Liver Tumors Research Articles

Clinical and immunophenotype correlating with response to immunotherapy in paediatric patients with primary liver carcinoma. A case series

Paediatric hepatocellular carcinomas (HCC) traditionally arise in the context of a normal structural and functional liver and carry a dismal prognosis. While chemotherapy is the frontline standard, there is emerging interest in the study of immunotherapies for paediatric patients with relapsed/refractory disease. There is limited data to support whether immunotherapies will be of utility in this patient population. Six paediatric patients (median age:16 years, range: 12-17at the time of treatment) with advanced hepatocellular neosplams, either conventional hepatocellular or fibrolamellar carcinoma, were treated with immunotherapy. Patients were consented to institutional genomic profiling and biobanking protocols. Baseline samples and serial tissue samples, when available, were evaluated for somatic mutation rate, actionable gene mutations, and pan-immune bulk RNA expression profiling. Results were correlated with clinical course. Three patients responded to checkpoint inhibition: one achieved a complete, durable response and the other two, prolonged stable disease. Three additional patients progressed. Diagnostic tissue from the complete responder demonstrated a higher relative mutational burden and robust immune infiltrate. Pre-treatment samples from the three responders demonstrated decreased expression of genes associated with T-cell dysfunction. A subset of patients with primary paediatric hepatocellular tumours will respond to immunotherapy. Immunotherapies are currently under prospective study for relapsed/refractory liver tumours in paediatric patients. Results from this report support the prospective collection of serial serum and tissue samples which may further identify genomic and immunophenotypic patterns predictive of response. This work was supported by Philanthropic funds (Pan Mass Challenge, Team Angus and Team Perspective).

An indocyanine green-based liquid biopsy test for circulating tumor cells for pediatric liver cancer.

Hepatoblastoma and HCC are the most common malignant hepatocellular tumors seen in children. The aim of this study was to develop a liquid biopsy test for circulating tumor cells (CTCs) for these tumors that would be less invasive and provide real-time information about tumor response to therapy. For this test, we utilized indocyanine green (ICG), a far-red fluorescent dye used clinically to identify malignant liver cells during surgery. We assessed ICG accumulation in cell lines using fluorescence microscopy and flow cytometry. For our CTC test, we developed a panel of liver tumor-specific markers, including ICG, Glypican-3, and DAPI, and tested it with cell lines and noncancer control blood samples. We then used this panel to analyze whole-blood samples for CTC burden with a cohort of 15 patients with hepatoblastoma and HCC and correlated with patient characteristics and outcomes. We showed that ICG accumulation is specific to liver cancer cells, compared to nonmalignant liver cells, non-liver solid tumor cells, and other nonmalignant cells, and can be used to identify liver tumor cells in a mixed population of cells. Experiments with the ICG/Glypican-3/DAPI panel showed that it specifically tagged malignant liver cells. Using patient samples, we found that CTC burden from sequential blood samples from the same patients mirrored the patients' responses to therapy. Our novel ICG-based liquid biopsy test for CTCs can be used to specifically detect and quantify CTCs in the blood of pediatric patients with liver cancer.

Dosimetric comparison of proton therapy and CyberKnife in stereotactic body radiation therapy for liver cancers.

Stereotactic body radiation therapy (SBRT) has been increasingly used for the ablation of liver tumours. CyberKnife and proton beam therapy (PBT) are two advanced treatment technologies suitable to deliver SBRT with high dose conformity and steep dose gradients. However, there is very limited data comparing the dosimetric characteristics of CyberKnife to PBT for liver SBRT. PBT and CyberKnife plans were retrospectively generated using 4DCT datasets of ten patients who were previously treated for hepatocellular carcinoma (HCC, N = 5) and liver metastasis (N = 5). Dose volume histogram data was assessed and compared against selected criteria; given a dose prescription of 54Gy in 3 fractions for liver metastases and 45Gy in 3 fractions for HCC, with previously published consensus-based normal tissue dose constraints. Comparison of evaluation parameters showed a statistically significant difference for target volume coverage and liver, lungs and spinal cord (p < 0.05) dose, while chest wall and skin did not indicate a significant difference between the two modalities. A number of optimal normal tissue constraints was violated by both the CyberKnife and proton plans for the same patients due to proximity of tumour to chest wall. PBT resulted in greater organ sparing, the extent of which was mainly dependent on tumour location. Tumours located on the liver periphery experienced the largest increase in organ sparing. Organ sparing for CyberKnife was comparable with PBT for small target volumes.

