Potential application of ultrasound-guided thermal ablation in rare liver tumors

Background: With the advances of imaging techniques, the detection rate of rare liver tumor is increased. However, the therapeutic strategies of the rare liver tumors remain limited. Methods: We analyzed twelve pathologically confirmed rare liver tumors in 8 patients. All of the patients underwent ultrasound(US) guided biopsy and subsequent thermal ablation. The tumors were ablated according to the preoperative plans and monitored by real-time US. CT/MRI fused with contrast enhanced US(CEUS) or three-dimensional(3 D) US-CEUS images were used to guide and assess the ablation zone more accurately during thermal ablation. The rate of technical efficacy was assessed based on the contrast-enhance CT/MRI(CECT/MRI) results one month after ablation. Local tumor progression(LTP), recurrence and complications were followed up and recorded. Results: Among these twelve nodules, nine were subject to US-guided thermal ablation, whereas the other three inconspicuous nodules were subject to CEUS-guided thermal ablation. Intra-procedure CT/MRI-CEUS or 3 D US-CEUS fusion imaging assessments demonstrated that the ablation zone sufficiently covered the original tumor, and no immediate supplementary ablation was required. Additionally, no major complications were observed during the follow-up period. The postoperative CECT/MRI confirmed that the technique success rate was 100%. Within the surveillance period of 13 months, no LTP or recurrence was noted. Conclusions: US-guided thermal ablation was feasible and safe for rare liver tumors. The use of fusion imaging technique might make US-guided thermal ablation as effective as surgical resection, and this technique might serve as a potential therapeutic modality for rare liver tumors in the future.

Are liver nested stromal epithelial tumors always low aggressive?

Nested stromal-epithelial tumor(NSET) is a nonhepatocytic and non-biliary tumor of the liver consisting of nests of epithelial and spindled cells with associated myofibroblastic stroma and variable intra-lesional calcification and ossification, which represents a very rare and challenging disease. Most of the reported cases have been treated with surgery, obtaining a long survival outcome. Here, we report the case of a 31-year-old Caucasian man who underwent surgery at our institution for a large, lobulated, multinodular mass of the right hemi-liver. The histological exam confirmed the diagnosis of NSET. After 6 mo from surgery, a liver recurrence was described and a chemoembolization was performed. After a further disease progression, based on the correlation between the histological features of the disease and those of the hepatoblastoma, a similar chemotherapy regimen(with cisplatin and ifosfamide/mesna chemotherapy, omitting doxorubicin due to liver impairment) was administered. However, infection of the biliary catheter required a dose modification of the treatment. No benefit was noted and a progression of disease was radiologically assessed after only four cycles. The worsening of the clinical status prevented further treatments, and the patient died a few months later. This case report documents how the NSET might have an aggressive and non-preventable behavior. No chemotherapy schedules with a proved efficacy are available, and new data are needed to shed light on this rare neoplasm.

成人肝脏少见肿瘤或肿瘤样变18例临床观察

目的探讨成人肝脏少见肿瘤或肿瘤样变的诊断和治疗。方法收集2009年6月至2015年5月收治的18例肝脏少见肿瘤或肿瘤样变患者的临床资料,回顾性分析临床诊治过程。结果 18例患者中,纤维瘤2例,腺瘤3例,局灶结节性增生4例,癌肉瘤2例,错构瘤2例,梭形细胞瘤1例,原发性肝恶性间质瘤1例,肝结核1例,炎性假瘤2例。8例影像学诊断出现误诊,良恶性诊断准确率为50%。1例炎性假瘤术前CA19-9为246.4 k U/L,其他病例肿瘤标志物均正常。除1例肝结核因术中见胃小弯多发肿大淋巴结和膈肌硬结未行肝脏肿块切除及1例腺瘤患者行射频消融外,其他病例均行肝脏病灶完整切除(包括局部切除、肝叶肝段切除)。结论肝脏少见肿瘤或肿瘤样变术前难以确诊,检查误诊率较高,主要依靠病理诊断,治疗以手术切除为主。

