Size Of Hepatic Lesions Research Articles

Management of Hepatic Burkitt Lymphoma in Children

Hepatic Burkitt lymphoma is extremely rare in childhood and can be overlooked in differential diagnosis of liver masses. Patient: A8-year-old girl presented with a 1 month history of abdominal pain and weight loss and jaundice. Results: Physical examination revealed hepatomegaly and no palpable lymph node. Laboratory finding showed mild anemia (hemoglobin, 10,8 g/dL), elevated transaminase (ALT, 305 IU/L; ASAT,755 IU/L), elevated bilitubin (Bilirubin total, 179mg/L, Bilirubin direct, 143mg/l). Abdominal ultrasound shouwed a multiple hepatic lesions. Liver biopsy examination confirmed Burkitt's lymphoma. No metastasis was detected in the thoracic cavity, bone marrow, and spinal fluid. The patient was treated with the combination regimen of cyclophosphamide, doxorubicin, vincristine, prednisone and high dose methotrexate. Cytosine arabinoside and methotrexate were added for CNS prophylaxis by intrathecal installation. Serial follow-up ultrasound showed a marked decrease in the size of hepatic lesions but residual hilar lymph nodes at 2cm and the control showed stable size of lymph node after 28 months of chemotherapy. Conclusion: The clinical feature of primary hepaticlymphoma varies from no symptom to fulminant hepatic failure. There are no specific imaging criteria for diagnosing primary hepatic Burkitt’s lymphoma. Thus, histology by biopsy is necessary for diagnosis.

S2603 A Case Series: Pseudocirrhosis Presenting as Acute Upper Gastrointestinal Bleeding After FOLFOX Therapy

INTRODUCTION: Pseudocirrhosis refers to morphologic changes seen on imaging in patients with metastatic disease to the liver. We present two cases of upper gastrointestinal bleed in patients with pseudocirrhosis due to metastatic gastrointestinal adenocarcinomas. CASE DESCRIPTION/METHODS: Case 1 A 31 year old female with metastatic adenocarcinoma to the liver, likely cholangiocarcinoma, presented with abdominal pain and vomiting. She completed a course of FOLFOX and was on ivosidenib. She was admitted with concern for sepsis and developed emesis. Imaging revealed progressive metastatic disease with pseudocirrhosis. Placement of a nasogastric tube returned bright red blood and a three point drop in hemoglobin to 4.5 g/dL. Emergent EGD revealed large esophageal varices with a “white nipple sign.” A pediatric bite block precluded banding. The varices were sclerosed with sodium tetradecyl sulfate without complication. Due to poor prognosis she was discharged to hospice. Case 2 A 44 year old male with metastatic colon cancer to the liver, on FOLFOX and panitumumab, presented with hematemesis and melena. He was tachycardiac, tender to abdominal palpation and rectal exam was positive for melena. Laboratory data revealed a hemoglobin of 7.6 g/dL, three points below his baseline. Imaging showed an increased number and size of hepatic lesions and pseudocirrhosis with sequelae of portal venous hypertension. EGD revealed large esophageal varices with red wales. Seven bands were deployed without complication. He was placed on hospice due to lack of chemotherapy options. DISCUSSION: Pseudocirrhosis describes morphologic changes in the liver that mimic cirrhosis, such as diffuse hepatic nodularity, capsular retraction and caudate lobe enlargement, in patients without histopathologic changes of cirrhosis. The diagnosis is made radiologically and is seen in patients with metastatic malignancy to the liver. It is thought that infiltrating tumors lead to fibrosis. Chemotherapy causes decreased tumor burden and scarring leads to capsular retraction. Chemotherapy can induce ischemic injury leading to nodular regenerative hyperplasia. Qayyum et al, report only 9% of patients with pseudocirrhosis have signs of portal hypertension. These patients rarely develop severe manifestations of portal hypertension such as a variceal bleed. Pseudocirrhosis is commonly associated with metastatic breast cancer. Pseudocirrhosis is rarely seen with gastrointestinal malignancy and only two cases were associated with FOLFOX, as in our patients.Image 1.: Case 1's EGD revealed large esophageal varices with a “white nipple sign.”Image 2.: Case 2's EGD revealed large esophageal varices with red wales.Image 3.: CT Image of Case 2 with ascites in the right paracolic gutter and perigastric ascites, splenomegaly, scalloping of the liver margins and metastases. Medial to the spleen is a visible splenorenal shunt.

