Liver Mass Biopsy Research Articles

Incidence of major hemorrhage after aggressive image-guided liver mass biopsy in the era of individualized medicine.

To analyze a large volume of image-guided liver mass biopsies to assess for an increased incidence of major hemorrhage after aggressive liver mass sampling, and to determine if coaxial technique reduces major hemorrhage rate. Patients who underwent image-guided liver mass biopsy over a 15-year period (December 7, 2001-September 22, 2016) were retrospectively identified. An aggressive biopsy was defined as a biopsy event in which ≥ 4 core needle passes were performed. Association of major hemorrhage after aggressive liver mass biopsy and other potential risk factors of interest were assessed using logistic regression analysis. For the subset of aggressive biopsies, Fisher's exact test was used to compare the incidence of major hemorrhage using coaxial versus noncoaxial techniques. Aggressive biopsies constituted 11.6% of biopsy events (N =579/5011). The incidence of major hemorrhage with <4 passes was 0.4% (N =18/4432) and with ≥4 passes 1.2% (N =6/579). In univariable models, aggressive biopsy was significantly associated with major hemorrhage (OR 3.0, 95% CI 1.16-6.92, p =0.025). After adjusting for gender and platelet count, the association was not significant at the p =0.05 level (OR 2.58, 95% CI 0.927-6.24, p =0.067). The rate of major hemorrhage in the coaxial biopsy technique group was 1.4% (N =3/209) compared to 1.1% (N =4/370) in the noncoaxial biopsy technique group, which was not a significant difference (p =0.707). Although aggressive image-guided liver mass biopsies had an increased incidence of major hemorrhage, the overall risk of bleeding remained low. The benefit of such biopsies will almost certainly outweigh the risk in most patients.

Bleeding Complications After Percutaneous Liver Biopsy: Do Subcapsular Lesions Pose a Higher Risk?

The purpose of this study is to determine the incidence of moderate and severe bleeding complications after subcapsular liver mass biopsy and compare it with the incidences of such complications after nonsubcapsular liver mass biopsy and after random biopsy. This retrospective review of ultrasound-guided liver biopsies was performed between January 2006 and February 2015. Biopsy type, needle size, the number of needle passes, and mass size and depth were recorded. A mass was categorized as subcapsular if it abutted the capsule and if the needle entered the mass directly without first traversing normal liver. Patients were observed postprocedurally, and the electronic medical record and findings from imaging performed within 1 month of the procedure were reviewed to assess for bleeding. Bleeding complications were categorized by size (with mild bleeding denoted by perihepatic blood ≤ 2 cm thick; moderate bleeding denoted by perihepatic blood > 2 cm thick, observation of blood elsewhere in the upper abdomen, or a combination of both findings; and severe bleeding denoted by blood extending into the lower abdomen, pelvis, or both). Bleeding rates were compared between groups using the Fisher exact test. Of a total of 1876 biopsies, 347 (18.5%) involved subcapsular masses, 760 (40.5%) involved nonsubcapsular masses, and 769 (41.0%) were random biopsies. There were no significant differences in biopsy type (p = 1.00), needle size (p = 0.12), or the number of needle passes (p = 0.10) when subcapsular and nonsubcapsular masses were compared. Thirteen moderate or severe bleeding complications (0.69%) occurred overall. The bleeding rate after subcapsular mass biopsy (3/347; 0.86%) was not statistically different from that noted after nonsubcapsular mass biopsy (5/760; 0.66%) (p = 0.71) or after random biopsy (5/769; 0.65%) (p = 0.71). Moderate and severe bleeding complications are rare after subcapsular liver mass biopsy, and their incidence is not significantly higher than that noted after nonsubcapsular mass biopsy or random biopsy. Biopsy of subcapsular lesions should no longer be considered contraindicated.

The Validity of HCC Diagnosis Codes in Chronic Hepatitis B Patients in the Veterans Health Administration.