A pilot study of virtual liver segment projection technology in subsegment-oriented laparoscopic anatomical liver resection when indocyanine green staining fails (with video).

Precision surgery for liver tumors favors laparoscopic anatomical liver resection (LALR), involving the removal of specific liver segments or subsegments. Indocyanine green (ICG)-negative staining is a commonly used method for defining resection boundaries but may be prone to failure. The challenge arises when ICG staining fails, as it cannot be repeated during surgery. In this study, we employed the virtual liver segment projection (VLSP) technology as a salvage approach for precise boundary determination. Our aim was to assess the feasibility of the VLSP to be used for the determination of the boundaries of the liver resection in this situation. Between January 2021 and June 2023, 12 consecutive patients undergoing subsegment-oriented LALR were included in this pilot series. The VLSP technology was utilized to define the resection boundaries at the time of ICG-negative staining failure. Routine surgical parameters and short-term outcomes were evaluated to assess the safety of VLSP in this procedure. In addition, its feasibility was assessed by analyzing the accuracy between the predicted resected liver volume (PRLV) and actual resected liver volume (ARLV). Of the 12 enrolled patients, the mean operation time was 444.58 ± 101.70min (range 290-570min), with a mean blood loss of 125.00 ± 96.53ml (range 50-400mL). One patient (8.3%) was converted to laparotomy for subsequent parenchymal transection, four (33.3%) received blood transfusions and four (33.3%) had postoperative complications. All patients received an R0 resection. The Pearson correlation coefficient (r) between PRLV and ARLV was 0.98 (R2 = 0.96, p < 0.05), and the relative error (RE) was 8.62 ± 6.66% in the 12 patients, indicating agreement. Failure of intraoperative ICG-negative staining during subsegment-oriented LALR is possible, and VLSP may be an alternative to define the resection boundaries in such cases.

Heterogeneity in Liver Cancer Immune Microenvironment: Emerging Single-Cell and Spatial Perspectives.

Primary liver cancer is a solid malignancy with a high mortality rate. The success of immunotherapy has shown great promise in improving patient care and highlights a crucial need to understand the complexity of the liver tumor immune microenvironment (TIME). Recent advances in single-cell and spatial omics technologies, coupled with the development of systems biology approaches, are rapidly transforming the landscape of tumor immunology. Here we review the cellular landscape of liver TIME from single-cell and spatial perspectives. We also discuss the cellular interaction networks within the tumor cell community in regulating immune responses. We further highlight the challenges and opportunities with implications for biomarker discovery, patient stratification, and combination immunotherapies.

The Loss of an Orphan Nuclear Receptor NR2E3 Augments Wnt/β-catenin Signaling via Epigenetic Dysregulation that Enhances Sp1-β catenin-p300 Interactions in Hepatocellular Carcinoma.

The orphan nuclear receptor NR2E3 (Nuclear receptor subfamily 2 group E, Member 3) is an epigenetic player that modulates chromatin accessibility to activate p53 during liver injury. Nonetheless, a precise tumor suppressive and epigenetic role of NR2E3 in hepatocellular carcinoma (HCC) development remains unclear. HCC patients expressing low NR2E3 exhibit unfavorable clinical outcomes, aligning with heightened activation of the Wnt/β-catenin signaling pathway. The murine HCC models utilizing NR2E3 knockout mice consistently exhibits accelerated liver tumor formation accompanied by enhanced activation of Wnt/β-catenin signaling pathway and inactivation of p53 signaling. At cellular level, the loss of NR2E3 increases the acquisition of aggressive cancer cell phenotype and tumorigenicity and upregulates key genes in the WNT/β-catenin pathway with increased chromatin accessibility. This event is mediated through increased formation of active transcription complex involving Sp1, β-catenin, and p300, a histone acetyltransferase, on the promoters of target genes. These findings demonstrate that the loss of NR2E3 activates Wnt/β-catenin signaling at cellular and organism levels and this dysregulation is associated with aggressive HCC development and poor clinical outcomes. In summary, NR2E3 is a novel tumor suppressor with a significant prognostic value, maintaining epigenetic homeostasis to suppress the Wnt/β-catenin signaling pathway that promotes HCC development.

