Metastatic Liver Mass Research Articles

Metastatic liver mass with heart failure presentation: A case report

Objective: Dyspnea is a common symptom of heart disease that can also be related to other disorders, such as liver disease. In this case report, we aim to describe a rare case of metastatic liver mass that presented with heart failure. Case Presentation: A 50-year-old woman without a past medical history arrived at our hospital with a history of dyspnea and swelling in the lower extremities. She did not complain of pain, arthralgia, trauma, or chest pain but complained of exertional dyspnea and fatigue that had started one month before and had aggravated two days before. Her laboratory test indicated anemia. In echocardiography, we saw mild right ventricle enlargement and dysfunction, but the left heart was normal with acceptable systolic and diastolic function. In the subcostal view, the inferior vena cava (IVC) was dilated but under compression of a large liver mass. According to our literature review, this is the first case in which a metastatic liver mass had presented with heart failure. Conclusion: In patients presenting with dyspnea, despite normal echocardiographic findings, the exact evaluation of the IVC should be considered.

Diagnostic performance and safety of endoscopic ultrasound-guided fine-needle aspiration/biopsy for gallbladder lesions.

Endoscopic ultrasound-guided fine-needle aspiration and fine-needle biopsy (EUS-FNA/FNB) is not fully established as a pathological sampling tool for gallbladder lesions due to limited evidence. We therefore aimed to clarify the effectiveness and safety of this procedure in a large-population cohort. This study retrospectively evaluated the diagnostic yield of EUS-FNA/FNB for accurately differentiating between benign and malignant gallbladder lesions. Puncture targets included the gallbladder mass, lymph node, and liver mass. Adverse events and factors associated with diagnostic accuracy were analyzed as well. In 187 patients with gallbladder lesions undergoing EUS-FNA/FNB, 18 benign lesions and 169 malignant lesions were identified. Overall sampling adequacy was 98% (184/187). The diagnostic accuracy of EUS-FNA/FNB was 97% (182/187), sensitivity was 97% (164/169), and specificity was 100% (18/18). A single postprocedural complication (minor bleeding) was recorded in one patient. In the 169 cases of malignancy, 203 sites were punctured for pathological sampling of the primary mass (n = 94), lymph node (n = 79), and metastatic liver mass (n = 30). No significant difference was found for diagnostic accuracy among the puncture sites (P = 0.70). In cases having specimens obtained from the primary mass, the accuracy of those targeting liver invasion sites was significantly higher than that of other sites (98% vs. 83%, P < 0.01). EUS-FNA/FNB demonstrated clinical usefulness and safety for the pathological diagnosis of gallbladder lesions, with high diagnostic yield and a low incidence of adverse events. Targeting the site of liver infiltration may improve the diagnostic rate of EUS-FNA/FNB in the primary mass.

Local therapies for liver metastases of rare head and neck cancers: a monoinstitutional case series.

Transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) are established procedures for treating hepatocellular cancer and selected malignancies with liver metastasis. The aim of this study is to describe a monoinstitutional case series of local approaches in patients with liver metastases from rare head and neck cancers (HNCs). This is a retrospective series of adult patients with HNC treated with liver locoregional approaches (TACE or RFA) at our institution from 2007 to 2018. In case of chemoembolization, the preferred chemotherapeutic drug was doxorubicin. Response according to RECIST (Response Evaluation Criteria in Solid Tumors) was assessed with contrast-enhanced computed tomography scans. Thirty-four patients were treated (20 men, median age 58 years) with TACE (27), transarterial embolization (2), or RFA (7). Primary tumours were salivary gland (21), thyroid (6), nasopharyngeal (5), and sinonasal cancers (2). Seventeen patients (50%) had a single metastatic liver nodule; 70% of the remaining 17 patients had at least three liver metastases. The median diameter of the metastatic liver mass undergoing treatment was 39 mm (range 11-100 mm). Median follow-up was 27.6 months. Response rate was 35% (3% complete, 32% partial response). Median progression-free survival and overall survival were 6.9 and 19.6 months, respectively. Treatment-related adverse events occurred in 59% of patients (21% grade ⩾ 3; no grade 5). This retrospective case series demonstrates that locoregional radiologic approaches for rare HNCs with liver metastases are feasible. These procedures deserve further prospective studies before being considered safe and active in these malignancies where the availability of effective systemic treatments is lacking.

