedge resections was performed, all lesions were resected and the patient recovered well. Pathology results showed 4cm HCC in segment 6 and four small (< 1cm) BDAs of segments 2, 3, 6, and 7. BDA is a rare benign liver tumor, usually a small (< 5mm) singular lesion and rarely presents together with HCC. Our case showed multiple BDAs can coexist with HCC. From our literature search, this has never been reported. This is the first case of multiple BDAs in conjunction with HCC. Increased knowledge and awareness is essential to appropriately diagnose and treat patients.

Feasibility, safety, and efficacy of ultrasound-guided percutaneous microwave ablation for giant hepatic hemangioma

Background: Hepatic hemangioma is a common benign liver tumor. The majority of cases are asymptomatic and require no specific treatment. The aim of this study was to evaluate the feasibility, safety and efficacy of microwave ablation (MWA) for symptomatic or enlarging giant hepatic hemangioma (≥10 cm).Methods: From December 2013 to June 2016, 12 patients with giant hepatic hemangioma (≥10 cm) underwent ultrasound-guided percutaneous MWA, and ablation-related complications were observed. All patients were followed up with magnetic resonance or enhanced CT imaging at one month postoperatively to evaluate efficacy.Results: This study included a total of 13 giant hepatic hemangiomas (mean: 11.7 ± 1.6 cm) in 12 patients who initially underwent 16 sessions of MWA; three lesions were treated with two sessions of planned ablation. The average ablation time for a single hepatic hemangioma was 39.0 ± 14.4 minutes. Two patients had acute postoperative non-oliguric renal insufficiency without intra-abdominal hemorrhage, liver failure or other complications. Initially, complete ablation was achieved in ten lesions in nine patients (76.9%, 10/13). One patient underwent a second session of MWA at 5 months postoperatively due to fast growing residual tissue; complete necrosis was achieved after treatment. The remaining two cases did not receive any invasive treatment due to small residual volumes. The total complete ablation rate was 84.6% (11/13).Conclusion: Image-guided MWA is a safe, feasible, effective treatment for giant hepatic hemangioma; these findings may open a new avenue for treatment.

Regression of hepatocellular adenoma after bariatric surgery in severe obese patients.

Obesity and metabolic syndrome are increasingly recognized as risk factors for hepatocellular adenomas (HCA). There is still sparse evidence whether weight loss or bariatric surgery could induce HCA regression in these patients. In this brief report we describe the effect of weight loss on HCA regression in severe obese patients that had undergone bariatric surgery in our centre. We performed an Electronic Patient Database search and included all patients who underwent bariatric surgery in our bariatric referral centre and had an ICD-10 code of benign neoplasm of liver in our centre from (2006-2017). All imaging studies of eligible patients were re-evaluated by the study radiologist. Primary outcome was change in maximal diameter of HCA. Six of 11 eligible patients were excluded because their lesions were classified as probable focal nodular hyperplasia and two were lost to follow-up. Finally, three women with solitary (n=1) or multiple HCA (n=2) and a body mass index (BMI) ranging between 39 and 50kg/m2 were included. In two patients, HCA completely regressed in 1-2years following bariatric surgery, after BMI reductions of 36%-48%. The third patient showed a reduction of >50% in diameter of the largest HCA in 2.5years after bariatric surgery (31% BMI reduction), with complete resolution of smaller HCA. Bariatric induced weight loss results in significant regression of HCA in severe obese women, which emphasizes the role of overweight in HCA pathophysiology.

AB004. Quality of life in patients who underwent liver resection: a single centre study

Background: Hepatic resection has evolved into a common surgical procedure for a wide range of benign and malignant indications. It has been widely accepted that long-term quality of life (QoL) has been used as a valuable outcome parameter in the success of surgical treatment. This retrospective study is aimed to evaluate postoperative QoL after resection of benign or malignant liver tumors.

Characterization of hepatocellular adenoma and carcinoma using microRNA profiling and targeted gene sequencing.

BackgroundHepatocellular adenomas (HCA) are benign liver tumors that may transform into hepatocellular carcinoma (HCC), but the molecular drivers of this transformation remain ill-defined. This study evaluates the molecular changes in HCA and HCC and in comparison to their adjacent non-neoplastic liver.Methods11 patients with HCA and 10 patients with HCC without underlying hepatitis or cirrhosis were included in this pilot study. Tumor and non-tumor liver tissues were selected for immunohistochemical staining, small RNA sequencing, and targeted gene sequencing. We compared microRNA expressions and mutations between HCA and HCC and non-neoplastic liver.ResultsHCA were classified as inflammatory (n = 6), steatotic (n = 4), or β-catenin activated (n = 1) subtypes. MicroRNA profile of all 3 HCA subtypes clustered between that of normal liver and HCC in principal component analysis. In both HCA and HCC, miR-200a, miR-429, and miR-490-3p were significantly downregulated compared to normal liver, whereas miR-452, miR-766, and miR-1180 were significantly upregulated. In addition, compared to HCA, HCC had significantly higher expression of members of the chromosome 19 miRNA cluster (C19MC), including miR-515-5p, miR-517a, miR-518b, and miR-520c-3p.ConclusionsThis study indicates that while there are significant differences in the molecular profile between HCA and HCC, several miRNAs are similarly deregulated in HCA and HCC compared to adjacent normal liver. These results may provide insights into the drivers of hepatocarcinogenesis and warrant further investigations.