Semi-supervised segmentation of abdominal organs and liver tumor: uncertainty rectified curriculum labeling meets X-fuse

Precise liver tumors and associated organ segmentation hold immense value for surgical and radiological intervention, enabling anatomical localization for pre-operative planning and intra-operative guidance. Modern deep learning models for medical image segmentation have evolved from convolution neural networks to transformer architectures, significantly boosting global context understanding. However, accurate delineation especially of hepatic lesions remains an enduring challenge due to models’ predominant focus solely on spatial feature extraction failing to adequately characterize complex medical anatomies. Moreover, the relative paucity of expertly annotated medical imaging data restricts model exposure to diverse pathological presentations. In this paper, we present a three-phrased cascaded segmentation framework featuring an X-Fuse model that synergistically integrates spatial and frequency domain’s complementary information in dual encoders to enrich latent feature representation. To enhance model generalizability, building upon X-Fuse topology and taking advantage of additional unlabeled pathological data, our proposed integration of curriculum pseudo-labeling with Jensen–Shannon variance-based uncertainty rectification promotes optimized pseudo supervision in the context of semi-supervised learning. We further introduce a tumor-focus augmentation technique including training-free copy-paste and knowledge-based synthesis that show efficacy in simplicity, contributing to the substantial elevation of model adaptability on diverse lesional morphologies. Extensive experiments and modular evaluations on a holdout test set demonstrate that our methods significantly outperform existing state-of-the-art segmentation models in both supervised and semi-supervised settings, as measured by the Dice similarity coefficient, achieving superior delineation of bones (95.42%), liver (96.26%), and liver tumors (89.53%) with 16.41% increase comparing to V-Net on supervised-only and augmented-absent scenario. Our method marks a significant step toward the realization of more reliable and robust AI-assisted diagnostic tools for liver tumor intervention. We have made the codes publicly available [https://github.com/lyupengju/X-Fuse].

An Organophosphorescence Probe with Ultralong Lifetime and Intrinsic Tissue Selectivity for Specific Tumor Imaging and Guided Tumor Surgery.

Organic phosphorescent materials are excellent candidates for use in tumor imaging. However, a systematic comparison of the effects of the intensity, lifetime, and wavelength of phosphorescent emissions on bioimaging performance has not yet been undertaken. This study addresses these gaps and reveals that longer lifetimes effectively increase the signal intensity, whereas longer wavelengths enhance the penetration depth. Conversely, a strong emission intensity with a short lifetime does not necessarily yield robust imaging signals. Building upon these findings, an organo-phosphorescent material with a lifetime of 0.94 s was designed for tumor imaging. Remarkably, the phosphorescent signals of various organic nanoparticles are nearly extinguished in blood-rich organs because of the quenching effect of iron ions. Moreover, for the first time, we demonstrated that iron ions universally quench the phosphorescence of organic room-temperature phosphorescent materials, which is an inherent property of such substances. Leveraging this property, both the normal liver and hepatitis tissues exhibit negligible phosphorescent signals, whereas liver tumors display intense phosphorescence. Therefore, phosphorescent materials, unlike chemiluminescent or fluorescent materials, can exploit this unique inherent property to selectively distinguish liver tumor tissues from normal tissues without additional modifications or treatments.

Ablation of liver tumors : From pre-interventional imaging to post-interventional assessment

The aim of this article is to provide an overview on the most frequently applied image-guided, percutaneous, local ablative techniques for treatment of primary and secondary liver tumors. The technical procedures of microwave ablation (MWA) and radiofrequency ablation (RFA) are presented. The pre-interventional diagnostics, indications and feasibility are also discussed, taking the current national guidelines into consideration. Finally, treatment outcomes and recommendations on post-interventional imaging following local tumor ablation are presented.

Efficacy and Safety of Local Liver Radioablation in HCC Lesions within and beyond Limits of Thermal Ablation.