Administrative databases that include diagnostic codes are valuable sources of information for research purposes. To validate diagnostic codes for hepatocellular carcinoma (HCC) in chronic hepatitis B patients. We conducted a retrospective study of patients with chronic HBV seen in the national Veterans Administration (VA). HCC cases were identified by the presence of ICD-9 code 155.0. We randomly selected 200 HBV controls without this code as controls. We manually reviewed the electronic medical record (EMR) of all cases and controls to determine HCC status. We calculated the positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity for the HCC code. We conducted an implicit review of the false-positive cases to determine possible reasons for the miscoding. Of the 8350 patients with HBV, 416 hadan ICD-9 code for HCC. Of these 416, 332 patients had confirmed HCC and 61 did not; HCC status was indeterminate for 23 patients. Of the 200 controls, none had HCC confirmed in the EMR. The PPV ranged from 85.3 to 80.0% and specificity ranged from 99.2 to 99.0% based on classification of indeterminate cases as true versus false positives, respectively. The NPV, sensitivity, and specificity were 100%. Two-thirds of false-positive cases were diagnosed with HCC prematurely as a workup of liver mass and latter imaging and/or biopsy were not diagnostic for HCC. The diagnostic code of HCC in chronic HBV patients in the VHA data is predictive of the presence of HCC in medical records and can be used for epidemiological and clinical research.

Immune Thrombocytopenia in Association with Pancreatic Adenocarcinoma

Context: Evaluation for Immune thrombocytopenic purpura leading to diagnosis of advanced pancreatic adenocarcinoma has not been previously reported in literature. Case report: We present a case of a 72 year old male who presented to our center with epistaxis, hematuria and prolonged bleeding from leg wound. Complete blood count revealed a platelet count of 2 k/uL. A complete physical exam with an extensive work up, ruled out other causes of thrombocytopenia including drugs, infections, liver disease and coagulation disorders. Computed tomography abdomen and pelvis, done as a part of workup to assess for hepatosplenomegaly revealed a pancreatic and a liver mass. Biopsy of liver mass confirmed the diagnosis of pancreatic adenocarcinoma. A trial of intravenous steroids and immunoglobulins quadrupled the platelet count initially, but then platelet count continued to drop. Further treatment with rituximab improved platelet counts to over 100 k/uL. The absence of any apparent cause of thrombocytopenia, coupled with a response to steroids and immunoglobulins initially, and rituximab later, were confirmatory of immune thrombocytopenia. Conclusion: Immune thrombocytopenic purpura can be the presenting feature of advanced pancreatic adenocarcinoma and our case highlights the importance of a thorough workup that led to diagnosis of pancreatic malignancy. Context: Evaluation for Immune thrombocytopenic purpura leading to diagnosis of advanced pancreatic adenocarcinoma has not been previously reported in literature. Case report: We present a case of a 72 year old male who presented to our center with epistaxis, hematuria and prolonged bleeding from leg wound. Complete blood count revealed a platelet count of 2 k/uL. A complete physical exam with an extensive work up, ruled out other causes of thrombocytopenia including drugs, infections, liver disease and coagulation disorders. Computed tomography abdomen and pelvis, done as a part of workup to assess for hepatosplenomegaly revealed a pancreatic and a liver mass. Biopsy of liver mass confirmed the diagnosis of pancreatic adenocarcinoma. A trial of intravenous steroids and immunoglobulins quadrupled the platelet count initially, but then platelet count continued to drop. Further treatment with rituximab improved platelet counts to over 100 k/uL. The absence of any apparent cause of thrombocytopenia, coupled with a response to steroids and immunoglobulins initially, and rituximab later, were confirmatory of immune thrombocytopenia. Conclusion: Immune thrombocytopenic purpura can be the presenting feature of advanced pancreatic adenocarcinoma and our case highlights the importance of a thorough workup that led to diagnosis of pancreatic malignancy.

