scholarly journals MR Imaging of Hepatocellular Adenomas and Differential Diagnosis Dilemma

2013 ◽  
Vol 2013 ◽  
pp. 1-20 ◽  
Author(s):  
Luigi Grazioli ◽  
Lucio Olivetti ◽  
Giancarlo Mazza ◽  
Maria Pia Bondioni
Keyword(s):  
Differential Diagnosis ◽  
Malignant Transformation ◽  
Fatty Infiltration ◽  
Hepatocellular Adenoma ◽  
Malignant Degeneration ◽  
Dual Phase ◽  
Genetic Abnormalities ◽  
Malignant Lesions ◽  
Nuclear Factor 1 ◽  
Hepatocellular Adenomas

Hepatocellular adenomas (HCAs) are currently categorized into distinct genetic and pathologic subtypes as follows: inflammatory hepatocellular adenoma, hepatocyte-nuclear-factor-1-alpha (HNF-1α-mutated) hepatocellular adenoma, andβ-catenin-mutated hepatocellular adenomas; the fourth, defined as unclassified subtype, encompasses HCAs without any genetic abnormalities. This classification has accepted management implications due to different risks of haemorrhage and malignant transformation of the four subtypes. Imaging guided biopsy and/or surgical resection very important in obtaining definitive characterization; nevertheless, MRI with intra-extravascular and hepatobiliary (dual phase) agents, is an important tool not only in differential subtypes definition but even in surveillance with early identification of complications and discovery of some signs of HCA malignant degeneration. Inflammation, abnormal rich vascularisation, peliotic areas, and abundant fatty infiltration are pathologic findings differently present in the HCA subtypes and they may be detected by multiparametric MRI approach. Lesion enlargement and heterogeneity of signal intensity and of contrast enhancement are signs to be considered in malignant transformation. The purpose of this paper is to present the state of the art of MRI in the diagnosis of HCA and subtype characterization, with particular regard to morphologic and functional information available with dual phase contrast agents, and to discuss differential diagnosis with the most common benign and malignant lesions mimicking HCAs.

scholarly journals Histological and Immunohistochemical Revision of Hepatocellular Adenomas: A Learning Experience

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
S. Fonseca ◽  
D. Hoton ◽  
S. Dardenne ◽  
L. Annet ◽  
C. Hubert ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Malignant Transformation ◽  
Surgical Resection ◽  
Immunohistochemical Staining ◽  
Learning Experience ◽  
Hepatocellular Adenoma ◽  
Phenotype Correlation ◽  
Vascular Abnormalities ◽  
Sinusoidal Dilatation ◽  
Hepatocellular Adenomas

Light has been shed on the genotype/phenotype correlation in hepatocellular adenoma (HCA) recognizingHNF1α-inactivated HCA (H-HCA), inflammatory HCA (IHCA), andβ-catenin-activated HCA (b-HCA). We reviewed retrospectively our surgical HCA series to learn how to recognize the different subtypes histopathologically and how to interpret adequately their immunohistochemical staining. From January 1992 to January 2012, 37 patients underwent surgical resection for HCA in our institution. Nine had H-HCA (25%) characterized by steatosis and loss of L-FABP expression; 20 had IHCA (55.5%) showing CRP and/or SAA expression, sinusoidal dilatation, and variable inflammation; and 1 patient had both H-HCA and IHCA. In 5 patients (14%), b-HCA with GS andβ-catenin nuclear positivity was diagnosed, two already with hepatocellular carcinoma. Two cases (5.5%) remained unclassified. One of the b-HCA showed also the H-HCA histological and immunohistochemical characteristics suggesting a subgroup ofβ-catenin-activated/HNF1α-inactivated HCA, another b-HCA exhibited the IHCA histological and immunohistochemical characteristics suggesting a subgroup ofβ-catenin-activated/inflammatory HCA. Interestingly, three patients had underlying vascular abnormalities. Using the recently published criteria enabled us to classify histopathologically our retrospective HCA surgical series with accurate recognition of b-HCA for which we confirm the higher risk of malignant transformation. We also underlined the association between HCA and vascular abnormalities.

scholarly journals Long-term outcomes following resection of hepatocellular adenomas with small foci of malignant transformation or malignant adenomas

JHEP Reports ◽  
2021 ◽  
pp. 100326
Author(s):  
Sophie Chopinet ◽  
François Cauchy ◽  
Christian Hobeika ◽  
Aurélie Beaufrère ◽  
Nicolas Poté ◽  
...  
Keyword(s):  
Malignant Transformation ◽  
Long Term Outcomes ◽  
Hepatocellular Adenomas

scholarly journals Diagnostic accuracy of dual-phase 18F-FP-CIT PET imaging for detection and differential diagnosis of Parkinsonism

