One of the leading causes of mortality worldwide is liver cancer.The earlier the detection of hepatic tumors,the lower the mortality rate.This paper introduces a computer-aided diagnosis system to extract hepatic tumo...One of the leading causes of mortality worldwide is liver cancer.The earlier the detection of hepatic tumors,the lower the mortality rate.This paper introduces a computer-aided diagnosis system to extract hepatic tumors from computed tomography scans and classify them into malignant or benign tumors.Segmenting hepatic tumors from computed tomography scans is considered a challenging task due to the fuzziness in the liver pixel range,intensity values overlap between the liver and neighboring organs,high noise from computed tomography scanner,and large variance in tumors shapes.The proposed method consists of three main stages;liver segmentation using Fast Generalized Fuzzy C-Means,tumor segmentation using dynamic thresholding,and the tumor’s classification into malignant/benign using support vector machines classifier.The performance of the proposed system was evaluated using three liver benchmark datasets,which are MICCAI-Sliver07,LiTS17,and 3Dircadb.The proposed computer adided diagnosis system achieved an average accuracy of 96.75%,sensetivity of 96.38%,specificity of 95.20%and Dice similarity coefficient of 95.13%.展开更多
BACKGROUND Strongyloides sterocoralis is a parasitic infection caused by a roundworm that is transmitted through soil contaminated with larvae.It can infrequently cause hepatic abscesses in immunocompromised patients ...BACKGROUND Strongyloides sterocoralis is a parasitic infection caused by a roundworm that is transmitted through soil contaminated with larvae.It can infrequently cause hepatic abscesses in immunocompromised patients and is rarely reported to form hepatic lesions in immunocompetent hosts.CASE SUMMARY We present a case study of a 45-year-old female who presented with right upper quadrant abdominal pain and constitutional symptoms for several weeks.Crosssectional imaging identified several malignant-appearing liver masses.Further investigation,including serological testing and histopathologic examination,revealed the presence of serum Strongyloides antibodies and hepatic granulomas with extensive necrosis.Following treatment with ivermectin for 2 wk,there was complete resolution of the liver lesions and associated symptoms.CONCLUSION This case highlights the importance of considering parasitic infections,such as Strongyloides,in the differential diagnosis of hepatic masses.Early recognition and appropriate treatment can lead to a favorable outcome and prevent unnecessary invasive procedures.Increased awareness among clinicians is crucial to ensure the timely diagnosis and management of such cases.展开更多
BACKGROUND Hepatic inflammatory myofibroblastic tumor(HIMT)is a rare type of hepatic tumor.It is always misdiagnosed and mistreated because it is primarily found with no obvious specific manifestation,and its imaging ...BACKGROUND Hepatic inflammatory myofibroblastic tumor(HIMT)is a rare type of hepatic tumor.It is always misdiagnosed and mistreated because it is primarily found with no obvious specific manifestation,and its imaging findings are diverse.CASE SUMMARY Here,we report a case of HIMT that was initially diagnosed as liver malignancy but was confirmed as HIMT by histopathology after hepatectomy.Mostly,HIMTs are infiltrated with plasma cells and stain positively for anaplastic lymphoma kinase on immunohistochemistry as well as for some other kinases.CONCLUSION HIMT can be treated with single nonsteroidal anti-inflammatory drugs and without surgery when it is diagnosed accurately.Because the etiology of HIMT is unknown and the diagnosis is difficult,the pathogenesis and clinical process need to be further studied.展开更多
BACKGROUND Perivascular epithelioid cell tumor(PEComa)is an uncommon tumor of mesenchymal origin.Cases of PEComa in the liver are extremely rare.AIM To analyze the clinicopathological features and treatment of hepatic...BACKGROUND Perivascular epithelioid cell tumor(PEComa)is an uncommon tumor of mesenchymal origin.Cases of PEComa in the liver are extremely rare.AIM To analyze the clinicopathological features and treatment of hepatic PEComa and to evaluate the prognosis after different treatments.METHODS Clinical and pathological data of 26 patients with hepatic PEComa were collected.All cases were analyzed by immunohistochemistry and clinical follow-up.RESULTS This study included 17 females and 9 males,with a median age of 50 years.Lesions were located in the left hepatic lobe in 13 cases,in the right lobe in 11,and in the caudate lobe in 2.The median tumor