Hypoechoic Tumor Research Articles

A case of acinar cell carcinoma originating from the accessory papilla of the duodenum

Case presentationA 61-year-old female was referred to our hospital with a neoplastic lesion in the duodenum. Computed tomography with contrast enhancement revealed a 10-mm tumor in the duodenum. Upper gastrointestinal endoscopy revealed a submucosal tumor-like lesion in the descending part of the duodenum. Endoscopic ultrasound revealed a well-defined hypoechoic tumor. Biopsy and immunohistochemical findings including negative Synaptophysin and Chromogranin A staining and positive Trypsin and BCL10 staining suggested a carcinoma with acinar cell differentiation. Pancreatoduodenectomy was performed, and the resected specimen had a 15-mm solid nodule in the submucosal layer of the duodenum. Pancreatogram of the resected specimen revealed a tumor localized in the accessory papilla region. In histopathological examination, the tumor was found in the submucosa of the duodenum with pancreatic tissue present nearby, and these were separated from the pancreatic parenchyma by the duodenal muscle layer. These findings led to a diagnosis of acinar cell carcinoma originating from the accessory papilla of the duodenum.ConclusionAcinar cell carcinoma originating from the accessory papilla of the duodenum is exceptionally rare, with no reported cases to date. The origin was considered to be pancreatic tissue located in the accessory papilla region.

A Case of a Granular Cell Tumor Arising in a Patient with Long-segment Barrett's Esophagus.

Esophageal cell tumors are rare. Esophagogastroduodenoscopy performed on a 48-year-old woman revealed an elevated esophageal lesion and the presence of long-segment Barrett's esophagus. Endoscopic ultrasonography showed a 15 mm homogeneous hypoechoic tumor extending from the lamina propria mucosa to the submucosa. Pathological examination of the biopsy tissue revealed a sheet-like cluster of histiocytoid cells with an abundant eosinophilic granular cytoplasm. Immunohistochemical examination revealed S-100 (+) and CD68 (+), thus suggesting the diagnosis of a granular cell tumor. The tumor was resected by endoscopic submucosal dissection. Pathologically, the background mucosa was Barrett's mucosa. This is the first reported case of an esophageal granular cell tumor in long-segment Barrett's esophagus.

A Retrospective Analysis of High Resolution Ultrasound Evaluation of the "Split Fat Sign" in Peripheral Nerve Sheath Tumors.

Peripheral nerve sheath tumors (PNST) comprise schwannomas and neurofibromas. The finding of increased adipose tissue around benign PNSTs has been described as the "split fat sign" on magnetic resonance imaging exams, which is suggestive of an intramuscular or intermuscular location of the tumor. However, few studies have described this sign as a salient ultrasound feature of PNSTs. The main purpose of this study was to retrospectively evaluate the presence of increased fatty tissue deposition around benign PNSTs diagnosed by high-resolution ultrasound. In addition, we aimed to corroborate the presence of vascularization around the affected area. A retrospective analysis of ten cases of PNSTs and two cases of post-traumatic neuromas diagnosed by high-resolution ultrasound was performed with a Logiq® P8 ultrasound with a 2-11 MHz multifrequency linear probe L3-12-D (central frequency: 10 MHz). Localized types of neurofibromas and schwannomas in any location were seen as predominantly hypoechoic tumors with an oval or fusiform shape. Exiting and entering nerves (tail sign) were observed in six cases, showing localized lesions both in intermuscular and subcutaneous locations. The presence of increased hyperechoic tissue (the split fat sign) was noted in cases of solitary intermuscular and intramuscular peripheral nerve sheath tumors, mainly the schwannomas. Though small tumors did not demonstrate the tail sign, the increase in adipose tissue and vascularity on US was well demonstrated. In conclusion, the nerve in continuity forms the basis of the ultrasonographic diagnosis of PNSTs. However, high-resolution US can convincingly demonstrate the increased presence of fat in the upper and lower poles as well as circumferentially in intermuscular or intramuscular benign PNSTs.