CT-guided interstitial Brachytherapy (iBT) Radiotherapy has been established in the treatment of liver tumors. With iBT, HCC lesions can be treated beyond the limits of thermal ablation (i.e., size and location). However, a comprehensive analysis of the efficacy of iBT in patients within and beyond thermal ablation limits is lacking. 146 patients with 216 HCC lesions have been analyzed retrospectively. Clinical and imaging follow-up data has been collected. Lesions were evaluated in terms of suitability for thermal ablation or not. The correlation between local tumor control (LTC), time-to-progression (TTP), and overall survival (OS), and clinical and imaging parameters have been evaluated using univariable and multivariable Cox regression analyses. LTC rates at 12 months, 24 months, and 36 months were 87%,75%, and 73%, respectively. 65% of lesions (n=141) were not suitable for RFA. The median TTP was 13 months, and the median OS was not reached (3-year OS rate: 70%). No significant difference in LTC, TTP, or OS regarding RFA suitability existed. However, in the overall multivariable analysis, lesion diameter > 5 cm was significantly associated with lower LTC (HR: 3.65, CI (1.60-8.31), p=0.002) and shorter TTP (HR: 2.08, CI (1.17-3.70), p=0.013). Advanced BCLC stage, Child-Pugh Stage, and hepatitis B were associated with shorter OS. iBT offers excellent LTC rates and OS in local HCC treatment regardless of the limits of thermal ablation, suggesting further evidence of its alternative role to thermal ablation in patients with early-stage HCC.

UBXN1 promotes liver tumorigenesis by regulating mitochondrial homeostasis

BackgroundThe maintenance of mitochondrial homeostasis is critical for tumor initiation and malignant progression because it increases tumor cell survival and growth. The molecular events controlling mitochondrial integrity that facilitate the development of hepatocellular carcinoma (HCC) remain unclear. Here, we report that UBX domain-containing protein 1 (UBXN1) hyperactivation is essential for mitochondrial homeostasis and liver tumorigenesis.MethodsOncogene-induced mouse liver tumor models were generated with the Sleeping Beauty (SB) transposon delivery system. Assessment of HCC cell growth in vivo and in vitro, including tumour formation, colony formation, TUNEL and FACS assays, was conducted to determine the effects of UBXN1 on HCC cells, as well as the involvement of the UBXN1-prohibitin (PHB) interaction in mitochondrial function. Coimmunoprecipitation (Co-IP) was used to assess the interaction between UBXN1 and PHB. Liver hepatocellular carcinoma (LIHC) datasets and HCC patient samples were used to assess the expression of UBXN1.ResultsUBXN1 expression is commonly upregulated in human HCCs and mouse liver tumors and is associated with poor overall survival in HCC patients. UBXN1 facilitates the growth of human HCC cells and promotes mouse liver tumorigenesis driven by the NRas/c-Myc or c-Myc/shp53 combination. UBXN1 interacts with the inner mitochondrial membrane protein PHB and sustains PHB expression. UBXN1 inhibition triggers mitochondrial damage and liver tumor cell apoptosis.ConclusionsUBXN1 interacts with PHB and promotes mitochondrial homeostasis during liver tumorigenesis.

Glycolytic enzyme PFKL governs lipolysis by promoting lipid droplet-mitochondria tethering to enhance β-oxidation and tumor cell proliferation.

Lipid droplet tethering with mitochondria for fatty acid oxidation is critical for tumor cells to counteract energy stress. However, the underlying mechanism remains unclear. Here, we demonstrate that glucose deprivation induces phosphorylation of the glycolytic enzyme phosphofructokinase, liver type (PFKL), reducing its activity and favoring its interaction with perilipin 2 (PLIN2). On lipid droplets, PFKL acts as a protein kinase and phosphorylates PLIN2 to promote the binding of PLIN2 to carnitine palmitoyltransferase 1A (CPT1A). This results in the tethering of lipid droplets and mitochondria and the recruitment of adipose triglyceride lipase to the lipid droplet-mitochondria tethering regions to engage lipid mobilization. Interfering with this cascade inhibits tumor cell proliferation, promotes apoptosis and blunts liver tumor growth in male mice. These results reveal that energy stress confers a moonlight function to PFKL as a protein kinase to tether lipid droplets with mitochondria and highlight the crucial role of PFKL in the integrated regulation of glycolysis, lipid metabolism and mitochondrial oxidation.