diameter was 6.5 cm.Light microscopy revealed that the tumor cells were mainly composed of epithelioid cells.The cytoplasm contained heterogeneous eosinophilic granules.There were thick-walled blood vessels,around which tumor cells were radially arranged.Immunohistochemical analysis of pigment-derived and myogenic markers in PEComas revealed that 25 cases were HMB45(+),23 were Melan-A(+),and 22 SMA(+).TFE3 and Desmin were negative in all cases.All the fluorescence in situ hybridization samples were negative for TFE3 gene break-apart probe.Tumor tissues were collected by extended hepatic lobe resection or simple hepatic tumor resection as the main treatments.Median follow-up was 62.5 mo.None of the patients had metastasis or recurrence,and there were no deaths due to the disease.CONCLUSION Hepatic PEComa highly expresses melanin and smooth muscle markers,and generally exhibits an inert biological behavior.The prognosis after extended hepatic lobe resection and simple hepatic tumor resection is semblable.展开更多
In the United States,80%-90%of primary hepatic tumors are hepatocellular carcinomas and 10%-15%are cholangiocarcinomas(CCA),both with high mortality rate,particularly CCA,which portends a worse prognosis.Traditional m...In the United States,80%-90%of primary hepatic tumors are hepatocellular carcinomas and 10%-15%are cholangiocarcinomas(CCA),both with high mortality rate,particularly CCA,which portends a worse prognosis.Traditional management with surgery has good outcomes in appropriately selected patients;however,novel ablative treatment options have emerged,such as radiofrequency ablation(RFA),which can improve the prognosis of both hepatic and biliary tumors.RFA is aimed to generate an area of necrosis within the targeted tissue by applying thermal therapy via an electrode,with a goal to completely eradicate the tumor while preserving surrounding healthy tissue.Role of RFA in management of hepatic and biliary tumors forms the focus of our current mini-review article.展开更多
BACKGROUND Primary hepatic neuroendocrine tumors(PHNETs)are rare hepatic tumors.Their diagnosis,which is based on radiological findings,is difficult.CASE SUMMARY We present a case of PHNET in a 79-year-old man with no...BACKGROUND Primary hepatic neuroendocrine tumors(PHNETs)are rare hepatic tumors.Their diagnosis,which is based on radiological findings,is difficult.CASE SUMMARY We present a case of PHNET in a 79-year-old man with no clinical symptoms.Computed tomography(CT)and 2-Deoxy-2-[fluorine-18]fluorodeoxyglucose positron emission tomography/CT(18F-FDG PET/CT)were performed for further evaluation.A hypoattenuating mass with rim-like enhancement in segment 6 of the liver was detected on contrast-enhanced CT imaging.Increased uptake was also observed on 18F-FDG PET/CT.Histopathological and immunohistochemical examinations,which revealed a grade 2 neuroendocrine tumor(NET),confirmed the diagnosis.CONCLUSION Diagnosing PHNET is challenging,and must be distinguished from other liver tumors.Metastatic NETs should be excluded.展开更多
BACKGROUND Primary hepatic neuroendocrine tumors(PHNETs),a group of neuroendocrine neoplasms,are extremely rare.There are only few case reports about PHNETs in the literature.The lack of large samples and multicenter ...BACKGROUND Primary hepatic neuroendocrine tumors(PHNETs),a group of neuroendocrine neoplasms,are extremely rare.There are only few case reports about PHNETs in the literature.The lack of large samples and multicenter research results in poor diagnostic and therapeutic approaches.AIM To discuss the clinical characteristics,diagnosis,and treatment of PHNETs and risk factors related to survival.METHODS We retrospectively analyzed the clinical data,imaging features,immunohistochemistry data,and treatment efficacy of 40 patients who were pathologically diagnosed with PHNETs and admitted to The First Affiliated Hospital of Zhengzhou University from January 1,2014 to November 15,2019.Finally,survival analysis was performed to identify the risk factors for survival.RESULTS The main symptoms and signs included intermittent abdominal pain(19 patients,47.5%)and bloating(8 patients,20.0%).The positive rates of tested tumor markers were recorded as follows:Carbohydrate antigen 19-9(CA19-9)(6 patients,15.0%),CA72-4(3 patients,7.5%),carcinoembryonic antigen(7 patients,17.5%),and alpha-fetoprotein(6 patients,15.0%).Immunohistochemical staining results showed positivity for Syn in 38(97.4%)of 39 patients,for chromogranin A in 17(65.4%)of 26 patients,for CD56 in 35(94.6%)of 37 patients,for AE1/AE3 in 28(87.5%)of 32 patients,and for Ki-67 in all 40(100.0%)patients.The overall survival rate was significantly related to the tumor grade,AE1/AE3,and Ki-67.tumor number,tumor size,metastasis,and treatment)and overall survival.CONCLUSION Higher grade,negative AE1/AE3,and higher Ki-67 are associated with a worse survival rate.Kinds of treatment and other parameters have no significant influence on overall survival.展开更多
Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performin...Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation(LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma(HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation AssociationEuropean Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma(HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient.Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches,alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver.展开更多
In Japan,liver biopsies were previously crucial in evaluating the severity of hepatitis caused by the hepatitis C virus(HCV)and diagnosing HCV-related hepatocellular carcinoma(HCC).However,due to the development of ef...In Japan,liver biopsies were previously crucial in evaluating the severity of hepatitis caused by the hepatitis C virus(HCV)and diagnosing HCV-related hepatocellular carcinoma(HCC).However,due to the development of effective antiviral treatments and advanced imaging,the necessity for biopsies has significantly decreased.This change has resulted in fewer chances for diagnosing liver disease,causing many general pathologists to feel less confident in making liver biopsy diagnoses.This article provides a comprehensive overview of the challenges and potential solutions related to liver biopsies in Japan.First,it highlights the importance of considering steatotic liver diseases as independent conditions that can coexist with other liver diseases due to their increasing prevalence.Second,it emphasizes the need to avoid hasty assumptions of HCC in nodular lesions,because clinically diagnosable HCCs are not targets for biopsy.Third,the importance of diagnosing hepatic immune-related adverse events caused by immune checkpoint inhibitors is increasing due to the anticipated widespread use of these drugs.In conclusion,pathologists should be attuned to the changing landscape of liver diseases and approach liver biopsies with care and attention to detail.展开更多
Differential diagnosis of pediatric vascular liver tumors can be challenging due to inconsistent nomenclature,histologic overlap and the rarity of some entities.Here we give an up-to-date overview of the most importan...Differential diagnosis of pediatric vascular liver tumors can be challenging due to inconsistent nomenclature,histologic overlap and the rarity of some entities.Here we give an up-to-date overview of the most important entities.We discuss the clinic,histology and pathophysiology of hepatic congenital and infantile heman-gioma,hepatic epithelioid hemangioendothelioma and hepatic angio-sarcoma.展开更多
Accurate preoperative diagnosis is highly important for the treatment of perivascular epithelioid cell tumors(PEComas)because PEComas are mainly benign tumors and may not require surgical intervention.By analyzing the...Accurate preoperative diagnosis is highly important for the treatment of perivascular epithelioid cell tumors(PEComas)because PEComas are mainly benign tumors and may not require surgical intervention.By analyzing the causes,properties and clinical manifestations of PEComas,we summarize the challenges and solutions in the diagnosis of PEComas.展开更多
Primary malignant liver mesenchymal tumor is a rare condition defined as a tumor with vascular, fibrous, adi-pose, and other mesenchymal tissue differentiation. We report a case of primary malignant liver mesenchymal ...Primary malignant liver mesenchymal tumor is a rare condition defined as a tumor with vascular, fibrous, adi-pose, and other mesenchymal tissue differentiation. We report a case of primary malignant liver mesenchymal tumor in a 51-year-old male with anemia, weight loss and hepatomegaly. Finally unconventional liver biopsy and histological manifestation led to the definitive diag-nosis.展开更多
Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract.They originate from the interstitial cells of Cajal and are usually found in extrahepatic gastrointestinal sites.How...Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract.They originate from the interstitial cells of Cajal and are usually found in extrahepatic gastrointestinal sites.However,a small subset are derived from the liver and are known as primary hepatic gastrointestinal stromal tumors(PHGIST).They have a poor prognosis and are historically difficult to diagnose.Our objective was to review and update the latest evidence-based knowledge concerning PHGIST,with a focus on epidemiology,etiology,pathophysiology,clinical presentation,histopathology,and treatment.These tumors are usually found incidentally,occur sporadically,and are associated with mutations of KIT and PDGFRA genes.PHGIST is a diagnosis of exclusion,as it has the same molecular,immunochemistry and histological appearance as gastrointestinal stromal tumors(GIST).Thus,imaging,such as positron emission tomography-computed tomography(PET-CT)must be used to rule out metastatic GIST before a diagnosis can be made.However,with mutation analysis and pharmacological advances,tyrosine kinase inhibitors are typically pursued with or without surgical intervention.Other potential treatments include transcatheter arterial chemoembolization and tumor ablation.However,these are typically considered palliative options.As there are only a limited number of publications regarding PHGIST,data concerning morbidity and mortality are not yet available.Immunohistopathology can help develop screening guidelines and evaluating resistance to treatment.展开更多
Background:Hepatic vein tumor thrombus(HVTT)is a significant poor risk factor for survival outcomes in hepatocellular carcinoma(HCC)patients.Currently,the widely used international staging systems for HCC are not refi...Background:Hepatic vein tumor thrombus(HVTT)is a significant poor risk factor for survival outcomes in hepatocellular carcinoma(HCC)patients.Currently,the widely used international staging systems for HCC are not refined enough to evaluate prognosis for these patients.A new classification for macroscopic HVTT was established,aiming to better predict prognosis.Methods:This study included 437 consecutive HCC patients with HVTT who underwent different treatments.Overall survival(OS)and time-dependent receiver operating characteristic(ROC)curve area analysis were used to determine the prognostic capacities of the new classification when compared with the different currently used staging systems.Results:The new HVTT classification was defined as:type I,tumor thrombosis involving hepatic vein(HV),including microvascular invasion;type II,tumor thrombosis involving the retrohepatic segment of inferior vena cava;and type III,tumor thrombosis involving the supradiaphragmatic segment of inferior vena cava.The numbers(percentages)of patients with types I,II,and III HVTT in the new classification were 146(33.4%),143(32.7%),and 148(33.9%),respectively.The 1-,2-,and 3-year OS rates for types I to III HVTT were 79.5%,58.6%,and 29.1%;54.8%,23.3%,and 13.8%;and 24.0%,10.0%,and 2.1%,respectively.The time-dependent-ROC curve area analysis demonstrated that the predicting capacity of the new HVTT classification was significantly better than any other staging systems.Conclusions:A new HVTT classification was established to predict prognosis of HCC patients with HVTT who underwent different treatments.This classification was superior to,and it may serve as a supplement to,the commonly used staging systems.展开更多
Background:The presence of hepatic vein tumor thrombus(HVTT)is a major determinant of survival outcomes in hepatocellular carcinoma(HCC)patients.This study compared survival outcomes between liver resection(LR)and int...Background:The presence of hepatic vein tumor thrombus(HVTT)is a major determinant of survival outcomes in hepatocellular carcinoma(HCC)patients.This study compared survival outcomes between liver resection(LR)and intensity-modulated radiation therapy(IMRT)in HCC patients with HVTT.Methods:Data from patients who underwent LR or IMRT for HCC with HVTT at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed.Their survival outcomes were compared before and after propensity score matching(PSM).Results:Three hundred and seven HCC patients with HVTT who underwent either LR(n=140)or IMRT(n=167)were enrolled.PSM matched 82 pairs of patients.The overall survival(OS)and recurrence-free survival(RFS)rates were significantly higher for patients in the LR group than those in the IMRT group.On subgroup analysis,significantly better survival outcomes were obtained after LR than IMRT in patients with peripheral type of HVTT(pHVTT)and major type of HVTT(mHVTT).However,similar survival outcomes were obtained after LR and IMRT when the HVTT had developed into inferior vena cava tumor thrombus(IVCTT).Conclusions:LR resulted in significantly better survival outcomes in HCC patients with HVTT when compared to IMRT.Once the HVTT had developed IVCTT,LR and IMRT resulted in similarly bad survival outcomes.