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Minyoung Oh ◽  
Narae Lee ◽  
Chanwoo Kim ◽  
Hye Joo Son ◽  
Changhwan Sung ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Clinical Diagnosis ◽  
Fdg Pet ◽  
Brain Activity ◽  
Visual Assessment ◽  
Dual Phase ◽  
Regional Brain ◽  
Parkinsonian Disorders ◽  
Regional Brain Activity ◽  
Delayed Phase

AbstractDelayed phase 18F-FP-CIT PET (dCIT) can assess the striatal dopamine transporter binding to detect degenerative parkinsonism (DP). Early phase 18F-FP-CIT (eCIT) can assess the regional brain activity for differential diagnosis among parkinsonism similar with 18F-FDG PET. We evaluated the diagnostic performance of dual phase 18F-FP-CIT PET (dual CIT) and 18F-FDG PET compared with clinical diagnosis in 141 subjects [36 with idiopathic Parkinson’s disease (IPD), 77 with multiple system atrophy (MSA), 18 with progressive supranuclear palsy (PSP), and 10 with non-DP)]. Visual assessment of eCIT, dCIT, dual CIT, 18F-FDG and 18F-FDG PET with dCIT was in agreement with the clinical diagnosis in 61.7%, 69.5%, 95.7%, 81.6%, and 97.2% of cases, respectively. ECIT showed about 90% concordance with non-DP and MSA, and 8.3% and 27.8% with IPD and PSP, respectively. DCIT showed ≥ 88% concordance with non-DP, IPD, and PSP, and 49.4% concordance with MSA. Dual CIT showed ≥ 90% concordance in all groups. 18F-FDG PET showed ≥ 90% concordance with non-DP, MSA, and PSP, but only 33.3% concordance with IPD. The combination of 18F-FDG and dCIT yielded ≥ 90% concordance in all groups. Dual CIT may represent a powerful alternative to the combination of 18F-FDG PET and dCIT for differential diagnosis of parkinsonian disorders.

scholarly journals Cardiac magnetic resonance imaging in differential diagnosis of cardiac masses

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
EC D"angelo ◽  
P Paolisso ◽  
L Bergamaschi ◽  
A Foa ◽  
I Magnani ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Pericardial Effusion ◽  
Tissue Characterization ◽  
Descriptive Analysis ◽  
Gadolinium Enhancement ◽  
Malignant Lesions ◽  
T1 And T2 ◽  
Cardiac Masses

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): S. Orsola Hospital Background  Differential diagnosis of cardiac masses represents a challenging issue with important implications for therapeutic management and patient’s prognosis. Cardiac Magnetic Resonance (CMR) is a non-invasive imaging technique used to characterize morphologic and functional features of masses. Integration of these information can lead an accurate diagnosis. Purpose  To evaluate the diagnostic role of CMR in defining the nature of cardiac masses. Methods : Ninety-three patients with cardiac masses evaluated with CMR were enrolled. All masses had histological certainty. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion. Tissue characterization resulted from an estimation of contrast enhancement - early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) sequences - and tissue homogeneity in T1 and T2 weighted acquisitions. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours, primitive malignant tumours, metastatic tumours and pseudotumours.  Results  The descriptive analysis of the morphologic features showed that diameter > 50mm, invasion of surrounding planes, irregular margins and presence of pericardial effusion were able to predict malignancy (p < 0.001). As for tissue characteristics, heterogeneous signal intensity - independently from T1 and T2 weighted acquisitions - and EGE were more common in malignant lesions (p <0.001). When analysing the four subgroups, CMR features did not discriminate between primitive malignant masses and metastasis. Conversely, hyperintensity signal and EGE were able to distinguish benign primitive lesions from pseudotumors (p = 0.002).  Furthermore, using classification and regression tree (CART) analysis, we developed an algorithm to differentiate masses: invasion of surrounding planes was a common characteristic of malignancy and identifies itself malignant tumors. In the absence of invasive features, gadolinium enhancement was evaluated: the lack of contrast uptake was able to exclude a pseudotumor diagnosis and reduced the probability of a primary benign tumor.  Conclusions Cardiac magnetic resonance is a very powerful diagnostic tool for differential diagnosis of cardiac masses as it correctly addresses malignancy. Furthermore, an accurate evaluation of the several CMR features, may discriminate primary benign masses and pseudotumours. Abstract Figure. Benign and malignant cardiac masses

scholarly journals Application of ultrasound artificial intelligence in the differential diagnosis between benign and malignant breast lesions of BI-RADS 4A