Magnetic resonance with diffusion-weighted imaging improves assessment of focal liver lesions in patients with potentially resectable pancreatic cancer on CT.

To investigate added value of MRI to preoperative staging MDCT for evaluation of focal liver lesions (FLLs) in potentially resectable pancreatic ductal adenocarcinomas (PDACs). In patients with potentially resectable PDACs after staging MDCT (n=167), characteristics of FLLs were scored as benign, indeterminate or metastases on an MDCT set and combined MDCT and MRI set by two readers, independently. Size of hepatic lesions was measured and detection rate of hepatic metastasis unsuspected by MDCT and diagnostic yield of MRI for FLLs were assessed. Reader-averaged figure-of-merit (FOM) of the combined set was significantly higher than that of MDCT alone (0.94 vs. 0.86, p=.028). In the negative-on-CT group, the diagnostic yield of MRI was 1.5-2.3% (2/133 and 3/133 for readers 1 and 2, respectively). In the indeterminate-on-CT group, MRI yield was 10.5-13.6% (2/19 and 3/22) and in patients with suspicious-metastasis-on-CT, 8.3-26.7% (1/12 and 4/15). All lesions with false-positive and false-negative CT findings were ≤1 cm. In potentially resectable PDACs, addition of MRI with DWI can provide significantly better diagnostic performance in characterization of focal liver lesions, especially for small-sized (≤ 1 cm) MDCT-indeterminate or suspicious metastasis lesions, aiding in determination of appropriate operation candidates. • Addition of MRI provides better diagnostic performance in characterization of liver lesions. • Combined interpretation of MRI and MDCT provided less frequent indeterminate liver lesions. • Diagnostic yield of MRI was high in CT-indeterminate or suspicious metastatic lesions. • Operation candidates can be determined with greater confidence in potentially resectable PDACs.

Regression of multifocal infantile hepatic hemangioendothliomas after steroid therapy

Abstract Hepatic hemangioendotheliomas are rare childhood tumors. Infantile hepatic hemangioendothelioma (IHHE) is the most common vascular tumor of the liver in children accounting for 12% of all childhood hepatic tumors. We report an 8-month-old female infant presented at the age of 4 months with incidental hepatomegaly. On presentation her abdomen was soft and lax. The liver was at 8 cm below the right costal margin, not tender with rounded edge and nodular surface. The spleen was not felt and there were no other masses and no ascites. Her liver functions tests were normal. MRI of the liver showed numerous rounded lesions in all the hepatic segments with characteristic of low signal intensity at T1 and high intensity at T2. Post contrast, the lesions showed a peripheral thick rim of enhancement and in the delayed porto-venous phase showed central filling with contrast. The portal and hepatic veins were patent. Our findings were compatible with the diagnosis of multifocal infantile hemangioendothelioma of the liver. Oral prednisone was started for 2 weeks then was tapered over 4 months. A follow up MRI confirmed the decrease in the number and the size of hepatic lesions. A follow-up liver US 24 months after treatment showed residual solitary small lesion in left hepatic lobe measuring 1.2 × 1.0 cm. The authors report that steroid therapy was effective in the treatment of massive multifocal HHE without a need for other advanced therapies including liver transplantation.

Liver metastases in germ cell cancer: defining a role for surgery after chemotherapy.