A Rare Cause of Sister Mary Joseph Nodule

A 67-year-old man with hepatitis B–related cirrhosis received liver transplantation because of hepatic decompensation, and small hepatomas were found in the resected liver. The postoperative course was uneventful, but the α-fetoprotein level rose from 5 ng/mL to 107 ng/mL 1 year after transplantation. Whole body computed tomography scans failed to find any recurrent tumor. The α-fetoprotein level continued to increase, and was 413.2 ng/mL 18 months after transplantation. An abdominal computed tomography revealed an enhancing lesion over the umbilical area (Figure A, arrow). An abdominal ultrasound revealed a hypoechoic tumor in the subcutaneous area with increased blood flow (Figure B, arrow). Ultrasound-guided biopsy revealed atypical oval to epithelioid-shaped tumor cells with high N/C ratio, eosinophilic cytoplasm, and hyperchromatic nuclei (Figure C). Immunohistochemical studies demonstrated that the tumor cells were glypican-3(+), Hep-par-1(+), CK19(-), and CK7(-). A diagnosis of umbilical metastatic hepatocellular carcinoma was made (Figure D). He received surgical resection followed by sorafenib therapy. He had no evidence of recurrence in the following 6 months.

Leydig Cell Tumors of the Testis: An Update of the Imaging Characteristics of a Not So Rare Lesion

Simple SummaryStromal tumors of the testis are rare. However, among this group, Leydig cell tumors (LCT) are the most frequent, and recent studies suggest that LCTs account for up to 22% of small testicular nodules. It is now accepted that small LCTs can benefit from testis-sparing surgery or in some selected cases radiological surveillance. Since percutaneous testicular biopsy is still not recommended, the diagnosis of LCT rests on multimodal imaging techniques. Therefore, it is essential for the radiologist and the urologist to know the main imaging features of LCTs in ultrasound and MRI.Pre-operative testicular tumor characterization is a challenge for radiologists and urologists. New data concerning imaging approaches or immunochemistry markers improve the management of patients presenting with a testicular tumor, sometimes avoiding radical orchiectomy. In the past 20 years, imaging modalities, especially ultrasound (US) and magnetic resonance imaging (MRI), improved, allowing for great progress in lesion characterization. Leydig cell tumors (LCT) are rare testicular tumors developing from the stromal tissue, with relatively scarce literature, as most of the studies focus on the much more frequent germ cell tumors. However, with the increase in testicular sonography numbers, the incidence of LCT appears much higher than expected, with some studies reporting up to 22% of small testicular nodules. Multimodal ultrasound using Doppler, Elastography, or injection of contrast media can provide crucial arguments to differentiate LCT from germ cell tumors. Multiparametric MRI is a second intention exam, but it allows for extraction of quantifiable data to assess the diagnosis of LCT. The aims of this article are to review the latest data regarding LCT imaging features, using multimodal ultrasound and multiparametric MRI, and to focus on the peculiar aspect of the testis of patients with Klinefelter’s syndrome. The possibility of an LCT should be raised in front of a small hypoechoic tumor with a marked corbelling hypervascularization in an otherwise normal testicular pulp. Ultrasonographic modules, such as ultrasensitive Doppler, contrast-enhanced ultrasonography, or elastography, can be used to reinforce the suspicion of LCT. MRI provides objective data regarding vascularization and enhancement kinetics.

Assessment of Basal Cell Carcinoma Using Dermoscopy and High Frequency Ultrasound Examination.

Basal cell carcinoma (BCC) is the most common form of cutaneous neoplasia in humans, and dermoscopy may provide valuable information for histopathological classification of BCC, which allows for the choice of non-invasive topical or surgical therapy. Similarly, dermoscopy may allow for the identification of incipient forms of BCC that cannot be detected in clinical examination. The importance of early diagnosis using the dermoscopy of superficial BCC forms is proven by the fact that despite their indolent clinical appearance, they can be included in high-risk BCC forms due to the rate of postoperative recurrence. Nodular pigmentary forms of BCCs present ovoid gray-blue nests or multiple gray-blue dots/globules associated with arborized vessels, sometimes undetectable on clinical examination. The management of BCC depends on this, as pigmentary forms have been shown to have a poor response to photodynamic therapy. High frequency ultrasound examination (HFUS) aids in the diagnosis of BCC with hypoechoic tumour masses, as well as in estimating tumour size (thickness and diameter), presurgical margin delineation, and surgical planning. The examination is also useful for determining the invasion of adjacent structures and for studying local recurrences. The use of dermoscopy in combination with HFUS allows for optimisation of the management of the oncological patient.