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)with inferior vena cava and right atrium thrombus is rare,accounting for approximately 1.4%-4.9%of cases.These patients are rarely reported,but the condition is being increasing...BACKGROUND Hepatocellular carcinoma(HCC)with inferior vena cava and right atrium thrombus is rare,accounting for approximately 1.4%-4.9%of cases.These patients are rarely reported,but the condition is being increasingly discovered with advances in imaging techniques,and their prognosis is extremely pessimistic with no current effective treatment.This condition is further associated with unexpected sudden death by cardiac arrest and acute large area pulmonary embolism.CASE SUMMARY A 34-year-old man with advanced HCC with a hepatic vein thrombus extending into the right atrium had a long-term,disease-free survival following 5-mo sequential treatment combined with transcatheter arterial chemoembolization and curative liver resection.No severe adverse effects were encountered,such as massive hemorrhage or pulmonary embolism.The proper selection of operative method is an important factor.CONCLUSION HCC with a tumor thrombus extending into the right atrium has a significant impact on the survival of patients.Thrombectomy combined with adjuvant therapy may be beneficial for these patients.展开更多
文摘One of the leading causes of mortality worldwide is liver cancer.The earlier the detection of hepatic tumors,the lower the mortality rate.This paper introduces a computer-aided diagnosis system to extract hepatic tumors from computed tomography scans and classify them into malignant or benign tumors.Segmenting hepatic tumors from computed tomography scans is considered a challenging task due to the fuzziness in the liver pixel range,intensity values overlap between the liver and neighboring organs,high noise from computed tomography scanner,and large variance in tumors shapes.The proposed method consists of three main stages;liver segmentation using Fast Generalized Fuzzy C-Means,tumor segmentation using dynamic thresholding,and the tumor’s classification into malignant/benign using support vector machines classifier.The performance of the proposed system was evaluated using three liver benchmark datasets,which are MICCAI-Sliver07,LiTS17,and 3Dircadb.The proposed computer adided diagnosis system achieved an average accuracy of 96.75%,sensetivity of 96.38%,specificity of 95.20%and Dice similarity coefficient of 95.13%.
文摘BACKGROUND Strongyloides sterocoralis is a parasitic infection caused by a roundworm that is transmitted through soil contaminated with larvae.It can infrequently cause hepatic abscesses in immunocompromised patients and is rarely reported to form hepatic lesions in immunocompetent hosts.CASE SUMMARY We present a case study of a 45-year-old female who presented with right upper quadrant abdominal pain and constitutional symptoms for several weeks.Crosssectional imaging identified several malignant-appearing liver masses.Further investigation,including serological testing and histopathologic examination,revealed the presence of serum Strongyloides antibodies and hepatic granulomas with extensive necrosis.Following treatment with ivermectin for 2 wk,there was complete resolution of the liver lesions and associated symptoms.CONCLUSION This case highlights the importance of considering parasitic infections,such as Strongyloides,in the differential diagnosis of hepatic masses.Early recognition and appropriate treatment can lead to a favorable outcome and prevent unnecessary invasive procedures.Increased awareness among clinicians is crucial to ensure the timely diagnosis and management of such cases.
基金Supported by Shandong Provincial Natural Science Foundation of China,No.ZR2021MH033Postgraduates Foundation of Linyi People’s Hospital(Tong Meng).
文摘BACKGROUND Hepatic inflammatory myofibroblastic tumor(HIMT)is a rare type of hepatic tumor.It is always misdiagnosed and mistreated because it is primarily found with no obvious specific manifestation,and its imaging findings are diverse.CASE SUMMARY Here,we report a case of HIMT that was initially diagnosed as liver malignancy but was confirmed as HIMT by histopathology after hepatectomy.Mostly,HIMTs are infiltrated with plasma cells and stain positively for anaplastic lymphoma kinase on immunohistochemistry as well as for some other kinases.CONCLUSION HIMT can be treated with single nonsteroidal anti-inflammatory drugs and without surgery when it is diagnosed accurately.Because the etiology of HIMT is unknown and the diagnosis is difficult,the pathogenesis and clinical process need to be further studied.
基金Supported by the Anhui Provincial Natural Science Foundation,No.1908085MH275Bengbu Medical College Key projects of Natural Science Foundation,No.BYKF1710Bengbu City-Bengbu Medical College Joint Science and Technology Project,No.BYLK201812.
