Is hepatic neoplasm-related pyogenic liver abscess a distinct clinical entity?

AIM: To compare the clinical characteristics of pyogenic liver abscess (PLA) in patients with and without hepatic neoplasm (HN). METHODS: We performed a retrospective analysis involving patients with PLA. The demographic, clinical features, laboratory and imaging findings, management and outcome of patients with and without HN were studied. RESULTS: From January 2000 to December 2009 inclusive, 318 patients (35 with HN) had PLA, and mean age and comorbidity were comparable between the two groups. More patients with HN experienced right upper quadrant pain (68.6% vs 52.7%, P < 0.04), developed jaundice (14.3% vs 5.7%, P < 0.03) and hepatomegaly (17.1% vs 3.9%, P < 0.01), and had higher serum total bilirubin level (43.3 μmol/L vs 30.0 μmol/L, P = 0.05). Most patients in both groups had PLAs in the right hepatic lobe, and biliary tract disorder was the most common underlying cause (71.4% and 61.8%). However, more PLAs in the HN group were associated with thicker abscess wall (37.1% vs 19.4%, P < 0.01), septal lobulation (77.1% vs 58%, P < 0.02), gaseous cavitation (17% vs 7.8%, P = 0.03), portal thrombophlebitis (11.4% vs 1.8%, P < 0.01) and aerobilia (25.9% vs 5.5%, P < 0.01). Mixed bacterial growth (40% vs 15.2%, P < 0.01) and Gram-negative bacilli (22.8% vs 60.4%, P < 0.01) were dominant isolates in PLAs with and without HN, respectively. Although incidence of the complications was comparable between the two groups, patients with HN had a higher mortality rate than those without (71.4% vs 8.8%, P < 0.01). Multivariate logistic regression analysis revealed underlying active malignancy [odds ratio (OR): 40.45, 95% CI: 14.76-111.65], hypoalbuminemia (OR: 1.22, 95% CI: 1.14-1.38), disseminated intravascular coagulation (OR: 3.32, 95% CI: 1.19-9.69) and acute coronary syndrome (OR: 4.48, 95% CI: 1.08-17.8) were independent risk factors associated with mortality. However, several HN cases, presented concurrently with PLAs, were found to have curative resectable tumors and had good prognosis after surgery. CONCLUSION: PLA associated with HN tends to form a distinct clinical syndrome with a different extent of clinical manifestations, radiological and microbiological features and complications.

Changes and significances of SOD and MDA after ischemia reperfusion injury of hepatic neoplasm

To explore the influence and significance of the ischemia reperfusion on the hepatic neoplasm, the hepatic VX2 neoplasm model of rabbits was established under the guide of ultrasonography; and ischemia was caused by using a non-traumatic vascular clamp to block the branches distributing in the left-middle lobe of the hepatic artery for 60 min, and subsequently the clamp was removed and the reperfusion injury of hepatic neoplasm occurred. At different time-points, the normal and hepatic neoplasm tissues of the animal models were taken out to detect the superoxide dismutase (SOD) and malondialdehyde (MDA) respectively.The results show that the products and injurious effects of oxygen free radical (OFR) of the neoplasm tissues are more serious than those of the normal hepatic tissues.

Primary hepatic neuroendocrine neoplasm diagnosed by somatostatin receptor scintigraphy:A case report

BACKGROUND Primary hepatic neuroendocrine neoplasm(NEN)is a rare condition,and it is difficult to differentiate between primary and metastatic hepatic NENs.Herein,we report a case of primary hepatic NEN that initially mimicked a hemangioma but showed a gradual increase in size on long-term careful observation.CASE SUMMARY A 47-year-old woman was incidentally diagnosed with a 12-mm liver mass,suspected to be a hemangioma.Since then,regular follow-up had been carried out.Ten years later,she was referred to our institute due to the tumor(located in segment 4)having increased to 20 mm.Several imaging studies depicted no apparent extrahepatic lesion.Positron emission tomography(PET)/computed tomography exhibited significant accumulation in the mass lesion,which made us consider the possibility of malignancy.Left hepatectomy was performed.The histopathological diagnosis was neuroendocrine tumor grade 2,with somatostatin receptor 2 a/5 positivity.Postoperative somatostatin receptor scintigraphy(SRS)showed no other site,leading to the diagnosis of NEN of primary hepatic origin.The gradual growth of the hepatic NEN over 10 years suggested that it was likely to be a primary liver tumor.CONCLUSION In this case,positivity on PET and postoperative SRS may have helped determine whether the tumor was primary or metastatic.

PREOPERATIVE SEGMENTAL LOCALIZATION OF FOCAL HEPATIC LESION ON MRI

In order to evaluate the accuracy of preoperative segmental localization of hepatic mass lesions,68 cases were prospectively studied and evaluated by the correlation of magnetic resonance imaging (MRI) and surgical findings. Right, middle and left hepatic veins were seen in 100%, 97% and 94% of the subjects respectively on MRI. The right and left portal veins were seen in 100% and 95.6% respectively. The accuracy in determining the segmental location of hepatic lesions was 89.7%. The accuracy could be increased to 91. 3% if the lesion was located at single segment whereas it was only 86. 4% when the lesion extended across several segments. It is possible to say that MRI is an important modality in the preoperative segmental localization of masses.