Multiple schwannomas of the facial nerve mimicking cervical lymphoma: a case report

BackgroundIn this report, we describe the first case in literature of a patient with multiple schwannomas of the marginal mandibular branch of the facial nerve.Case presentationA Caucasian patient presented with a sudden onset of left lower facial nerve palsy House–Brackmann score III for 1 month. Computed tomography imaging was performed to exclude a cerebral event and revealed multiple tumors within the left parotid gland. Duplex ultrasound and magnetic resonance imaging scans delineated multiple, hypoechoic tumors, round in shape and well defined without a hilar structure along the left mandible. For histological verification, a left-side partial parotidectomy and extirpation of an intraparotideal node was performed with use of a nerve-integrity monitor. Histomorphological analysis of the resected tissue revealed a benign schwannoma. Facial nerve function remained unchanged since the operation. The size of the nonresected tumors is currently monitored regularly by ultrasonography. Fibromatosis has been excluded.ConclusionsIf multiple tumors occur in the parotid gland and the angle of the jaw, schwannomas need to be considered as a differential diagnosis. To plan the right diagnostic surgical intervention and prevent nerve damage, a thorough ultrasound examination is essential in preoperative diagnostic work-up for any suspicious lesion of the parotid gland and jaw region.

Ultra-High-Frequency Ultrasound in the Evaluation of Paediatric Pilomatricoma Based on the Histopathologic Classification.

Background: Pilomatricoma (PM) is one of the most common benign tumours in children. However, the inaccuracy of preoperative diagnosis and evaluation is high. Non-invasive examinations, including dermoscopy and ultrasound are helpful for diagnosing and evaluating PM. To date, ultra-high-frequency ultrasonographic features of PM have been rarely studied.Objective: We aimed to investigate the ultra-high frequency ultrasonographic features of PM in a large paediatric cohort and to determine the associations of these features with the clinical features of different histological subtypes of PM.Methods: This was a retrospective study. Patients who had both preoperative ultra-high-frequency ultrasonographic evaluation and pathological diagnosis of PM were enrolled. A series of infantile haemangiomas and cutaneous cysts during the same period were included as controls. Histological findings, including the stage, calcifying type, and ultrasonographic features of each lesion, were described.Results: A total of 133 patients with PM were included, and 147 PM lesions were analysed. The male-to-female ratio was 1:1.58, and the median age of onset was 91 (range: 10–188) months. On ultra-high-frequency ultrasonography, PM presented as heterogeneous (144/147, 98.0%), well-demarcated (143/147, 97.3%), and hypoechoic (126/147, 85.7%) tumours located between the deep dermis and subcutaneous tissue (139/147, 94.6%). The most common features were internal echogenic foci (135/147, 91.8%), hypoechoic rim (133/147, 90.5%), and posterior acoustic shadowing (94/147, 63.9%). Fourteen (9.5%) lesions were histologically categorized in the early stage, 58 (39.5%) in the fully developed stage, 65 (44.2%) in the early regressive stage and 10 (6.8%) in the late regressive stage. Three calcifying types, including scattered dots, clumps and arcs, were observed on histologic examination, which corresponded well with grey-scale imaging on ultra-high-frequency ultrasonography. Each calcifying type was significantly different in various histological stages (P = 0.001), among which scattered dots were mainly present in the early and fully developed stage and arc-shaped calcifying were present in the regressive stages. Calcification was observed in skin cysts, while there was more frequent posterior enhancement, less frequent posterior shadowing, and hypoechoic rim than PM. Haemangioma also presented as a hypoechoic tumour on grey-scale imaging. However, haemangioma was homogeneous and rarely calcifying.Conclusions: PM is a heterogeneous, well-demarcated, hypoechoic tumour located between the deep dermis and the subcutis on ultra-high-frequency ultrasonography. The most common features are internal echogenic foci (calcifying) and hypoechoic rim. Calcifying types can help in the staging of PM. Ultra-high-frequency ultrasound is a useful tool for the diagnosis and evaluation of PM.

A new CNN architecture for efficient classification of ultrasound breast tumor images with activation map clustering based prediction validation.