To review the clinical course and outcome of patients with germ cell cancer and liver metastases treated at one centre, as the presence of hepatic metastases, although rare, is a poor prognostic feature in germ cell cancer. The case records of all patients with germ cell cancer and liver metastases at presentation, and treated with chemotherapy at a medical oncology unit between 1984 and 2001, were reviewed. The treatment regimens, tumour responses and patient outcome were recorded. Twenty-seven patients with germ cell cancer metastatic to the liver were identified. Complete biochemical and radiological responses were achieved in eight patients after initial chemotherapy and surgery for non-hepatic residual disease. Seven patients had only residual radiological hepatic abnormalities with normal tumour markers at the completion of initial treatment. There were no immediate hepatic resections and no further therapy was given. Serial computed tomography (CT) confirmed a progressive reduction in the size of hepatic lesions in six of seven patients. The persistence of residual hepatic abnormalities was not predictive of relapse, and overall survival of these patients (median survival 49 months, range 15-120) compared well with recent reports of such patients who have undergone hepatic resection. Conservative management with regular assessment by CT is an acceptable alternative to immediate hepatic resection for patients with isolated residual radiological hepatic abnormalities on completing first-line therapy for metastatic germ cell cancer, and does not adversely affect their survival.

Molecular and immunological diagnosis of echinococcosis.

Echinococcosis is an infectious disease of humans caused by the larval (metacestode) stage of the cestode species Echinococcus granulosus (cystic echinococcosis or hydatid disease) or Echinococcus multilocularis (alveolar echinococcosis or alveolar hydatid disease). Clinical manifestations depend primarily on localization and size of hepatic lesions and may include hepatomegaly, obstructive jaundice, or cholangitis. Prognostically, alveolar echinococcosis is considered similar to liver malignancies, including a lethality rate of 90% for untreated cases. Diagnosis is based on imaging techniques coupled with immunodiagnostic procedures. Antibody detection tests for E. multilocularis have markedly improved with the use of affinity-purified Em2 antigen and recombinant antigen II/3-10 in enzyme immunoassays. Antigens of corresponding quality for E. granulosus are still unavailable. The detection of circulating antigens and immune complexes in the sera of patients with cystic echinococcosis, the demonstration of in vitro lymphocyte proliferation in response to stimulation with Echinococcus antigens, and the discrimination of serum immunoglobulin isotype activity to various Echinococcus antigens in both cystic and alveolar echinococcosis have been suggested for diagnostic purposes as well as for monitoring patients after treatment. New diagnostic molecular tools include DNA probes for Southern hybridization tests and polymerase chain reaction for the amplification of E. multilocularis and E. granulosus species-specific DNA fragments.

Molecular and immunological diagnosis of echinococcosis.

Echinococcosis is an infectious disease of humans caused by the larval (metacestode) stage of the cestode species Echinococcus granulosus (cystic echinococcosis or hydatid disease) or Echinococcus multilocularis (alveolar echinococcosis or alveolar hydatid disease). Clinical manifestations depend primarily on localization and size of hepatic lesions and may include hepatomegaly, obstructive jaundice, or cholangitis. Prognostically, alveolar echinococcosis is considered similar to liver malignancies, including a lethality rate of 90% for untreated cases. Diagnosis is based on imaging techniques coupled with immunodiagnostic procedures. Antibody detection tests for E. multilocularis have markedly improved with the use of affinity-purified Em2 antigen and recombinant antigen II/3-10 in enzyme immunoassays. Antigens of corresponding quality for E. granulosus are still unavailable. The detection of circulating antigens and immune complexes in the sera of patients with cystic echinococcosis, the demonstration of in vitro lymphocyte proliferation in response to stimulation with Echinococcus antigens, and the discrimination of serum immunoglobulin isotype activity to various Echinococcus antigens in both cystic and alveolar echinococcosis have been suggested for diagnostic purposes as well as for monitoring patients after treatment. New diagnostic molecular tools include DNA probes for Southern hybridization tests and polymerase chain reaction for the amplification of E. multilocularis and E. granulosus species-specific DNA fragments.