Cholangiocarcinoma: The Current Status of Surgical Options including Liver Transplantation

Cholangiocarcinoma (CCA) poses a substantial threat as it ranks as the second most prevalent primary liver tumor. The documented annual rise in intrahepatic CCA (iCCA) incidence in the United States is concerning, indicating its growing impact. Moreover, the five-year survival rate after tumor resection is only 25%, given that tumor recurrence is the leading cause of death in 53–79% of patients. Pre-operative assessments for iCCA focus on pinpointing tumor location, biliary tract involvement, vascular encasements, and metastasis detection. Numerous studies have revealed that portal vein embolization (PVE) is linked to enhanced survival rates, improved liver synthetic functions, and decreased overall mortality. The challenge in achieving clear resection margins contributes to the notable recurrence rate of iCCA, affecting approximately two-thirds of cases within one year, and results in a median survival of less than 12 months for recurrent cases. Nearly 50% of patients initially considered eligible for surgical resection in iCCA cases are ultimately deemed ineligible during surgical exploration. Therefore, staging laparoscopy has been proposed to reduce unnecessary laparotomy. Eligibility for orthotopic liver transplantation (OLT) requires certain criteria to be granted. OLT offers survival advantages for early-detected unresectable iCCA; it can be combined with other treatments, such as radiofrequency ablation and transarterial chemoembolization, in specific cases. We aim to comprehensively describe the surgical strategies available for treating CCA, including the preoperative measures and interventions, alongside the current options regarding liver resection and OLT.

Tryptophan fuels MYC-dependent liver tumorigenesis through indole 3-pyruvate synthesis

Cancer cells exhibit distinct metabolic activities and nutritional dependencies compared to normal cells. Thus, characterization of nutrient demands by individual tumor types may identify specific vulnerabilities that can be manipulated to target the destruction of cancer cells. We find that MYC-driven liver tumors rely on augmented tryptophan (Trp) uptake, yet Trp utilization to generate metabolites in the kynurenine (Kyn) pathway is reduced. Depriving MYC-driven tumors of Trp through a No-Trp diet not only prevents tumor growth but also restores the transcriptional profile of normal liver cells. Despite Trp starvation, protein synthesis remains unhindered in liver cancer cells. We define a crucial role for the Trp-derived metabolite indole 3-pyruvate (I3P) in liver tumor growth. I3P supplementation effectively restores the growth of liver cancer cells starved of Trp. These findings suggest that I3P is a potential therapeutic target in MYC-driven cancers. Developing methods to target this metabolite represents a potential avenue for liver cancer treatment.

Giant Hepatic Hemangioma: A Case Report

A giant hepatic hemangioma is a large benign liver tumor, typically over 10 cm in size. While often asymptomatic, these tumors can cause abdominal discomfort or pain. Diagnosis relies on imaging like ultrasound and CT/MRI scans showing characteristic features. Treatment options include surgery for symptomatic or enlarging tumors, with alternative approaches like embolization or ablation considered in certain cases. Prognosis is generally good with appropriate management, including rare instances of spontaneous regression, especially in postmenopausal women. Further research is needed to refine treatment strategies for giant hepatic hemangiomas.

PSO-PSP-Net + InceptionV3: An optimized hyper-parameter tuned Computer-Aided Diagnostic model for liver tumor detection using CT scan slices