Effective ultrasound (US) analysis for preliminary breast tumor diagnosis is constrained due to the presence of complex echogenic patterns. Implementing pretrained models of convolutional neural networks (CNNs) which mostly focuses on natural images and using transfer learning seldom gives good results in medical domain. In this work, a CNN architecture, StepNet, with step-wise incremental convolution layers for each downsampled block was developed for classification of breast tumors as benign/malignant. To increase noise robustness and as an improvement over existing methodologies, neutrosophic preprocessing was performed, and the enhanced images were appended to the original image during training and data augmentation. The final layers' activation maps are clustered using fuzzy c-means clustering which qualify as a validation method for the prediction of StepNet. Using neutrosophic preprocessing alone had increased the validation accuracy from 0.84 to 0.93, while using neutrosophic preprocessing and augmentation had increased the accuracy to 0.98. StepNet has comparably less training and validation time than other state of the art architectures and methods and shows an increase in prediction accuracy even for challenging isoechoic and hypoechoic tumors.

A New Ultrasonographic “Fluttering Sign” for Hepatic Hemangioma

The aim of the study described here was to clarify the diagnostic value of the fluttering sign, a new sign that characterizes hepatic hemangiomas in gray-scale ultrasonography (US). It refers to a phenomenon in which the speckled echogenicity inside the hemangioma changes continuously and seems to be moving. A total of 172 hemangiomas diagnosed with contrast-enhanced US were evaluated. The fluttering sign was found in 123 of 172 hemangiomas (71.5%). Its prevalence was significantly higher than that of the marginal strong echo (89/172, 51.7%, p < 0.001), posterior acoustic enhancement (103/172, 59.9%, p = 0.031) and chameleon sign (100/172, 58.1%, p = 0.013). In addition, the fluttering sign was observed significantly more frequently in mixed or hypo-echoic tumors than in hyper-echoic tumors (p < 0.001), relatively large tumors (p < 0.001) and tumors that were less than 5 cm from the body surface (p = 0.015). The fluttering sign in gray-scale US has great potential to be a new complementary sign for the diagnosis of hemangioma.

NEUTROSOPHIC TEXTURE-REGION DIFFERENCE-BASED FUZZY c-MEANS CLUSTERING OF ULTRASOUND TUMOR IMAGES

Owing to its cost effective and non-ionizing procedure, ultrasound imaging has become a primary tool for detection and diagnosis of breast tumors compared to mammography or biopsy. But the precise interpretation of the images obtained is limited due to the intensity inhomogeneties, speckle noise, low contrast, etc. present in the observed images. Also, tumors can appear in different echogenic patterns including visually challenging to detect isoechoic and slightly hypoechoic tumors, and distinguishing the tumor by means of intensity variations only will not suffice. Therefore it is important to preprocess the image to remove unwanted noise and variations, and thereby provide adequate enhancement to highlight the region of interest. In this paper, a segmentation method is proposed where the query images are clustered using fuzzy c-means clustering (FCM) after neutrosophic filtering and enhancement followed by extraction of textural and edge features through the use of Gabor and compass filters. In this work, Prewitt compass filters were implemented to capture the maximum region difference between the tumor and background. By using filters of different orientations, sufficient texture and edge information were able to be captured by using the combination of Gabor and compass filters, which can then aid in the accurate detection of isoechoic and hypoechoic tumors. The neutrosophic preprocessing implemented in this work models the ultrasound noise as combination of Gaussian and Rayleigh distributions, and shows better signal-to-noise ratio than traditionally modeling speckle as Gaussian alone. The proposed method gave an increase of 42.25%, 40.15%, 81.32% and 50.15% and a decrease of 95.83% compared to standard Otsu thresholding, an increase of 23.34%, 19.57%, 24.53% and 24.71% and a decrease of 91.81% compared to simple FCM and an increase of 37.89%, 44.64%, 35.86% and 48.11% and a decrease of 93.68% compared to active contour segmentation in structural similarity index, Jaccard index, Dice coefficient and accuracy and mean square error, respectively. On contrasting with recent learning-based methodologies for tumor segmentation, the proposed method gave comparable accuracy without the need for large training database and expensive graphical processing unit (GPU) computing capabilities.