Laparoscopic Isolated Caudate Lobectomy for Rectal Cancer Liver Metastasis

Summary: Metastatic tumor in the caudate lobe is difficult to manage and laparoscopic caudate lobectomy is regarded as a difficult procedure because of the deep location of the caudate lobe and its proximity to great vessels. Isolated caudate lobectomy is still rare and technically challenging. Therefore, we present a Case of a female patient who underwent laparoscopic isolated caudate lobectomy for liver metastasis of rectal cancer. A 58-year-old female was visited due to change in stool caliber. On the colonoscopy, mid rectal cancer was found. Surveillance computed tomography and magnetic resonance imaging showed 2cm metastatic liver mass in caudate lobe. We performed laparoscopic isolated caudate lobectomy for liver metastasis and laparoscopic low anterior resection for rectal cancer cooperatively. The caudate lobe was freed from the IVC and venous ligament. The short hepatic veins and the portal branches to the caudate lobe were ligated with clips. The procedure was completed totally laparoscopic technique. The operative time was 125 minutes. The intraoperative blood loss was minimal and the patient was safely discharged on the seventh postoperative day without perioperative complication. Pathology analysis showed a 2.4 × 2.1 × 2.1 cm metastatic adenocarcinoma with tumor-free resection margin. CT scan at 3 months after the operation showed complete removal of the caudate lobe with no evidence of recurrence. Our experience lobectomy demonstrated that laparoscopic caudate lobectomy is safe and feasible in patients with malignancy in caudate lobe.

Histologic and Oncologic Outcomes Following Liver Mass Resection With Retroperitoneal Lymph Node Dissection in Patients With Nonseminomatous Germ Cell Tumor

To evaluate the oncologic outcomes and histologic concordance of postchemotherapy residual liver mass resection with postchemotherapy retroperitoneal lymph node dissection (PC-RPLND). Retrospective review of our prospectively maintained germ cell tumor (GCT) surgical database identified patients with nonseminomatous GCT who underwent both postchemotherapy residual liver mass resection and PC-RPLND between 1990 and 2015. A total of 36 patients were identified, of whom 29 (81%) presented with a liver mass at initial diagnosis and 17 (47%) received second-line chemotherapy before liver resection. Teratoma was found in 8 (22%) and 5 (14%) of PC-RPLND and liver resection specimens, respectively. Viable GCT was found in 5 (14%) and 4 (11%) of PC-RPLND and liver resection specimens, respectively. Histologic discordance was observed in 4 of 19 patients (21%; 95% confidence interval [CI] 6.1%-46%); in all cases, liver resection specimens contained teratoma or viable GCT while PC-RPLND revealed only fibrosis or necrosis. At 3 years after surgical intervention, the Kaplan-Meier estimated probability of cancer-specific survival was 75% (95% CI 55%-85%) and the probability of progression-free survival was 75% (95% CI 56%-87%). In this contemporary cohort, clinically significant discordance was observed between the histology of metastatic liver masses and that of retroperitoneal lymph nodes. The benefit of postchemotherapy liver mass resection for patients with advanced nonseminomatous GCT is supported by favorable survival outcomes. Until more reliable predictors of postchemotherapy histology exist, complete surgical resection of all sites of residual disease should be performed whenever feasible.

KRAS mutation analysis by next-generation sequencing in endoscopic ultrasound-guided sampling for solid liver masses.