An automated diagnostic system leads to a supreme requirement in medical image analysis, greatly impacting the death rate due to the high spreading rate of liver tumors. However, the traditional histopathological diagnostic processes cause more disruption in the medical detection framework because of the procedure of manual estimation of CT scans and medical labor-intensive, which lead to the time consumption process. It is a highly challenging task for the segmentation of liver tumor because of the irregular appearance, distinct densities, patchy edges, and tumor sizes. To overcome this issue, an automated computer-aided diagnosis framework has been utilized to diagnose the liver cancer quickly and accurately with the less workload of expert radiologists.Presently, Deep learning-based techniques have been applied to identify the tumor regions and assist radiologists in the initial diagnosis and scrutinizing the severity level. The proposed work presents a modified pyramid scene parsing network (PSP-Net) model based on InceptionV3 deep network architecture with a particle swarm optimization algorithm, which increases the efficiency and effectiveness of the liver diagnostic model. Three publicly accessible benchmark datasets have been engaged with the pre-processing task accomplished by image normalization and data augmentation techniques. Moreover, a hyper-parameter tuned improved PSO-PSP-Net algorithm has analyzed the optimal set of gathered features. In the experimental evaluation, the proposed model outperformed than grey wolf optimization (GWO-PSP-Net), PSO-U-Net, GWO-U-Net, opposition based spotted hyena optimization (O-SHO-CRNN), and grey wolf-class topper optimization (GW-CTO) + U-Net by 8.42 %, 4.9 %, 9.54 %, 5.12 %, and 1.75 %, respectively in terms of accuracy for LiTS dataset. The developed PSO-PSP-Net model attained better accuracy than GWO-PSP-Net, PSO-U-Net, GWO-U-Net, and Residual Atrous U-Net (RA-U-Net) for the segmentation of Type-I and Type-II liver tumors by 6.88 %, 8.44 %, 13.75 %, 5.99 % and 6.12 %, 9.74 %, 17.3 %, and 5.11 %, respectively for 3DIRCAD-b1 dataset. The obtained accuracy of the developed model is 14.09 %, 7.54 %, 16.36 %, 2.64 %, and 14.9 %, 8.86 %, 17.76 %, and 4.87 % maximized than GWO-PSP-Net, PSO-U-Net, GWO-U-Net, and RA-U-Net, respectively, for the segmentation of the infected arteries and bones in the 3DIRCAD-b1 dataset. For the CHAOS dataset, the improved PSO-PSP-Net model outperformed GWO-PSP-Net, PSO-U-Net, and GWO-U-Net, respectively, in terms of overall accuracy by 7.44 %, 8.85 %, and 17.2 %, respectively. The investigational analysis validates the proposed PSO-PSP-Net model's effectiveness and performance in obtaining high segmentation accuracy in comparison with other state-of-the-art approaches.

Inflammatory myofibroblastic tumor of the liver after adrenal neuroblastoma surgery: a case report

A boy aged 55 months was diagnosed with stage IV Neuroblastoma (NB) of the right adrenal gland 2 years ago. Preoperative chemotherapy was given and he was then treated with retroperitoneal tumor resection and lymph node dissection. After surgery, the children were transferred to the Hemato-Oncology Department for chemotherapy according to the high-risk group NB, with outpatient follow-up every 6 months. In the second postoperative year, abdominal computed tomography (CT) scan revealed a rounded hypodense area in the upper part of the right posterior lobe of the liver, with marked inhomogeneous enhancement in the venous phase after enhancement, which was surgically resected, and postoperative pathology confirmed inflammatory myofibroblastic tumor (IMT) of liver. The patient was not given any special treatment after surgery. In this study, whole transcriptome sequencing was performed on the postoperative specimen of adrenal NB and the specimen of IMT of liver. This unusual case emphasizes the need for close monitoring of second tumor development in NB survivors even in the absence of known predisposing factors.

Conventional versus Hepatic Arteriography and C-Arm CT-Guided Ablation of Liver Tumors (HepACAGA): A Comparative Analysis.

Hepatic Arteriography and C-Arm CT-Guided Ablation of liver tumors (HepACAGA) is a novel technique, combining hepatic-arterial contrast injection with C-arm CT-guided navigation. This study compared the outcomes of the HepACAGA technique with patients treated with conventional ultrasound (US) and/or CT-guided ablation. In this retrospective cohort study, all consecutive patients with hepatocellular carcinoma (HCC) or colorectal liver metastases (CRLM) treated with conventional US-/CT-guided ablation between 1 January 2015, and 31 December 2020, and patients treated with HepACAGA between 1 January 2021, and 31 October 2023, were included. The primary outcome was local tumor recurrence-free survival (LTRFS). Secondary outcomes included the local tumor recurrence (LTR) rate and complication rate. 68 patients (120 tumors) were included in the HepACAGA cohort and 53 patients (78 tumors) were included in the conventional cohort. In both cohorts, HCC was the predominant tumor type (63% and 73%, respectively). In the HepACAGA cohort, all patients received microwave ablation. Radiofrequency ablation was the main ablation technique in the conventional group (78%). LTRFS was significantly longer for patients treated with the HepACAGA technique (p = 0.015). Both LTR and the complication rate were significantly lower in the HepACAGA cohort compared to the conventional cohort (LTR 5% vs. 26%, respectively; p < 0.001) (complication rate 4% vs. 15%, respectively; p = 0.041). In this study, the HepACAGA technique was safer and more effective than conventional ablation for HCC and CRLM, resulting in lower rates of local tumor recurrence, longer local tumor recurrence-free survival and fewer procedure-related complications.