文摘BACKGROUND Perivascular epithelioid cell tumor(PEComa)is an uncommon tumor of mesenchymal origin.Cases of PEComa in the liver are extremely rare.AIM To analyze the clinicopathological features and treatment of hepatic PEComa and to evaluate the prognosis after different treatments.METHODS Clinical and pathological data of 26 patients with hepatic PEComa were collected.All cases were analyzed by immunohistochemistry and clinical follow-up.RESULTS This study included 17 females and 9 males,with a median age of 50 years.Lesions were located in the left hepatic lobe in 13 cases,in the right lobe in 11,and in the caudate lobe in 2.The median tumor diameter was 6.5 cm.Light microscopy revealed that the tumor cells were mainly composed of epithelioid cells.The cytoplasm contained heterogeneous eosinophilic granules.There were thick-walled blood vessels,around which tumor cells were radially arranged.Immunohistochemical analysis of pigment-derived and myogenic markers in PEComas revealed that 25 cases were HMB45(+),23 were Melan-A(+),and 22 SMA(+).TFE3 and Desmin were negative in all cases.All the fluorescence in situ hybridization samples were negative for TFE3 gene break-apart probe.Tumor tissues were collected by extended hepatic lobe resection or simple hepatic tumor resection as the main treatments.Median follow-up was 62.5 mo.None of the patients had metastasis or recurrence,and there were no deaths due to the disease.CONCLUSION Hepatic PEComa highly expresses melanin and smooth muscle markers,and generally exhibits an inert biological behavior.The prognosis after extended hepatic lobe resection and simple hepatic tumor resection is semblable.
文摘In the United States,80%-90%of primary hepatic tumors are hepatocellular carcinomas and 10%-15%are cholangiocarcinomas(CCA),both with high mortality rate,particularly CCA,which portends a worse prognosis.Traditional management with surgery has good outcomes in appropriately selected patients;however,novel ablative treatment options have emerged,such as radiofrequency ablation(RFA),which can improve the prognosis of both hepatic and biliary tumors.RFA is aimed to generate an area of necrosis within the targeted tissue by applying thermal therapy via an electrode,with a goal to completely eradicate the tumor while preserving surrounding healthy tissue.Role of RFA in management of hepatic and biliary tumors forms the focus of our current mini-review article.
文摘BACKGROUND Primary hepatic neuroendocrine tumors(PHNETs)are rare hepatic tumors.Their diagnosis,which is based on radiological findings,is difficult.CASE SUMMARY We present a case of PHNET in a 79-year-old man with no clinical symptoms.Computed tomography(CT)and 2-Deoxy-2-[fluorine-18]fluorodeoxyglucose positron emission tomography/CT(18F-FDG PET/CT)were performed for further evaluation.A hypoattenuating mass with rim-like enhancement in segment 6 of the liver was detected on contrast-enhanced CT imaging.Increased uptake was also observed on 18F-FDG PET/CT.Histopathological and immunohistochemical examinations,which revealed a grade 2 neuroendocrine tumor(NET),confirmed the diagnosis.CONCLUSION Diagnosing PHNET is challenging,and must be distinguished from other liver tumors.Metastatic NETs should be excluded.
文摘BACKGROUND Primary hepatic neuroendocrine tumors(PHNETs),a group of neuroendocrine neoplasms,are extremely rare.There are only few case reports about PHNETs in the literature.The lack of large samples and multicenter research results in poor diagnostic and therapeutic approaches.AIM To discuss the clinical characteristics,diagnosis,and treatment of PHNETs and risk factors related to survival.METHODS We retrospectively analyzed the clinical data,imaging features,immunohistochemistry data,and treatment efficacy of 40 patients who were pathologically diagnosed with PHNETs and admitted to The First Affiliated Hospital of Zhengzhou University from January 1,2014 to November 15,2019.Finally,survival analysis was performed to identify the risk factors for survival.RESULTS The main symptoms and signs included intermittent abdominal pain(19 patients,47.5%)and bloating(8 patients,20.0%).The positive rates of tested tumor markers were recorded as follows:Carbohydrate antigen 19-9(CA19-9)(6 patients,15.0%),CA72-4(3 patients,7.5%),carcinoembryonic antigen(7 patients,17.5%),and alpha-fetoprotein(6 patients,15.0%).Immunohistochemical staining results showed positivity for Syn in 38(97.4%)of 39 patients,for chromogranin A in 17(65.4%)of 26 patients,for CD56 in 35(94.6%)of 37 patients,for AE1/AE3 in 28(87.5%)of 32 patients,and for Ki-67 in all 40(100.0%)patients.The overall survival rate was significantly related to the tumor grade,AE1/AE3,and Ki-67.tumor number,tumor size,metastasis,and treatment)and overall survival.CONCLUSION Higher grade,negative AE1/AE3,and higher Ki-67 are associated with a worse survival rate.Kinds of treatment and other parameters have no significant influence on overall survival.