KRAS mutation analysis may provide ancillary diagnostic yield in an endoscopic ultrasound (EUS)-guided histopathological evaluation. We evaluated the clinical impact of KRAS mutation analysis with cytological and histological evaluations in EUS-guided tissue sampling, using a core biopsy needle for solid liver masses. EUS-guided fine needle biopsy (EUS-FNB) using a core biopsy needle was performed in patients with primary or metastatic liver masses that were suspected malignancies. KRAS mutations were analyzed in all specimens obtained. The peptide nucleic acid (PNA)-mediated polymerase chain reaction (PCR) clamping method was compared with a next-generation sequencing (NGS) method for detecting KRAS mutations. EUS-FNB with a core biopsy needle was performed in 28 patients with solid liver masses located in the liver's left lobe. The diagnostic accuracies for malignancy of on-site cytology, cytology using Papanicolaou staining, and histology including immunohistochemical stains were 82.1%, 85.7%, and 89.3%, respectively. KRAS gene mutations were observed in 14.3% of patients by the PNA-PCR clamping method. The NGS method detected more KRAS mutations than the PNA-PCR clamping method: in 25% of patients. Adding the results of KRAS mutation analysis to the cytohistopathological evaluation, the overall diagnostic accuracy of EUS-guided tissue sampling was 96.4%. EUS-guided tissue sampling for solid liver masses in the left lobe provided high diagnostic accuracy from cytological and histological evaluations. KRAS mutation analysis provided additional diagnostic yield in patients with inconclusive cytohistopathological results from EUS-guided tissue sampling. The NGS method detected additional KRAS mutations in patients with negative PNA-mediated PCR clamping test results.

Vascular enhancement pattern of mass in computed tomography may predict chemo-responsiveness in advanced pancreatic cancer

IntroductionChemo-responsiveness in pancreatic cancer is known to be dependent on fibrosis and vascularity. The purpose of this study was to assess vascular enhancement in advanced pancreatic adenocarcinoma with or without liver metastasis in computed tomography (CT) and to analyze the correlation between enhancement patterns and chemo-responsiveness. MethodsPatients were assigned to either a responder group (partial response or stable disease) or a non-responder group (progressive disease) according to chemo-responsiveness assessed by CT before and after gemcitabine-based chemotherapy. Hounsefield unit (HU) was measured in pancreatic mass and the largest metastatic liver mass using region of interest (ROI). HU differences (ΔHU) between arterial and pre-contrast phase were calculated. ResultsOf the 101 study subjects, 78(77.2%) were assigned to the pancreas responder group {mean ΔHU (±SD), 36.7(±21.6)} and 23(22.8%) to the pancreas non-responder group {mean ΔHU (±SD), 20.6(±9.9)} (p = 0.001 for ΔHUs). Of the 46 study subjects with liver metastasis, 25(54.3%) were assigned to the liver metastasis responder group {mean ΔHU (±SD), 36.9(±21.0} and 21(45.7%) to the liver metastasis non-responder group {mean ΔHU (±SD), 17.1 (±24.0)}, (p = 0.005 for ΔHUs). ConclusionCT determined mass vascular enhancement patterns may predict chemoresponse in advanced pancreatic cancer.

Cardiovascular risk assessment in patients with chronic and recurrent pancreatitis-preliminary data

s / Pancreatology 16 (2016) S1eS130 S16 Patients & methods: 58 patients with advanced pancreatic adenocarcinomawere selected in three institutions. chemo-responsiveness of all patients was assessed with ct before and after receiving at least 3 cycles of gemcitabine-based chemotherapy. hounsefield unit (HU) was measured in pancreatic mass and the largest metastatic liver mass using region of interest. HU difference between arterial and pre-contrast phase (Delta value) could reflect vascular enhancement. According to chemo-responsiveness, the patients were divided into 2 group, Responder group (partial response and stable disease) and non-responder group (Progressive disease). Results: A total of 58 patients were included in the study. 41 patients belonged to pancreatic responder group (70.7%) and 17 patients belonged to pancreas non-responder group (29.3%). Mean delta value in pancreas responder group and non-responder group was 48.9 and 24.6 (p < 0.001). 29 of 59 patients had liver metastasis. 19 of 29 patients belonged to liver responder group and 10 patients belonged to liver non-responder group. mean delta value in liver responder group and non-responder group was 36.68 and 12.30 (p1⁄40.031). four patients showed inconsistency between pancreas and liver chemo-responsiveness. They all belonged to pancreas responder group (median delta value 35; range 30-44) and liver nonresponder group (13;range 6-16) Conclusion: Vascular enhancement pattern of the mass in ct may predict chemo-response in pancreatic cancer with liver metastasis.

Radiofrequency ablation of metastatic liver masses: recurrence patterns and prognostic factors based on radiologic features.