Success of an ultrasound guided liver mass biopsy is determined by needle size and liver lesion depth

Success of an ultrasound guided liver mass biopsy is determined by needle size and liver lesion depth

Breast cancer presenting with intramedullary cervical spinal cord metastasis

A 45-year-old female patient was admitted to our hospital with complaints of weakness in her legs. There was no disturbance in sphincter function. Neurologic examination revealed generalized weakness and numbness in all four limbs. Examination of cranial nerves and tendon reflexes revealed normal functioning. Magnetic resonance imaging of the cervical spine demonstrated a 3 cm×0.9 cm×1.1 cmmass between the inferior two thirds of C2 and superior third of C3 (Figure). The mass was isointense on T1-weighted images, hyperintense on T2-weighted images, and homogeneously enhancing on post-contrast T1-weighted images. Sagittal T2-weighted images showed a pencil-shaped hyperintensity extending proximal to the lesion (Figure). The features were typical for intramedullary spinal cord metastasis (ISCM) [1]. An Ffluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) scan showed a left breast lesion and multiple liver lesions. The patient underwent biopsy of the left breast mass and a liver mass. The breast mass was found to be a poorly differentiated, estrogen/progesterone (ER/ PR)-negative infiltrating ductal carcinoma, and an enlarged 1.6-cm left axillary lymph node biopsy revealed metastatic adenocarcinoma. The liver mass biopsy was reported to be an ER/PR-negative adenocarcinoma, consistent with metastatic breast cancer. The patient was started on dexamethasone, chemotherapy, and local external beam radiation therapy to the cervical spinal cord. After completion of the radiotherapy, there was improvement in the weakness and numbness of the extremities. The patient remained stable neurologically for 2 months after the diagnosis of breast cancer until death due to the liver metastases. Breast cancers can present with symptoms of the spinal cord metastasis. Intramedullary spinal cord metastasis of breast cancer is an extremely rare but severe condition that can cause neurologic deficits. Metastatic breast cancer should be considered when the typical features of ISCM are seen on spinal magnetic resonance imaging.

An Case of Perforated Gastric Gastrointestinal Stromal Tumor (GIST) Complicated by Bacteremia and Liver Abscess

Introduction: GIST is one of the most common mesenchymal tumors in the gastrointestinal (GI) tract closely related to the interstitial cells of Cajal and generally express c-KIT (CD114), a tyrosine kinase receptor. The most common locations are the stomach (40%-60%), small intestine (30%-40%), anorectum (7%), colon, and esophagus, as well as in extra-GI locations such as mesentery, omentum, and peritoneum(< 5%). We report a case of metastatic and perforated gastric GIST complicated by streptococcus bacteremia and hepatic abscess. Body: A 73 year old male presented with generalized weakness. At admission, he was febrile to 100.7F with RUQ tenderness. Imaging revealed peritoneal implants, a mass like process with air inseparable from the wall of the stomach near the fundus measuring 10 cm and left lobe liver mass measuring 6.4 cm (Fig 1). The patient was started on broad spectrum antibiotics. Blood cultures grew streptococcus intermedius (viridans group). Liver mass biopsy specimen revealed fragments of necrotic tissue and liver parenchyma without viable tumor. Endoscopy revealed a ˜3 cm perforated ulcer which appeared to be communicating with fundal mass (Fig 2). Pathologic showed poorly differentiated tumor with epithelioid and stromal features, CD117 +, CD34 +, cytokeratin - and CD45- compatible with GIST. Patient was ruled out for endocarditis and received antibiotics for total of 6 weeks. The patient was managed non surgically and repeat imaging (Fig 3) at 3 months showed marked improvement on Imatinib.Figure 1Figure 2Figure 3Discussion: GIST are well circumscribed tumors which may exhibit an exophytic or an endophytic pattern compromising bowel lumen patency. Mucosal necrosis and ulceration can be seen in GISTs with an endophytic component. Approximately 10-30% of GISTs are malignant and have intra-abdominal spread. The propensity of a GIST to become malignant depends on the primary anatomic site. Regardless of size and malignancy status, GISTs have a tendency to disrupt GI mucosal integrity, forming a conduit through which colonizing bacteria gain access to the portal and systemic circulation, resulting in bacteremia and liver abscess. A hematogenous source should be suspected if streptococcus or staphylococcous species are identified. Cystic degeneration, necrosis, and focal hemorrhage have been described in larger GIST accounting for the observed central necrotic cavitation resulting in fistulous connections with nearby structures, including the gastric lumen. There are only few case reports of a perforated gastric GIST, despite a higher overall incidence of GISTs in stomach. In our case, we suspect that the infection seeded from the GIST and should be included in the differential diagnosis in patients with suspected abdominal neoplasm and bacteremia.

