Liver metastasis from hepatoid adenocarcinoma of the stomach mimicking hepatocellular carcinoma: Dynamic computed tomography findings

AIM: To evaluate the dynamic computed tomography(CT) findings of liver metastasis from hepatoid adenocarcinoma of the stomach(HAS) and compared them with hepatocellular carcinoma(HCC).METHODS: Between January 2000 and January 2015, 8 patients with pathologically proven HAS and liver metastases were enrolled. Basic tumor status was evaluated for the primary tumor location and metastatic sites. The CT findings of the liver metastases were analyzed for tumor number and size, presence of tumor necrosis, hemorrhage, venous tumor thrombosis, and dynamic enhancing pattern.RESULTS: The body and antrum were the most common site for primary HAS(n = 7), and observed metastatic sites included the liver(n = 8), lymph nodes(n = 7), peritoneum(n = 4), and lung(n = 2). Most of the liver metastases exhibited tumor necrosis regardless of tumor size. By contrast, tumor hemorrhage was observed only in liver lesions larger than 5 cm(n = 4). Three patterns of venous tumor thrombosis were identified: direct venous invasion by the primary HAS(n = 1), direct venous invasion by the liver metastases(n = 7), and isolated portal vein tumor thrombosis(n = 2). Dynamic CT revealed arterial hyperattenuation and late phase washout in all the liver metastases.CONCLUSION: On dynamic CT, liver metastasis from HAS shared many imaging similarities with HCC. For liver nodules, the presence of isolated portal vein tumor thrombosis and a tendency for tumor necrosis are imaging clues that suggest the diagnosis of HAS.

Endoscopic salvage therapy after failed biliary cannulation using advanced techniques:A concise review

Therapeutic endoscopic retrograde cholangiopancreatography(ERCP)begins with successful biliary cannulation.However,it is not always be successful.The failure of the initial ERCP is attributed to two main aspects:the papilla/biliary orifice is endoscopically accessible,or it is inaccessible.When the papilla/biliary orifice is accessible,bile duct cannulation failure can occur even with advanced cannulation techniques,including double guidewire techniques,transpancreatic sphincterotomy,needle-knife precut papillotomy,or fistulotomy.There is currently no consensus on the next steps of treatment in this setting.Therefore,this review aims to propose and discuss potential endoscopic options for patients who have failed ERCP due to difficult bile duct cannulation.These options include interval ERCP,percutaneous-transhepatic-endoscopic rendezvous procedures(PTE-RV),and endoscopic ultrasound-assisted rendezvous procedures(EUS-RV).The overall success rate for interval ERCP was 76.3%(68%-79% between studies),and the overall adverse event rate was 7.5%(0-15.9% between studies).The overall success rate for PTE-RV was 88.7%(80.4%-100%between studies),and the overall adverse event rate was 13.2%(4.9%-19.2% between studies).For EUS-RV,the overall success rate was 82%-86.1%,and the overall adverse event rate was 13%-15.6%.Because interval ERCP has an acceptably high success rate and lower adverse event rate and does not require additional expertise,facilities,or other specialists,it can be considered the first choice for salvage therapy.EUS-RV can also be considered if local experts are available.For patients in urgent need of biliary drainage,PTE-RV should be considered.

Attenuation of liver stiffness in sorafenib-treated patients with advanced hepatocellular carcinoma

Aim: Sorafenib is a multi-tyrosine kinase inhibitor and the standard therapy for advanced hepatocellular carcinoma (HCC). This retrospective study aimed to observe the anti-fibrotic effect of sorafenib in patients with advanced HCC. Methods: Seventeen patients with advanced HCC were recruited. Shear wave velocity (SWV) using acoustic radiation force impulse elastography and non-invasive serum markers for liver fibrosis, such as the aspartate aminotransferase (AST) to alanine aminotransferase ratio (AAR), the AST to platelet ratio index, the fibrosis-4 index and the Lok index, were recorded at the beginning of sorafenib treatment and 3-6 months after sorafenib treatment in 2014-2015. Results: Nine (52.9%) patients achieved disease control status and 8 had progressive disease after a mean duration of 11.1 months with sorafenib treatment. The mean SWV decreased from 2.37 m/s at the beginning to 1.90 m/s after sorafenib treatment (P < 0.01). This trend was observed in patients with and without liver cirrhosis (from 2.49 to 2.06 m/s, P = 0.06, and from 2.32 to 1.69 m/s, P < 0.05, respectively). Among the non-invasive serum markers, no statistically significant differences were observed except for the AAR in the cirrhotic group. Conclusion: Sorafenib has potential antif-ibrotic effects in patients with advanced HCC.