To investigate the therapeutic result of RFA and the factors predicting recurrence after RFA in patients with hepatic metastases. We reviewed 33 patients who had hepatic metastases and underwent curative RFA. Statistical analysis of the determinants of tumor recurrence was done by sex, age, site and differentiation of the primary cancer, lesion size, location within the liver, ablative margin and presence of vessels contiguous to the mass and time from the initial liver metastasis to RFA. Marginal tumor recurrence was seen at the ablation margin in 13 (25%) of 52 lesions. Lesions with an ablative margin of 5mm or more had longer marginal recurrence-free interval compared to lesions with an ablative margin of less than 5mm. The patients with primary colorectal cancer had a significantly longer distant recurrence-free interval compared to patients with non-colorectal neoplasms. Percutaneous RFA is an effective alternative modality for the treatment of hepatic metastases from various primary cancers and has a relatively low recurrence rate. The presence of an ablative margin was a significant prognostic factor for marginal tumor recurrence. In addition, distant metastasis, a new hepatic lesion or extrahepatic was significantly influenced by the site of the primary cancer.

Transformation of Nonfunctioning Pancreatic Neuroendocrine Carcinoma Cells into Insulin Producing Cells after Treatment with Sunitinib

We report a rare case of severe hypoglycemia after sunitinib treatment for pancreatic neuroendocrine carcinoma. We describe the initial clinical presentation, laboratory results, pathologic findings, and managment in a patient with a nonfunctioning pancreatic neuroendocrine carcinoma with liver metastases who developed life threatening hypoglycemia after 2 months of sunitinib therapy. A 46-year-old woman presented to the emergency department with loss of consciousness from hypoglycemia. Serum C-peptide and insulin levels at fasting state revealed that the hypoglycemia resulted from endogenous hyperinsulinemia. She had been diagnosed with nonfunctioning pancreatic neuroendocrine carcinoma based on a biopsy of metastatic cervical lymph node and was being treated with sunitinib, a small molecule tyrosine kinase inhibitor. Immunohistochemical stain of the metastatic liver mass demonstrated that the initially nonfunctioning neuroendocrine carcinoma cells had changed into insulin-producing cells after sunitinib therapy. Transarterial chemoembolization of the liver masses and systemic chemotherapy with streptozotocin/adriamycin relieved the hypoglycemia. A nonfunctioning pancreatic neuroendocrine carcinoma was transformed into an insulin-producing tumor after treatment with sunitinib, causing endogenous hyperinsulinemia and severe hypoglycemia.

Hepatic Resection for Large Hepatic Metastasis of Adrenocortical Carcinoma after Cyberknife Treatment

Surgical resection is the best treatment for operable metastatic liver cancer. Large metastatic cancer usually has low operability, so a debulking modality of mass is needed to increase operability. Chemotherapy and radiotherapy were commonly used as neoadjuvant treatments. Cyberknife stereotactic radiosurgery systems were only considered as one of the palliative treatment modalities for inoperable or surgically complex tumors. But, in this case, we applied Cyberknife as the preoperative debulking modality for large hepatic metastasis of adrenocortical carcinoma. After Cyberknife treatment 3 cycle×2,700 cGY, tumor size decreased (metastatic liver mass decreased to 15×9 cm from 19×12.5 cm, adrenal mass decreased to 5×3 cm from 7.4×4.5 cm). We could then resect the tumor completely by extended right hemihepatectomy & right adrenalectomy. A preoperative multidisciplinary approach, including chemotherapy and radiation therapy can be considered to increase operability. So, cyberknife can be considered an additional modality as a neoadjuvant radiotherapy. (J Korean Surg Soc 2010;79:S45-49)

Liver metastases of pancreatic acinar cell carcinoma with marked nuclear atypia and pleomorphism diagnosed by EUS FNA cytology : A case report with emphasis on FNA cytological findings