A resected case of liver metastases from extra-adrenal retroperitoneal paraganglioma with von Recklinghausen's disease 16years after the initial surgery.

The patient was a 46-year-old man who had undergone resection for a bulky retroperitoneal tumor 16 years previously during a follow-up for von Recklinghausen’s disease. Histopathological examination of the resected specimen showed that the tumor was an extra-adrenal paraganglioma. After the surgery, he had survived without any recurrence of the tumor. However, 16 years after the initial surgery, liver tumors were identified, and he was referred to our hospital for further investigation and treatment. Abdominal imaging modalities showed three masses in the left lateral segment of the liver. Fluorodeoxyglucose-positron emission tomography/computed tomography showed an abnormal uptake of fluorodeoxyglucose corresponding to the mass lesions. The patient was diagnosed with a metastatic paraganglioma based on histopathological examination of a liver mass biopsy. The patient underwent left lateral sectionectomy of the liver. Histopathological examination of the resected specimen revealed proliferating cells with basophilic cytoplasm and oval densely stained nuclei arranged in an alveolar pattern, which was similar to the findings of the initial resection specimen. Immunohistochemical staining was positive for synaptophysin and chromogranin A. Based on these findings, the resected tumors were histopathologically diagnosed with liver metastases from the retroperitoneal paraganglioma. We concluded that this is an extremely rare case of liver metastases occurring long after the initial resection of extra-adrenal peritoneal paraganglioma with von Recklinghausen’s disease.

Liver Mass as a First Presentation of Missed Malignant Melanoma

Here we present a case of multiple systemic metastasis of missed malignant melanoma in a 26 year old male who was admitted to medical floor because of abdominal pain and B- symptoms. Abdominal Ultrasound revealed Right liver lobe mass with hepatomegaly. True cut biopsy of liver mass revealed an undifferntiated malignant tumor. The tumor cells were immunoreactive for Melan-A, Vimentin and focally for S-100 protein where the diagnosis of metastatic malignant melanoma was made.

A Case of Sacromatoid Hepatocellular Carcinoma Without Prior Anticancer Therapy

Introduction: Sarcomatoid hepatocelluar carcinoma (SHCC), also referred as spindle cell carcinoma, pseudosarcoma, or carcinosarcoma is a rare histological type of hepatocelluar carcinoma (HCC). Incidence of SHCC is 1.8% in surgically resected, and 3.9% to 9.4% in autopsy cases. Previous chemotherapy use is presumed to promote sarcomatous change. We report a case of SHCC without prior anticancer therapy. Case Report: A 66-year-old Hispanic male presented with complaint of abdominal distension. The patient had past medical history of cirrhosis due to hepatitis C infection, portal hypertension, esophageal varices, recurrent ascites s/p therapeutic paracentesis (last done 3 months prior), diabetes mellitus, and hypertension. The patient had a 20-pack a year smoking history, but quit 20 years ago and denied alcohol or illicit drug abuse. He had no family history of any cancer. Vital signs on presentation, blood pressure 105/58 mm hg, pulse 74 per minute, and regular, respirations rate 20 per minute, temperature 97.8 F, BMI 25.2. On physical exam, the patient was found to have distended abdomen, dull on percussion. Labs showed hemoglobin 12.5 gm/dL, white count 5700/ul, platelet count 134,000/ul, prothrombin time 15.8 seconds, INR 1.2, sodium 130 meq/L, potassium 4.1 meq/L, chloride 100 meq/L, bicarbonate 28 meq/L, glucose 218 mg/dl, BUN 18 mg/dl, creatinine 0.9 mg/dl, calcium 8.2 mg/dl. albumin 2.6 G/DL, total protein 8.2 G/DL, bilirubin total 1.20 MG/DL, alkaline phosphatase 179 U/L, AST 34 U/L, ALT 20 U/L, and alfa-feto protein 4.3 ng/mL. CT abdomen showed a 4.3-cm rim-enhancing mass in the medial segment of the left lobe of the liver in periphery along the diaphragmatic crus. Biopsy of liver mass was done, which showed areas of moderately differentiated conventional HCC and other areas of high-grade spindle tumor. Immunohistochemical stains showed both components stained for keratin. The spindle component did not stain for desmin, CD31, CD34 but was positive for vimentin. The patient underwent upper and lower gastrointestinal endoscopy, which showed no evidence of malignancy. The patient refused any further treatment, and eventually died 8 months after diagnosis. Conclusion: SHCC, compared to ordinary HCC, has relative low serum AFP levels, higher incidence of intrahepatic and adjacent organ invasion, high tendency to large tumor size with central necrosis and hemorrhage in the tumor, delayed peripheral enhancement of the tumor on CT images, resistance to treatment, early recurrence after treatment, and a poorer prognosis, with approximate life expectancy less than 1 year after diagnosis. We should consider SHCC even when a patient has not undergone anticancer therapies.