Pathological complete response with FOLFIRINOX therapy for recurrence of pancreatic acinar cell carcinoma.

Pancreatic acinar cell carcinoma (PACC) is a very rare subtype of pancreatic cancer. Due to small number of patients, no standard chemotherapy protocol has been established. We experienced an extremely rare case of PACC with liver metastasis that showed a pathological complete response after modified FOLFIRINOX (mFFX) therapy. A 42-year-old man who underwent distal pancreatectomy for an 80mm tumor at the pancreatic tail 3years ago was referred to our hospital in September 2017 for the treatment of a recurrent liver tumor. Percutaneous biopsy revealed an acinar-neuroendocrine carcinoma, similar to the surgical specimen. He received eight cycles of irinotecan plus cisplatin chemotherapy. However, the tumor increased in size, and treatment was switched to mFFX therapy. The tumor in the liver shrank remarkably after nine cycles of mFFX therapy. Conversion surgery was selected, and the patient underwent hepatic left and caudate lobectomy 8months after administration of mFFX. The resected specimen showed no viable tumor cells, indicating a pathological complete response. The histological diagnosis was reconsidered, and PACC was finally diagnosed via an additional immunohistological review. The patient has remained well with no recurrence for 6years after surgery. This study is the first to report a case of pathological complete response with mFFX therapy for the recurrence of PACC.

Effectiveness of deep learning-based reconstruction for improvement of image quality and liver tumor detectability in the hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance imaging.

To evaluate the effectiveness of deep learning-based reconstruction (DLR) in improving image quality and tumor detectability of isovoxel high-resolution breath-hold fat-suppressed T1-weighted imaging (HR-BH-FS-T1WI) in the hepatobiliary phase (HBP) of Gadoxetic acid-enhanced magnetic resonance imaging (Gd-EOB-MRI). This retrospective evaluated 42 patients with 98 liver tumors who underwent Gd-EOB-MRI between March 2023 and May 2023 using three techniques based on HBP imaging: isovoxel HR-BH-FS-T1WI reconstructed (1) with DLR (BH-DLR +) and (2) without DLR (BH-DLR -) and (3) HR-FS-T1WI scanned with a free-breathing technique using a navigator-echo-triggered technique and DLR (Navi-DLR +). The three techniques were qualitatively and quantitatively compared by the Friedman test and the Bonferroni post-hoc test. Tumor detectability was compared using the McNemar test. BH-DLR + (3.85, average score of two radiologists) showed significantly better qualitative scores for image noise than BH-DLR - (2.84) and Navi-DLR + (3.37) (p < 0.0167), and Navi-DLR + showed significantly better scores than BH-DLR - (p < 0.0167). BH-DLR + (3.77) and BH-DLR - (3.77) showed significantly better qualitative scores for respiratory motion artifact than Navi-DLR + (2.75) (p < 0.0167), but there was no significant difference in scores between BH-DLR + and BH-DLR - (p > 0.0167). BH-DLR + (0.32) and Navi-DLR + (0.33) showed significantly higher lesion-to-nonlesion CR than BH-DLR - (0.29) (p < 0.0167), but there was no significant difference in lesion-to-nonlesion CR between BH-DLR + and Navi-DLR + (p > 0.0167). BH-DLR + (89.8%) showed significantly better tumor detectability than BH-DLR - (76.0%) and Navi-DLR + (77.6%) (p < 0.05). The use of DLR for isovoxel HR-BH-FS-T1WI was effective in improving image quality and tumor detectability.