BackgroundAcinar cell carcinoma of the pancreas is a rare neoplasm. Although this tumor has been well characterized histologically, the morphological patterns in Fine Needle Aspiration Cytology have not been well defined. Unlike ductal adenocarcinomas, endocrine tumors, and solid pseudopapillary tumors of the pancreas with their characteristic FNA cytological features, acinar cell carcinomas pose a particular diagnostic challenge by sharing many cytomorphologic features with endocrine tumors of the pancreas.Case presentationA 37-year-old man presented with lower chest and left upper quadrant abdominal pain. Computed tomography revealed a 7.8 × 7.3 cm irregular, partially cystic mass in the body and tail of the pancreas, and two lesions in the liver compatible with metastases. Subsequently, the patient underwent endoscopic ultrasound-guided fine needle aspiration on one of the two metastatic liver masses.FNA cytology revealed abundant, loosely cohesive clusters of malignant epithelial cells with vaguely acinar and trabecular formations. The pleomorphic nuclei had fine granular chromatin and occasionally small nucleoli. There were scant to moderate amounts of cytoplasm. Scattered, strikingly large tumor cells with giant nuclei, prominent mitoses and associated necrosis were evident. A pancreatic endocrine tumor was suspected initially, but acinar cell carcinoma of the pancreas was confirmed by immunohistochemistry, cytochemical and ultrastructural studies.ConclusionWe describe a case of pancreatic acinar cell carcinoma with unusual cytomorphologic features mimicking an endocrine tumor of pancreas, encountered in endoscopic ultrasound-guided fine needle aspiration of a metastatic liver mass and discuss the diagnostic approach for this unusual pancreatic tumor in fine needle aspiration cytology.

Biliary obstruction in metastatic disease: thin-section helical CT findings.

We describe the thin-section helical computed tomographic (CT) findings of biliary obstruction caused by metastasis. Thin-section helical CT (5 mm slice thickness, 1:1 pitch, portal phase) and direct cholangiography in 50 consecutive patients with biliary obstruction caused by metastases were reviewed retrospectively by three radiologists. The primary sites were the stomach ( n = 36), colon ( n = 12), jejunum ( n = 1), and uterus ( n = 1). The level of biliary obstruction was analyzed with the Bismuth classification, and the CT findings of biliary obstruction were classified into six types: small (<2 cm) periductal masses, large (>/=2 cm) periductal masses, extrinsic compression by a metastatic liver mass, high-attenuation intraductal mass, intrapancreatic mass, and no demonstrable lesion. The level of biliary obstruction was the hilum in 18 patients (36%), the proximal common duct in 20 (40%), the distal common duct in five (10%), and the periampullary area in seven (14%). Of 18 hilar obstructions, tumor involvement of the secondary confluence of intrahepatic bile ducts was seen in 10 (right in six, left in one, and bilateral in three). Periductal masses were seen in 68% (small in 18, large in 16). In one patient (2%), a large metastatic mass of the liver resulted in extrinsic compression and biliary obstruction. Lesions mimicking primary biliary or pancreatic tumor were seen in four, respectively. In seven, we found no obstructing lesion on CT. Biliary obstruction in patients with known primary malignancies can show atypical patterns mimicking primary pancreatobiliary malignancies on thin-section helical CT.

A CASE OF DISSEMINATED METASTASIS TO THE DIAPHRAGMA DIAGNOSED BY MAGNETIC RESONANCE IMAGING (MRI)

A 14-year-old girl was admitted to the hospital for a suspecion of metastatic liver mass on abdominal CT and ultrasonography. There was a history of undergoing bilateral oophorectomy with histerectomy for a left ovarian immature teratoma 2 years before. After the operation chemotherapy was added. On admission ultrasonography revealed a solitary metastatic tumor in the S8 are of the liver, but abdominal angiography showed no abnormal finding. MRI revealed an apparent extrahepatic tumor. The patient was diagnosed as having a disseminated metastatic tumor in the right diaphragm. There was no other abnormal finding, so a laparotomy was performed. The tumor was on the right diaphragm and compressed the liver. There was neither adhesion nor invasion into the liver. Some red bean or broad bean-size disseminated tumor were found in the Douglas pouch, anterior wall of the rectum and right kidney area. All those tumors were excised. These tumors were mature teratoma histologically. In general, extra or intrahepatic tumors often present difficulty in diagnosing. This paper describes such a case in which MRI was useful in differential diagnosis.