文摘Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation(LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma(HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation AssociationEuropean Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma(HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient.Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches,alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver.
文摘In Japan,liver biopsies were previously crucial in evaluating the severity of hepatitis caused by the hepatitis C virus(HCV)and diagnosing HCV-related hepatocellular carcinoma(HCC).However,due to the development of effective antiviral treatments and advanced imaging,the necessity for biopsies has significantly decreased.This change has resulted in fewer chances for diagnosing liver disease,causing many general pathologists to feel less confident in making liver biopsy diagnoses.This article provides a comprehensive overview of the challenges and potential solutions related to liver biopsies in Japan.First,it highlights the importance of considering steatotic liver diseases as independent conditions that can coexist with other liver diseases due to their increasing prevalence.Second,it emphasizes the need to avoid hasty assumptions of HCC in nodular lesions,because clinically diagnosable HCCs are not targets for biopsy.Third,the importance of diagnosing hepatic immune-related adverse events caused by immune checkpoint inhibitors is increasing due to the anticipated widespread use of these drugs.In conclusion,pathologists should be attuned to the changing landscape of liver diseases and approach liver biopsies with care and attention to detail.
文摘Differential diagnosis of pediatric vascular liver tumors can be challenging due to inconsistent nomenclature,histologic overlap and the rarity of some entities.Here we give an up-to-date overview of the most important entities.We discuss the clinic,histology and pathophysiology of hepatic congenital and infantile heman-gioma,hepatic epithelioid hemangioendothelioma and hepatic angio-sarcoma.
基金Supported by Nantong Municipal Health Commission,No.MSZ2022036.
文摘Accurate preoperative diagnosis is highly important for the treatment of perivascular epithelioid cell tumors(PEComas)because PEComas are mainly benign tumors and may not require surgical intervention.By analyzing the causes,properties and clinical manifestations of PEComas,we summarize the challenges and solutions in the diagnosis of PEComas.
文摘Primary malignant liver mesenchymal tumor is a rare condition defined as a tumor with vascular, fibrous, adi-pose, and other mesenchymal tissue differentiation. We report a case of primary malignant liver mesenchymal tumor in a 51-year-old male with anemia, weight loss and hepatomegaly. Finally unconventional liver biopsy and histological manifestation led to the definitive diag-nosis.
文摘Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract.They originate from the interstitial cells of Cajal and are usually found in extrahepatic gastrointestinal sites.However,a small subset are derived from the liver and are known as primary hepatic gastrointestinal stromal tumors(PHGIST).They have a poor prognosis and are historically difficult to diagnose.Our objective was to review and update the latest evidence-based knowledge concerning PHGIST,with a focus on epidemiology,etiology,pathophysiology,clinical presentation,histopathology,and treatment.These tumors are usually found incidentally,occur sporadically,and are associated with mutations of KIT and PDGFRA genes.PHGIST is a diagnosis of exclusion,as it has the same molecular,immunochemistry and histological appearance as gastrointestinal stromal tumors(GIST).Thus,imaging,such as positron emission tomography-computed tomography(PET-CT)must be used to rule out metastatic GIST before a diagnosis can be made.However,with mutation analysis and pharmacological advances,tyrosine kinase inhibitors are typically pursued with or without surgical intervention.Other potential treatments include transcatheter arterial chemoembolization and tumor ablation.However,these are typically considered palliative options.As there are only a limited number of publications regarding PHGIST,data concerning morbidity and mortality are not yet available.Immunohistopathology can help develop screening guidelines and evaluating resistance to treatment.
基金This work was supported by the Key Project of Natural Science Foundation of China(No.81730097)grants from the Science Fund for Creative Research Groups(No.81521091)+3 种基金the Chang Jiang Scholars Programme[2013]of China Ministry of Educationthe National Key Basic Research Programme“973 Project”(No.2015CB554000)the National Natural Science Foundation of China(No.81602523),the Shanghai Municipal Health Bureau(No.SHDC12015106)the Shanghai Science and Technology Committee(No.134119a0200).