Description and management of non-metastatic thoracic myxofibrosarcoma: a case report

Myxofibrosarcoma is a soft tissue sarcoma (STS) prevailing in the elderly and is associated with metastasis and mortality. In this case, an 88-year-old male is presented with a progressively enlarging mass in the posterior thorax. The physical examination revealed a solid, irregular, painful mass on palpation. Doppler ultrasonography and high-resolution computed tomography (CT) scan revealed a 60 × 38 mm hypoechoic tumor in the left paraspinal thoracic area with a little vascularity with no adherence and invasion. Radical excisional surgery was performed. The histopathology findings were in line with myxofibrosarcoma except for CD34. He underwent high dose radiotherapy due to the reported not assessable margins at one side. The patient was asymptomatic and recurrent free in the 12 months follow up assessment. It was the first known case of the non-metastatic intermediate grade of myxofibrosarcoma in the thorax. Due to its deceptive findings, myxofibrosarcoma should always be considered in the assessment of chest wall tumors.

Ultrasonographic findings and diagnosis of omental dedifferentiated liposarcoma: a case report.

Liposarcoma is one of the most common types of soft tissue sarcomas and can develop at any site, although omental liposarcoma is extremely rare. Omental liposarcoma has a poor prognosis because the diagnosis is difficult, until it presents as a large tumor causing severe noticeable clinical symptoms. A 51-year-old male with lower abdominal pain was referred to our clinic. Abdominal ultrasonography revealed an ill-defined, solid, heterogeneous, and hypoechoic tumor deep in the lower abdomen. Generally, liposarcomas are hyperechoic, though 20% of liposarcomas present as hypoechoic tumors. This variation might occur depending on the pathological classification. We should consider the possibility of a dedifferentiated component if ultrasonography reveals typical features of soft tissue sarcoma with hypoechoic lesion.

Endoscopic findings of esophageal submucosal gland duct adenoma.

Endoscopic findings of esophageal submucosal gland duct adenoma.

The value of preoperative ultrasound in predicting microvascular invasion of hepatocellular carcinoma

Objective To analyze the ultrasound imaging features and clinical characteristics in patients with hepatocellular carcinoma (HCC), and assess the value of ultrasound in preoperatively predicting microvascular invasion(MVI) of HCC. Methods One hundred and seventy-one patients with HCC were retrospectively collected from January 2016 to July 2018. The ultrasound imaging features and clinical data that may be associated with MVI were analyzed by univariate and multivariate analyses, and the diagnostic efficacy of independent risk factors was further evaluated. ROC curves were plotted to compare the diagnostic efficacy of combined diagnostic mode 1, mode 2, peritumoral enhancement, and tumor margin. Results Univariate analysis showed that the serum AFP level, tumor size, peritumoral hypoechoic halo, peritumoral enhancement, and tumor margin were significantly correlated with MVI (P<0.05). Multivariate logistic regression analysis further indicated that peritumoral enhancement and non-smooth tumor margin were the independent risk factors for predicting MVI. The sensitivity, specificity, positive predictive value and negative predictive value of peritumoral enhancement and non-smooth tumor margin were 51.4% vs 83.8%, 81.4% vs 48.5%, 67.9% vs 55.4%, and 68.7% vs 79.7%, respectively. The AUC of mode 1, mode 2, peritumoral enhancement and tumor margin were 0.741, 0.716, 0.664, and 0.661, respectively. Conclusions Preoperative ultrasound is valuable in predicting MVI of HCC. Peritumoral enhancement and non-smooth tumor margins are independent risk factors for predicting MVI of HCC. Tumor size, hypoechoic halo around the tumor, and serum AFP levels must be taken into account when predicting MVI of HCC by using preoperative ultrasound. Key words: Ultrasonography; Carcinoma, hepatocellular; Contrast-enhanced ultrasound; Microvascular invasion; Risk factors

Doppler ultrasound appearance of neck tumors.