The comparative analysis of two different ultrasoud elastography in the differential diagnosis of benign and malignant liver tumors

Objective To compare the diagnostic performances of real time of shear wave elastography (SWE) and strain ratio (SR) in differentiating benign and malignant liver tumors. Methods From March 2017 to August 2017, 68 patients with 70 lesions were examined with SR and SWE respectively, the parameters of SWE were maximum real-time shear wave velocity (Vmax), average real-time shear wave velocity (Vmean) and real-time shear wave velocity elasticity ratio of lesion/peripheral liver tissue (Vratio). The receiver operating characteristic (ROC) curve of SWE and SR parameters were plotted to assess the value in distinguishing benign and malignant liver tumors. The results were compared using the area under the ROC curve (AUC). The sensitivity, specificity, accuracy of SWE and SR were calculated, The accuracy of the parameters with the largest AUC were compared between SWE and SR by McNemar test in differentiating focal liver lesions. Results The AUC of SR, Vmax, Vmean and Vratio were 0.948, 0.868, 0.918 and 0.956 respectively. The comparison of AUC reveals no significant difference between them. The sensitivity, specificity, accuracy of SR in differentiating benign and malignant liver tumors were 92.73%, 93.33%, 92.86% respectively (P>0.05). The SWE parameter with the largest AUC was Vratio. The sensitivity, specificity, accuracy of Vratio was 94.56%, 100.00%, 95.71%, respectively. The accuracy of Vratio and SR in differentiating benign and malignant liver tumors showed no significant difference (P>0.05). Conclusions The application of SWE and SR in the differential diagnosis of benign and malignant liver tumors is of high diagnostic value. They provide a new method for the differential diagnosis of liver tumor lesions, and the diagnostic value of both of them is equivalent. Key words: Liver neoplasms/US; Elasticity imaging techniques; Diagnosis, differential

Hepatic Sclerosing Hemangioma Simulating Gallbladder Carcinoma: A Rare Case

Sclerosing hemangiomas of the liver are rare benign tumors of the liver. Although hepatic hemangiomas are the most common benign liver tumor, they are mostly cavernous in nature. A hepatic sclerosing hemangioma is defined by presence of fibrosis and hyalinization as a result of degenerative changes in a cavernous hemangioma. The radiological features of sclerosing hepatic hemangioma can resemble those of cholangiocarcinoma, fibrolamellar carcinoma, or metastasis. We present a case of a hepatic sclerosing hemangioma in which an unusual magnetic resonance imaging (MRI) and computed tomography (CT) appearance lead to radiographic concern for gallbladder carcinoma. To the best of our knowledge, this is the first case in the literature of a hepatic sclerosing hemangioma mimicking a gallbladder carcinoma.

A two-stage multi-view learning framework based computer-aided diagnosis of liver tumors with contrast enhanced ultrasound images.

With the fast development of artificial intelligence techniques, we proposed a novel two-stage multi-view learning framework for the contrast-enhanced ultrasound (CEUS) based computer-aided diagnosis for liver tumors, which adopted only three typical CEUS images selected from the arterial phase, portal venous phase and late phase. In the first stage, the deep canonical correlation analysis (DCCA) was performed on three image pairs between the arterial and portal venous phases, arterial and delayed phases, and portal venous and delayed phases respectively, which then generated total six-view features. While in the second stage, these multi-view features were then fed to a multiple kernel learning (MKL) based classifier to further promote the diagnosis result. Two MKL classification algorithms were evaluated in this MKL-based classification framework. We evaluated proposed DCCA-MKL framework on 93 lesions (47 malignant cancers vs. 46 benign tumors). The proposed DCCA-MKL framework achieved the mean classification accuracy, sensitivity, specificity, Youden index, false positive rate, and false negative rate of 90.41 ± 5.80%, 93.56 ± 5.90%, 86.89 ± 9.38%, 79.44 ± 11.83%, 13.11 ± 9.38% and 6.44 ± 5.90%, respectively, by soft margin MKL classifier. The experimental results indicate that the proposed DCCA-MKL framework achieves best performance for discriminating benign liver tumors from malignant liver cancers. Moreover, it is also proved that the three-phase CEUS image based CAD is feasible for liver tumors with the proposed DCCA-MKL framework.