原发性肝细胞癌少见CT征象及误漏诊分析

目的探讨原发性肝细胞癌(HCC)少见CT征象,减少误漏诊,进一步提高肝癌CT诊断的准确性。方法回顾性分析8例经病理证实的HCC的临床资料。所有患者均经GE Lightspeed16螺旋CT常规平扫、增强后肝动脉期和门脉期及延迟期扫描,观察瘤灶多期动态扫描的CT征象。结果平扫时多数病灶境界模糊,增强后逐渐变清晰。病灶内部密度及强化特点分为4种类型:①病灶大面积脂肪变1例,平扫以略低密度为主,内见大量脂肪成分,动脉期呈轻度强化,密度整体略低于周围正常肝实质,门脉期密度明显低于周围正常肝实质,即低-低-低型伴大面积脂肪变。②病灶大面积囊性变1例,平扫呈低密度伴大面积囊变液化区及散在小片状高密度出血区,动脉期轻度强化,呈略低密度,门脉期以低密度为主,囊变区密度均匀,即低-低等混杂-低型;③延迟强化型2例,平扫呈略低密度,动脉期呈低密度,门脉期病灶呈环形强化,密度高于周围正常肝实质,内见片状不定形强化程度较轻的低密度区,即低-低-高型。④其它类型4例,平扫呈等或略低密度,病灶与正常肝实质境界不清,动脉期轻度不均匀强化,低于周围正常肝实质,门脉期呈更低密度,即等-低-低型或低-低-低型。结论动脉期无强化或强化较轻,或静脉期持续强化的肝癌结节,容易被忽视甚至误诊为其它病变,综合分析各期强化特点方可减少误漏诊。

启东市居民主要恶性肿瘤死亡情况与减寿分析

目的：了解启东市居民19年来（1986年-2004年）主要恶性肿瘤的死亡情况并进行减寿分析，通过比较不同年代的不同恶性肿瘤对居民寿命的危害程度，为恶性肿瘤的防治提供重要线索。方法：采用减寿分析方法中的最大期望值法。结果：（1）19年间启东居民恶性肿瘤前5位死因顺位依次为肝癌、肺癌、胃癌、结肠直肠癌、食管癌，这期间启东居民的肝癌呈持续高死亡率，肺癌的死亡率也呈逐渐升高趋势，胃癌、结肠、直肠癌死亡率有所下降。（2）减寿年数（PYLL）前5位由高至低依次为肝癌、肺癌、胃癌、白血病、结肠直肠癌；而白血病、肝癌、结肠、直肠癌、乳腺癌等对平均减寿年数（AYLL）影响较大。（3）35岁前恶性肿瘤死亡率最高的是肝癌和白血病，35465岁死亡率最高的为肝癌和肺癌，65岁以上死亡率高的为肺癌和胃癌。结论：肝癌、肺癌、胃癌、白血病、结肠、直肠癌是引起寿命损失最主要的恶性肿瘤，乳腺癌对女性寿命损失较大。肝癌防治依然是启东慢病控制的重要任务；肺癌死亡率的升高是值得关注的问题。

1例儿童肝罕见组织学形态上皮样炎性肌纤维母细胞肉瘤的临床病理分析

采用光镜、免疫组织化学及荧光原位杂交等方法分析1例以微囊性、腺泡样及实性结构为主的儿童肝上皮样炎性肌纤维母细胞肉瘤(epithelioid inflammatory myofibroblastic sarcoma,EIMS)临床病理特征,结合文献复习,做出相应鉴别。患者为3岁女童,肝巨大占位。术后病理检查:镜下见肿瘤与肝组织界限较清,肿瘤主体部分呈疏密不均的微囊样或肺泡样结构,囊壁被覆多角形或短梭形上皮样细胞,囊腔内大量淋巴细胞、浆细胞、组织细胞浸润;局部上皮样细胞呈腺泡样至实性片状。免疫组织化学:上皮样细胞CK18、Vim、Desmin强阳性,ALK阴性,Ki-67指数约3%。综合分析后诊断为EIMS,术后9个月随访,患儿状况良好,无肿瘤复发等异常。本例特殊组织学形态EIMS,未见有文献报道描述,诊断主要依据形态学、免疫组织化学及分子检测,临床病理上需和多个肿瘤鉴别。治疗以手术扩大切除为主,需密切随访,进一步了解其生物学行为及预后。