Bladder and liver involvement of visceral larva migrans may mimic malignancy.

Visceral larva migrans (VLM) syndrome is a clinical manifestation of systemic organ involvement by Toxocara species. VLM with involvement of the bladder and liver is a rare finding. A 62-year-old woman presented with diffuse bladder wall thickening and multiple liver masses with peripheral eosinophilia and urinary symptoms. We considered malignancy or eosinophilic cystitis through clinical manifestations and imaging findings. However, no suspicious malignant lesions were observed on cystoscopy and liver mass biopsy revealed the presence of eosinophilic necrotizing granuloma without malignant cells. Anti-Toxocara antibodies were detected by western blotting and the patient was diagnosed with VLM syndrome. After taking prednisolone, urinary symptoms disappeared. On abdominal CT scan taken after three months, the size of multiple liver masses and bladder wall thickening had decreased. VLM syndrome should be suspected in patients with an atypical imaging pattern and peripheral eosinophilia.

PET/CT-guided percutaneous liver mass biopsies and ablations: Targeting accuracy of a single 20 s breath-hold PET acquisition

To determine whether a single 20 s breath-hold positron-emission tomography (PET) acquisition obtained during combined PET/computed tomography (CT)-guided percutaneous liver biopsy or ablation procedures has the potential to target 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG)-avid liver masses as accurately as up to 180 s breath-hold PET acquisitions. This retrospective study included 10 adult patients with 13 liver masses who underwent FDG PET/CT-guided percutaneous biopsies (n = 5) or ablations (n = 5). PET was acquired as nine sequential 20 s, monitored, same-level breath-hold frames and CT was acquired in one monitored breath-hold. Twenty, 40, 60, and 180 s PET datasets were reconstructed. Two blinded readers marked tumour centres on randomized PET and CT datasets. Three-dimensional spatial localization differences between PET datasets and either 180 s PET or CT were analysed using multiple regression analyses. Statistical tests were two-sided and p < 0.05 was considered significant. Targeting differences between 20 s PET and 180 s PET ranged from 0.7-20.3 mm (mean 5.3 ± 4.4 mm; median 4.3) and were not statistically different from 40 or 60 s PET (p = 0.74 and 0.91, respectively). Targeting differences between 20 s PET and CT ranged from 1.4-36 mm (mean 9.6 ± 7.1 mm; median 8.2 mm) and were not statistically different from 40, 60, or 180 s PET (p = 0.84, 0.77, and 0.35, respectively). Single 20 s breath-hold PET acquisitions from PET/CT-guided percutaneous liver procedures have the potential to target FDG-avid liver masses with equivalent accuracy to 180 s summed, breath-hold PET acquisitions and may facilitate strategies that improve image registration and shorten procedure times.