Minor laparoscopic liver resection as day-case surgery (without overnight hospitalisation): a pilot study.

Day-case surgery (DCS) has become increasingly popular over recent years, as has laparoscopic liver resection (LLR) for the treatment of benign or malignant liver tumours. The purpose of this prospective study was to demonstrate the feasibility of minor LLR as DCS. Prospective, intention-to-treat, non-randomised study of patients undergoing minor LLR between July 2015 and December 2017. Exclusion criteria were resection by laparotomy, major LLR, difficult locations for minor LLR, history of major abdominal surgery, hepatobiliary procedures without liver parenchyma resection, cirrhosis with Child > A and/or portal hypertension, significant medical history and exclusion criteria for DCS. The primary endpoint was the unplanned overnight admission rate. Secondary endpoints were the reason for exclusion, complication data, criteria for DCS evaluation, satisfaction and compliance with the protocol. One hundred sixty-seven patients underwent liver resection during the study period. LLR was performed in 92 patients (55%), as DCS in 23 patients (25%). Reasons for minor LLR were liver metastasis (n = 9), hepatic adenoma (n = 5), hepatocellular carcinoma (n = 4), ciliated hepatic foregut cyst (n = 2) and other benign tumours (n = 3). All day-case minor LLR, except two patients, consisted of single wedge resection, while one patient underwent left lateral sectionectomy. There were four unplanned overnight admissions (17.4%), one unscheduled consultation (4.3%), two hospital readmissions (8.6%) and no major complications/mortality. Compliance with the protocol was 69.5%. Satisfaction rate was 91%. In selected patients, day-case minor LLR is feasible with acceptable complication and readmission rates. Day-case minor LLR can therefore be legitimately proposed in selected patients.

The clinical value of virtual touch tissue quantification (VTQ)in the differential diagnosis of the benign and malignant liver tumor

Objective The purpose of our study is to investigate the clinical value of virtual touch tissue quantification (VTQ)in the differential diagnosis of the benign and malignant liver tumor. Methods VTQ was used to inspect 53 patients with liver space-occupying lesions. Results After choosing the little lesions (the largest diameter less than 35 mm) from all the case groups, the VTQ value of the malignant group was higher than the hepatic hemangioma group(with significant differences among the different groups, P>0.05). Through the analysis of receiver operating characteristic curve (ROC), the optimal cut-off point as diagnosis reference value for differential diagnosis between malignant and benign groups was available. When the Area under the curve was 0.778, and with the VTQ value of 1.91 m/s, the sensitivity, specificity and Youden index was 78.6%, 90.0%, 0.686 respectively. The correlation analysis showed that the VTQ values of the lesion was positively correlated with the largest diameter of the lesion in the liver hemangioma group, with significant statistically differences (P<0.05). The correlation index was 0.812. Conclusions VTQ could provide a new effective way to benign and malignant liver lesions in differential diagnosis. Key words: Liver neoplasms/US; Diagnosis, differential; Elasticity imaging techniques

Angiotensin II and tumor necrosis factor-α stimulate the growth, migration and invasion of BEL-7402 cells via down-regulation of GRK2 expression

PurposeTo investigate the effects of angiotensin II (Ang II) and tumor necrosis factor-α (TNF-α) on the biological characteristics of hepatocellular carcinoma (HCC) cells and the associated changes in G protein-coupled receptor kinase 2 (GRK2) expression. MethodsThe mean serum levels of Ang II and TNF-α in normal subjects and patients with benign liver tumors (BLTs) and HCC were evaluated by enzyme-linked immunosorbent assay (ELISA), and liver samples from the patients with HCC and HCC mice were used to assess the protein levels of both cytokines, their major receptors and GRK2. In addition, the dynamics of Bel-7402 cells were determined with cell counting kit-8 (CCK-8) and Transwell experiments, while the levels of the primary cytokine receptors Ang II type-1 receptor (AT1R) and type-2 receptor (AT2R) as well as TNF receptor 1 (TNFR1) were detected by flow cytometry (FCM). The effects of Ang II and TNF-α on the GRK2 levels in Bel-7402 cells and on the dynamics of GRK2-knockdown HCC cells were also investigated. ResultsBoth cytokines independently enhanced Bel-7402 cell growth, migration and invasion by decreasing the GRK2 level. In contrast, down-regulating the GRK2 level in Bel-7402 cells suppressed these effects. No synergistic effects were discovered when Ang II and TNF-α were administered together. Furthermore, increased AT1R and TNFR1 levels stimulated HCC initiation and progression, whereas AT2R overexpression produced the opposite effect. ConclusionsThe present results suggested that Ang II and TNF-α promote Bel-7402 cell growth, migration and invasion by down-regulating GRK2 expression, and that the associated receptors AT1R, AT2R and TNFR1 participate in HCC initiation and progression.