Imaging findings of primary hepatic leiomyoma

Objective： To investigate the imaging features of primary hepatic leiomyoma. Methods： 3 patients of primary hepatic leiomyoma confirmed by pathology without immunodeficiency were retrospectively analyzed about CT and MRI findings, clinical and pathological correlation. 2 cases had routine CT scan, 2 cases had routine MRI. Results： 2 case CT scans showed low-density lesions, 2 cases MRI showed lesions with long T1 and long T2 signal. One case of uniform density and signal showed homogeneous enhancement; two cases showed uneven density and signal, of which one case was inhomogeneous enhancement. 3 cases presented pseudocapsule without hepatic cirrhosis and venous tumor thrombus. Pathology showed spindle tumor cell proliferation and capillary hyperplasia; one case showed central hyalinization and one case central liquefaction necrosis. Conclusion： Primary hepatic leiomyoma is a hypervascular tumor, and CT and MRI help in the diagnosis.

Current and future treatments for hepatocellular carcinoma

Hepatocellular carcinoma(HCC) represents a unique challenge for physicians and patients.There is no definitively curative treatment.Rather,many treatment and management modalities exist with differing advantages and disadvantages.Both current guidelines and individual patient concerns must be taken into account in order to properly manage HCC.In addition,quality of life issues are particularly complex in patients with HCC and these concerns must also be factored into treatment strategies.Thus,considering all the options and their various pros and cons can quickly become complex for both clinicians and patients.In this review,we systematically discuss the current treatment modalities available for HCC,detailing relevant clinical data,risks and rewards and overall outcomes for each approach.Surgical options discussed include resection,transplantation and ablation.We also discuss the radiation modalities:conformal radiotherapy,yttrium 90 microspheres and proton and heavy ion radiotherapy.The biologic agent Sorafenib is discussed as a promising new approach,and recent clinical trials are reviewed.We then detail currently described molecular pathways implicated in the initiation and progression of HCC,and we explore the potential of each pathway as an avenue for drug exploitation.We hope this comprehensive and forward-looking review enables both clinicians and patients to understand various options and thereby make more informed decisions regarding this disease.

Hepatocellular carcinoma with inferior vena cava and right atrium thrombus: A case report

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.

Aggressive primary hepatic histiocytic sarcoma: case report and literature review

Histiocytic sarcoma is an uncommon non-Langerhans histiocyte disorder of mature tissue histiocytes.The authors presented an example of this rare tumor in a 14-year-old girl who presented with left upper quadrant pain,loss of appetite,and weight loss.A large 18 cm×10 cm heterogeneous solid and cystic enhancing mass was found in the left lobe of the liver.Based on the histomorphology and positivity for histiocyte-specific markers in a needle biopsy,a diagnosis of histiocytic sarcoma was made.Chemotherapy was initiated,but the tumor did not respond well,and she died about 7 weeks following initial diagnosis with multi-organ failure.At autopsy,the tumor showed extensive necrosis,with no evidence of metastatic spread.In conclusion,the diagnosis of histiocytic sarcoma is challenging,and requires a high index of suspicion,with an appropriate panel of confirmatory immunohistochemical stains.Recognition of this rare tumor is important because of its poor response to chemotherapy and high mortality.

Non-Hodgkin Lymphoma of the Liver:A US Population-based Analysis

Background and Aims:Non-Hodgkin lymphoma (NHL) of the liver is a rare lymphoid malignancy,accounting for less than 1% of extranodal lymphomas.Methods:I conducted an analysis of the U.S Surveillance,Epidemiology,and End Results (SEER) database to evaluate the histological subtypes and the survival outcomes of 785 cases with hepatic NHL between 1973 and 2012.Results:There were 785 of 312 459 cases with NHL had a first primary hepatic NHL (0.25%).Of the total 785 cases,the median age at diagnosis was 61 years (range 3-95 years) and male-female ratio of 1.7∶1.The most common subtype was diffuse large B cell lymphoma (63.2%).In all patients,the median overall survival (OS) was 33 months (95%CI,22-48 months).The 5-year OS rate for indolent B-cell NHLs was 62%,compared with 44% for an aggressive B-cell NHLs and 42% for T-cell NHLs.The median OS improved from 19 months in patients diagnosed in a period 1996-2000 to 60 months when diagnosed between 2006 and 2012 (p <.001).In a multivariable Cox regression analysis,the age ≥80 years (adjusted hazard ratio [aHR] 3.21,p <.001),male gender (aHR 1.26,p =.02),Black race (aHR,1.70,p <.001),and T-cell NHLvariants (aHR 1.73,p =.03) were unfavourable prognostic factors.Conclusion:NHL of the liver comprises about 0.3% of all NHLs and survival was improved in the recent calendar period.