Neuroendocrine Tumors with Metastasis to Liver: Two Cases and Literature Review

Introduction: Neuroendocrine tumors (NETs) are a genetically diverse spectrum of malignant solid tumors arising from the secretory cells of the neuroendocrine system. Often, patients with neuroendocrine tumors (NETs) suffer from neuroendocrine liver metastases (NLMs), causing significant morbidity and mortality. We describe two patients with liver metastases secondary to NETs, and review current literature on pathogenesis, diagnosis, and therapy. Case 1: A 44-year-old female presented with abdominal distension, abdominal pain, and persistent, watery diarrhea. Her lab studies were significant for alkaline phosphatase (ALP)=188, aspartate aminotransferase (AST)=58, alanine aminotransferase (ALT)=43, direct bilirubin=0.5, and total bilirubin=1.0. Abdominal ultrasound and MRI revealed multiple masses in the liver, the largest lesion being 5 cm, and a 4-cm x 5-cm pancreatic head mass. Pathologic analysis of a liver and pancreatic head mass biopsy revealed metastatic well-differentiated neuroendocrine carcinoma, grade 2. Case 2: A 57-year-old male presented with tea-colored urine, clay-colored stools, abdominal pain and a 12-kilogram weight loss during one month. His labs were significant for marked elevation of AST=215, ALT=175, Alk phos=236, total bilirubin=12.2, and direct bilirubin=7.5. Abdominal ultrasound and abdominal CT scan revealed multiple liver lesions, the largest being three cm, and a 3-cm x 4-cm soft tissue mass at the rectosigmoid junction. Pathologic biopsy analysis of the liver and rectosigmoid mass revealed neuroendocine carcinoma, grade 3. Discussion: Neuroendocrine tumors are a rare form of hormone-secreting neoplasms presenting with varied clinical symptoms. Multiple metastatic liver lesions from NETs causing liver disease result in a poorer prognosis for patients. The 5-year survival rate of patients with NLMs receiving supportive care is 0-20%. Surgical resection was the main and only treatment option in past, but now, due to widespread use of chemotherapy and radiotherapy, patients with NLM have an improved survival rate.

Selective transitional zone sampling approach versus random biopsy in cases with malignant liver masses: Is there any superiority?

Currently, the diagnostic sensitivity of malignant liver mass biopsies is an important problem in the definitive diagnosis. In this study, we aimed to investigate the role of selective peripheral approach to lesion biopsies for diagnostic sensitivity of liver masses. Between June 2007 and March 2011, totally 88 patients (50 male, 38 female), referred to our Interventional Radiology Department for sonographically guided Tru-cut biopsies for liver lesions, were examined.All biopsies were performed by an experienced radiologist with an 18-gauge Tru-cut biopsy needle with a spring-loaded biopsy gun under sonographic guidance. We describe two locations (peripheral and central) for liver lesions, with the inner 2/3 part of the mass as central and the outer 1/3 part as peripheral. We obtained biopsy from both of these locations, and samples were transferred to the Pathology Department separately. According to pathological and immunohistochemistry studies, there were 42 hepatocellular carcinomas and 46 metastases. All of the metastatic tumors were stained by cytokeratin (10 lung adenocarcinoma, 15 breast adenocarcinoma, 16 gastrointestinal tract, 4 prostate, and 1 malignant melanoma of these 46 metastases were reported as primary). According to histopathological results, diagnostic sensitivity was 97.7% in peripherally located biopsies and 86.3% in biopsies taken from the center of the masses (p=0.0063). Selective peripheral biopsy approach in Tru-cut biopsies of liver lesions has better sensitivity rates for histopathologic diagnosis compared to the centrally located and random biopsies.

Inflammatory pseudotumor of the liver and spleen.

We report the case of a 44-year-old woman with an inflammatory pseudotumour of the liver and spleen. This concomitant association has been rarely described. Our patient presented with a 2-day history of low grade fever and pain in the right hypochondrium and lower abdomen, and an abdominal scan revealed a contrast-enhanced mass in the liver in addition to an enlarged spleen with another contrast-enhanced mass. The patient was admitted to the hospital with the diagnosis of multiple liver abscesses and a spleen mass which suggested a neoplasm such as lymphoma. The final diagnosis was made by ultrasound-guided liver mass biopsy, and splenectomy. We review the literature, and highlight the difficulties of diagnosing this entity.

