Multi-parameter ultrasound based on the logistic regression model in the differential diagnosis of hepatocellular adenoma and focal nodular hyperplasia

BACKGROUND Focal nodular hyperplasia(FNH)has very low potential risk,and a tendency to spontaneously resolve.Hepatocellular adenoma(HCA)has a certain malignant tendency,and its prognosis is significantly different from FNH.Accurate identification of HCA and FNH is critical for clinical treatment.AIM To analyze the value of multi-parameter ultrasound index based on logistic regression for the differential diagnosis of HCA and FNH.METHODS Thirty-one patients with HCA were included in the HCA group.Fifty patients with FNH were included in the FNH group.The clinical data were collected and recorded in the two groups.Conventional ultrasound,shear wave elastography,and contrast-enhanced ultrasound were performed,and the lesion location,lesion echo,Young’s modulus(YM)value,YM ratio,and changes of time intense curve(TIC)were recorded.Multivariate logistic regression analysis was used to screen the indicators that can be used for the differential diagnosis of HCA and FNH.A ROC curve was established for the potential indicators to analyze the accuracy of the differential diagnosis of HCA and FNH.The value of the combined indicators for distinguishing HCA and FNH were explored.RESULTS Multivariate logistic regression analysis showed that lesion echo(P=0.000),YM value(P=0.000)and TIC decreasing slope(P=0.000)were the potential indicators identifying HCA and FNH.In the ROC curve analysis,the accuracy of the YM value distinguishing HCA and FNH was the highest(AUC=0.891),which was significantly higher than the AUC of the lesion echo and the TIC decreasing slope(P<0.05).The accuracy of the combined diagnosis was the highest(AUC=0.938),which was significantly higher than the AUC of the indicators diagnosing HCA individually(P<0.05).This sensitivity was 91.23%,and the specificity was 83.33%.CONCLUSION The combination of lesion echo,YM value and TIC decreasing slope can accurately differentiate between HCA and FNH.

COVID-19 or treatment associated immunosuppression may trigger hepatitis B virus reactivation: A case report

BACKGROUND Since the initial recognition of coronavirus disease 2019(COVID-19)in Wuhan,this infectious disease has spread to most areas of the world.The pathogenesis of COVID-19 is yet unclear.Hepatitis B virus(HBV)reactivation occurring in COVID-19 patients has not yet been reported.CASE SUMMARY A 45-year-old hepatitis B man with long-term use of adefovir dipivoxil and entecavir for antiviral therapy had HBV reactivation after being treated with methylprednisolone for COVID-19 for 6 d.CONCLUSION COVID-19 or treatment associated immunosuppression may trigger HBV reactivation.

Sarcomatoid intrahepatic cholangiocarcinoma with good patient prognosis after treatment with Huaier granules following hepatectomy:A case report

BACKGROUND Sarcomatoid intrahepatic cholangiocarcinoma(SICC)is an extremely rare and highly invasive malignant tumor of the liver.The precise pathologic mechanism of SICC has not been clearly identified,and the prognosis is very poor.The effectiveness of the treatment strategy of radical hepatectomy combined with Huaier granules has not yet been reported.CASE SUMMARY The patient was a 69-year-old male who presented with intermittent right upper abdominal pain for one month and 4-pound weight loss before admission.Abdominal magnetic resonance imaging and magnetic resonance cholangiopancreatography showed multiple stones in the bile ducts accompanied by dilatation of the intrahepatic and extrahepatic bile ducts.The preoperative diagnoses were right intrahepatic bile duct stones and extrahepatic bile duct stones;thus,surgical resection was performed.Choledochoscopy showed that the bile duct wall of the right anterior lobe was thickened,and a mass was visible in the duct.Then,a biopsy was performed,and rapid frozen-section biopsy analysis indicated that the tumor was malignant.The final diagnosis was SICC(T1a N0M0).Huaier granules were taken by the patient as anticancer therapy after surgery.The patient attended follow-up for 72 mo with no tumor recurrence or metastasis.CONCLUSION Sarcomatous intrahepatic cholangiocarcinoma is an extremely rare,aggressive malignancy,and the diagnostic gold standard is pathological diagnosis.We reported the first case of successful treatment with Huaier granules as anticancer therapy after surgery,which indicated that Huaier granules are safe and effective.Further studies are needed to study the anticancer molecular mechanisms of Huaier granules in sarcomatous intrahepatic cholangiocarcinoma.