Aim: The purpose of this study was the evaluation of the sonographic appearance of neck tumors and determining the features useful in differential diagnosis. Material and method: The studied group consisted of 57 patients: 16 patients with carotid body tumors, 9 patients with neurogenic tumors, 8 patients with venous anomalies, 12 patients with neck cysts, 6 patients with lipomas, 5 patients with extracranial carotid artery aneurysms and 1 with a laryngocele. Results: All carotid paragangliomas were located within the carotid bifurcation and demonstrated rich low-resistance vascular flow, with higher maximum velocity and lower flow resistance parameters registered in the ipsilateral external carotid artery. In 7 out of 9 cases, neurogenic tumors were homogeneous, and in the remaining 2 cases – heterogeneous. Four schwannomas were hypervascular or showed moderate vascularity, and the rest of neurogenic tumors were hypovascular or avascular, with symmetrical maximum velocity and resistance values of carotid blood flow. Apart from one branchial cleft cyst with multiple fine internal acoustic reflexes, all other neck cysts were anechoic and avascular, and presented with posterior acoustic enhancement. The laryngocele presented as a well-demarcated, hypoechoic, homogeneous lesion located in the immediate proximity of the larynx, without signs of internal vascular flow. Lipomas were well-demarcated, homogeneous, hypoechoic tumors with regular margins, without signs of internal vascular flow. Venous malformations presented as irregular, hypoechoic spaces with venous blood flow, easily compressed by the probe. Extracranial carotid artery aneurysms were hypoechoic, well-defined spaces, which presented with slow internal, turbulent flow on Doppler study, and showed continuity with the carotid artery. Conclusions: Doppler ultrasound allows to visualize features characteristic for certain neck tumors. Solid or cystic structure, echogenicity, localization, as well as internal flow signals and vascularity pattern create a combination of ultrasound findings helpful in the differential diagnosis of lesions such as paragangliomas, venous malformations, neurogenic tumors, aneurysms, cysts and laryngoceles.

Esophageal Granular Cell Tumors Can Be Differentiated from Leiomyomas Using Endoscopic Ultrasonography

Objective Although esophageal granular cell tumors have been reported to present as hypoechoic tumors, we noticed that their echogenicity is similar to that of the submucosal layer. We investigated the sonographic features of esophageal granular cell tumors and the diagnostic accuracy of the features. Methods Seven patients with esophageal granular cell tumors who underwent endoscopic ultrasonography were retrospectively reviewed. Thirteen patients with esophageal leiomyoma were selected as historical control subjects. The brightness of the tumor on ultrasonography images was measured and the echogenicity was standardized according to the echogenicity of the proper muscle and submucosal layers. Ten board-certified endoscopists then independently evaluated the endoscopic pictures of the 20 patients (Test 1), as well as the endoscopic ultrasonography images together with endoscopic pictures of the same patient set (Test 2). Results The standardized echogenicity in granular cell tumors was significantly higher than that in leiomyomas. The diagnostic accuracy of the 10 evaluators using endoscopic pictures alone (Test 1) was 72.0%. The addition of endoscopic ultrasonography images (Test 2) significantly improved the accuracy to 93.0%. Conclusion The echogenicity of granular cell tumors was similar to that of the submucosal layer, and it was significantly higher than that of leiomyomas. Endoscopic ultrasonography images facilitate the accurate identification of esophageal granular cell tumors.

CT表现为“水肿环征”的肝脏炎性假瘤：一例报道

男，57岁，主诉右上腹不适伴右肝区隐痛1个月，既往无肝炎。体检：一般情况良好，皮肤巩膜无黄染，腹软，肝脾未触及。化验：WBC 9.0 × 109/L，Hb 97 g/L，白蛋白33.4 g/L，球蛋白35.3 g/L，丙氨酸转氨酶20 IU/L。甲胎蛋白(AFP) 2.6 μg/L (0~20.0 μg/L)、癌胚抗原(CEA) 3.0 μg/L、糖类抗原CA19-9 16 μg/L。B超检查见左肝内叶有55 × 47 mm大小低回声团块，境界尚清楚，其内部回声不均匀，可探及动脉型血流信号，提示左肝占位性病变、肝癌首先考虑。CT扫描提示左肝内叶可探及34 mm椭圆形等密度灶，病灶周边见环形低密度带，增强扫描后更为清楚(“水肿环征”)，余肝内多发小囊状低密度影，左肾也见小囊肿，诊断为左肝内占位性病变(肝癌首先考虑)、右肝多发小囊肿及左肾小囊肿。全身麻醉下剖腹探查行不规则肝切除，术中见左肝内叶有一个6.5 cm大小肿物，表面呈灰白色，边界清楚。术后病理组织学检查见大量淋巴细胞和浆细胞浸润以及纤维肉芽组织增生，符合炎性假瘤。术后恢复顺利，随诊10年无复发。 A 57 years old male patient’s chief complaint is the right epigastric discomfort associated with dull pain, no past history of hepatitis. On physical examination, he was in good general condition, no yellow stain of skin and sclera, soft abdomen with impalpable liver and spleen. Laboratory exam-ination revealed that WBC was 9.0 × 109/L, Hb 97 g/L, serum albumin 33.4 g/L, serum globulin 35.3 g/L, alanine aminotransferase 20 IU/L, alpha-fetoprotein (AFP) 2.6 μg/L (0 - 20.0 μg/L), car-cinoembryonic antigen (CEA) 3.0 μg/L, and carbohydrate CA19-9 16 μg/L. Ultrasonography revealed that a hypoechoic tumor about 55 × 47 mm located at left liver, with clear boundary, and uneven the echo in the tumor, and blood stream was detectable, suggesting left liver occupying lesion with the predominance of liver cancer. A tumor of 34 mm with elliptical density rang in the left liver on plain CT scanning, and hypodensity band around the tumor was found, it was enhanced by enhanced CT scanning (“edema rime sign”). The multiple liver and kidney cyst were also found, and the diagnosis was left liver occupying lesion with the predominance of liver cancer, with multiple liver and kidney cyst. An irregular hepatectomy was performed under general anesthesia, and a tumor about 6.5 cm in diameter was found in the left liver, with gray surface and clear boundary. The postoperative histopathology demonstrated an amount of lymphocytes and plasma cells infiltration in the tumor and hyperplasia of fibrous tissues. The recovery after surgery was smoothly, and there was no recurrence case on 10-year follow-up.