Lack of Tumor Seeding of Hepatocellular Carcinoma After Percutaneous Needle Biopsy Using Coaxial Cutting Needle Technique

The objective of our study was to determine the incidence of tumor seeding after biopsy of hepatocellular carcinoma (HCC) using a coaxial cutting needle technique. Seeding along the needle track is a dreaded complication of percutaneous biopsy in patients with HCC, particularly in potential liver transplant recipients. Reported seeding rates range from 0.6% to 5.1% using various biopsy techniques. To our knowledge, the rate of seeding using a coaxial cutting needle technique has not been reported. Retrospective review identified 128 patients with imaging-guided percutaneous liver biopsies positive for HCC. A coaxial cutting needle technique was uniformly used with a 17-gauge introducer and 18-gauge biopsy needle. Radiology and clinical reports were reviewed, and findings at clinical and imaging follow-up were assessed. During the 6-year study period, 1,012 liver mass biopsies were performed, with 128 positive for HCC (100 men and 28 women; average age, 58.4 years). One hundred one patients had more than 30 days of clinical or imaging follow-up (or both) after biopsy (mean, 410 days; range, 33-1,989 days) and constituted the study population. The remaining 27 were excluded because of inadequate follow-up. No suspected or confirmed tumor seeding on imaging, physical examination, or laparotomy was identified. We found no tumor seeding after percutaneous biopsy of HCC using a coaxial cutting needle technique. This rate, 0%, is lower than those reported with other techniques. The use of a needle introducer that remains in position during multiple cutting needle passes protects normal tissue along the track and may reduce seeding. This has particular importance for patients with stage I-II HCC, for whom liver transplantation may be curative.

An approach to the surgical pathology of tumours and tumour-like conditions of the liver

Hepatic masses are increasingly being found, often as a result of more frequent and sophisticated imaging. Lesions can be detected during screening for primary and metastatic tumours, or as an incidental finding. Although some have distinctive radiological appearances allowing for a confident diagnosis, histological assessment of biopsy and resection specimens remains the cornerstone for the correct identification of many lesions. This broadsheet describes the distinctive features of common and uncommon hepatic tumours and outlines diagnostic problems and pitfalls, particularly for the benign and malignant tumours of hepatocytes and bile ducts. Tumour-like lesions that mimic malignancy are also discussed. Finally, an approach to the assessment of biopsies from probable metastatic tumours is presented, as this is one of the most common indications for liver mass biopsy for the practising pathologist.

Controlling pain in liver biopsy, or “we will probably need to repeat the biopsy in a year or two to assess the response”

Data on the use of EUS-guided fine-needle biopsy (EUS-FNB) of solid liver mass (SLM) for pathology is limited.To prove superiority of the diagnostic rate of the newly designed modified Menghini-type needle with a beveled side-slot near the needle tip with slot cutting edge directed 20-gauge antegrade bevel (group A) over the original 22-gauge reverse bevel (group B) for EUS-guided fine-needle biopsy (EUS-FNB) of solid liver mass (SLM) in a prospective crossover randomized controlled trial.The overall diagnostic accuracy rate of the 52 passes was 86.5% (45/52) and of group A versus B were 88.5% (23/26) versus 84.6% (22/26), respectively, p = 0.858. Tissue adequacy levels of both groups were not significantly different (grade A: B: C = 18:6:2 versus 16:7:3), p = 0.839). Grading of blood contamination of both groups was not significantly different. However, it was found that the group-A needles could biopsy tissue of significantly longer length than that of the group B; 1.3 cm (SD = 0.76) versus 0.8 cm (SD = 0.54); p = 0.007.The use of EUS-FNB of SLM is highly effective with similar levels of efficacy and number of adverse events between both types of needles.Thai Clinical Trial Registration No. TCTR2018081002.