文摘Background:Hepatic vein tumor thrombus(HVTT)is a significant poor risk factor for survival outcomes in hepatocellular carcinoma(HCC)patients.Currently,the widely used international staging systems for HCC are not refined enough to evaluate prognosis for these patients.A new classification for macroscopic HVTT was established,aiming to better predict prognosis.Methods:This study included 437 consecutive HCC patients with HVTT who underwent different treatments.Overall survival(OS)and time-dependent receiver operating characteristic(ROC)curve area analysis were used to determine the prognostic capacities of the new classification when compared with the different currently used staging systems.Results:The new HVTT classification was defined as:type I,tumor thrombosis involving hepatic vein(HV),including microvascular invasion;type II,tumor thrombosis involving the retrohepatic segment of inferior vena cava;and type III,tumor thrombosis involving the supradiaphragmatic segment of inferior vena cava.The numbers(percentages)of patients with types I,II,and III HVTT in the new classification were 146(33.4%),143(32.7%),and 148(33.9%),respectively.The 1-,2-,and 3-year OS rates for types I to III HVTT were 79.5%,58.6%,and 29.1%;54.8%,23.3%,and 13.8%;and 24.0%,10.0%,and 2.1%,respectively.The time-dependent-ROC curve area analysis demonstrated that the predicting capacity of the new HVTT classification was significantly better than any other staging systems.Conclusions:A new HVTT classification was established to predict prognosis of HCC patients with HVTT who underwent different treatments.This classification was superior to,and it may serve as a supplement to,the commonly used staging systems.
基金This work was supported by the Key Project of the Natural Science Foundation of China(No.81730097)grants of the Science Fund for Creative Research Groups(No.81521091)+1 种基金the National Key Basic Research Program“973 Project”(No.2015CB554000)the National Natural Science Foundation of China(No.81602523 and No.81702335).
文摘Background:The presence of hepatic vein tumor thrombus(HVTT)is a major determinant of survival outcomes in hepatocellular carcinoma(HCC)patients.This study compared survival outcomes between liver resection(LR)and intensity-modulated radiation therapy(IMRT)in HCC patients with HVTT.Methods:Data from patients who underwent LR or IMRT for HCC with HVTT at the Eastern Hepatobiliary Surgery Hospital were retrospectively analyzed.Their survival outcomes were compared before and after propensity score matching(PSM).Results:Three hundred and seven HCC patients with HVTT who underwent either LR(n=140)or IMRT(n=167)were enrolled.PSM matched 82 pairs of patients.The overall survival(OS)and recurrence-free survival(RFS)rates were significantly higher for patients in the LR group than those in the IMRT group.On subgroup analysis,significantly better survival outcomes were obtained after LR than IMRT in patients with peripheral type of HVTT(pHVTT)and major type of HVTT(mHVTT).However,similar survival outcomes were obtained after LR and IMRT when the HVTT had developed into inferior vena cava tumor thrombus(IVCTT).Conclusions:LR resulted in significantly better survival outcomes in HCC patients with HVTT when compared to IMRT.Once the HVTT had developed IVCTT,LR and IMRT resulted in similarly bad survival outcomes.
基金Supported by the National Natural Science Foundation of China,No.81972749 and No.81471755Education Department of Liaoning Province,No.XLYC1802011。
文摘BACKGROUND Hepatocellular carcinoma(HCC)with inferior vena cava and right atrium thrombus is rare,accounting for approximately 1.4%-4.9%of cases.These patients are rarely reported,but the condition is being increasingly discovered with advances in imaging techniques,and their prognosis is extremely pessimistic with no current effective treatment.This condition is further associated with unexpected sudden death by cardiac arrest and acute large area pulmonary embolism.CASE SUMMARY A 34-year-old man with advanced HCC with a hepatic vein thrombus extending into the right atrium had a long-term,disease-free survival following 5-mo sequential treatment combined with transcatheter arterial chemoembolization and curative liver resection.No severe adverse effects were encountered,such as massive hemorrhage or pulmonary embolism.The proper selection of operative method is an important factor.CONCLUSION HCC with a tumor thrombus extending into the right atrium has a significant impact on the survival of patients.Thrombectomy combined with adjuvant therapy may be beneficial for these patients.