Detection of Subpubic Tumor Causing Bladder Outlet Obstruction by 3D Perineal Ultrasound.

This case report shows that 3D perineal ultrasound can be superior to clinical examination and routine 2D perineal ultrasound in the detection of an unusual subpubic tumor. A 73-year-old female patient was referred to our urogynecological outpatient unit complaining of over-active bladder symptoms and voiding dysfunction for 3years. Gynecological examination found no signs of pelvic organ prolapse or abnormality in the vaginal cavity. Routine 2D perineal ultrasound showed substantial residual urine (ca. 300 ml on catheter) and limited bladder neck mobility, but no signs of pelvic organ prolapse. Use of standardized 3D perineal ultrasound revealed a 24 × 26 × 32 mm spherical, hypoechoic tumor below the pubic symphysis between the distal urethra and the pubic bones. This structure was mistaken for the pubic symphysis in the midline on 2D ultrasound performed earlier. At surgery, the tumor was completely excised through a vaginal incision between the urethra and the pubic symphysis. After an uneventful postoperative recovery the patient developed de-novo stress urinary incontinence, which was corrected successfully by the insertion of a retropubic tension-free suburethral sling after an interval of 8 weeks. After a further follow-up of 8 weeks the patient reported well-being, urinary continence and no voiding dysfunction; no abnormalities were found on examination. In conclusion, 3D perineal ultrasound is a useful additional tool for the diagnostic workup of bladder outlet obstruction.

Diagnostic value and characterization of contrast enhanced ultrasound for hepatic giant hemangionmas

Objective To explore the enhancement pattern and characterization of hepatic hemangionmas with contrast enhanced ultrasound (CEUS). Methods A total of 44 patients with 49 nodules preliminary diagnosed of liver hemangioma were included in this study. For each nodule, the enhancement pattern, level, and dynamic change of CEUS were evaluated, and the features of hemangionmas were groups as echoic and compared with those on CEUS. Results All hemangiomas enhanced in arterial phase with centripetal progression in venous and late phase on CEUS, among which 41 lesions showed peripheral nodular enhancement while 8 showed peripheral rim-like enhancement. The whole-tumor enhancement pattern was seen in 13 lesions and part-tumor enhancement was shown in 36 lesions. The performance of part-tumor was independent of tumor echoic and hypoechoic tumors mostly presented to be whole-tumor enhancement pattern. During portal venous and late phase, 42 lesions showed hyperenhancement, while 7 lesions showed isoenhancement. Conclusions CEUS can suggest the enhancement dynamic characters of hepatic giant hemangionmas and reveals the relationship of grey-scale echoic and enhancement pattern of hemangiomas. It is important to diagnosethe hepatic giant hemangionmas for CEUS. Key words: Ultrasonography; Microbubbles; Liver neoplasms; Hemangioma