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sihua Niu ◽  
Jianhua Huang ◽  
Jia Li ◽  
Xueling Liu ◽  
Dan Wang ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Differential Diagnosis ◽  
Breast Imaging ◽  
Texture Features ◽  
Matrix Analysis ◽  
Width Ratio ◽  
Malignant Group ◽  
Malignant Lesions ◽  
Occurrence Matrix ◽  
Benign Group

Abstract Background The classification of Breast Imaging Reporting and Data System 4A (BI-RADS 4A) lesions is mostly based on the personal experience of doctors and lacks specific and clear classification standards. The development of artificial intelligence (AI) provides a new method for BI-RADS categorisation. We analysed the ultrasonic morphological and texture characteristics of BI-RADS 4A benign and malignant lesions using AI, and these ultrasonic characteristics of BI-RADS 4A benign and malignant lesions were compared to examine the value of AI in the differential diagnosis of BI-RADS 4A benign and malignant lesions. Methods A total of 206 lesions of BI-RADS 4A examined using ultrasonography were analysed retrospectively, including 174 benign lesions and 32 malignant lesions. All of the lesions were contoured manually, and the ultrasonic morphological and texture features of the lesions, such as circularity, height-to-width ratio, margin spicules, margin coarseness, margin indistinctness, margin lobulation, energy, entropy, grey mean, internal calcification and angle between the long axis of the lesion and skin, were calculated using grey level gradient co-occurrence matrix analysis. Differences between benign and malignant lesions of BI-RADS 4A were analysed. Results Significant differences in margin lobulation, entropy, internal calcification and ALS were noted between the benign group and malignant group (P = 0.013, 0.045, 0.045, and 0.002, respectively). The malignant group had more margin lobulations and lower entropy compared with the benign group, and the benign group had more internal calcifications and a greater angle between the long axis of the lesion and skin compared with the malignant group. No significant differences in circularity, height-to-width ratio, margin spicules, margin coarseness, margin indistinctness, energy, and grey mean were noted between benign and malignant lesions. Conclusions Compared with the naked eye, AI can reveal more subtle differences between benign and malignant BI-RADS 4A lesions. These results remind us carefully observation of the margin and the internal echo is of great significance. With the help of morphological and texture information provided by AI, doctors can make a more accurate judgment on such atypical benign and malignant lesions.

scholarly journals CERVICOFACIAL ACTINOMYCOSIS: A DIFFERENTIAL DIAGNOSIS OF MALIGNANT LESIONS

2019 ◽  
Author(s):  
DIVINO FRANÇA ◽  
ANA LUISA GARCIA GIAMBERARDINO ◽  
PATRICIA ARENAS ROCHA ◽  
VALERIA MIDORI GUTOSKI YUKI ◽  
LAURA PICCOLI SILVA GRANERO ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Malignant Lesions

scholarly journals Unusual Site for a White Nodule on the Palatine Tonsil: Presentation, Differential Diagnosis, and Discussion

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ashwag Yagoub Aloyouny
Keyword(s):  
Differential Diagnosis ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Fungal Infections ◽  
The Body ◽  
Palatine Tonsil ◽  
Unusual Site ◽  
Case Presentation ◽  
Lymphoepithelial Cysts ◽  
Malignant Lesions

Introduction. Palatine tonsils are part of the mucosa-associated lymphoid tissue, located in the oropharyngeal region. Although these tissues protect the body from foreign intruders, they are more prone to infections due to their anatomical structure and location. For instance, the differential diagnosis of a white lesion on the palatine tonsil can range from benign to malignant lesions. Oral lymphoepithelial cysts commonly arise as painless, yellowish nodules on the floor of the mouth and the ventral or lateral surface of the tongue. Case Presentation. This paper presents a rare case of an unusual site of a lymphoepithelial cyst (LEC) in the oral cavity. The lesion was located in the tonsil of a 20-year-old woman with a chief complaint of a painless, white lump in the back of the mouth for nine months. Discussion. The differential diagnosis of a white lesion on the palatine tonsil is caused by several factors, such as bacterial, viral, and fungal infections; trauma; stones; cysts; abscess; or cancer. In this case, both the clinical presentation and extra- and intraoral examinations were highly associated with LEC. Oral LEC etiopathogenesis is uncertain, and several theories have been proposed to discuss the causes of LEC. In addition, oral LEC could be monitored without surgical intervention if the nodule is asymptomatic. Conclusion. We emphasize the importance of a thorough clinical examination of oral and oropharyngeal lesions, which are usually neglected.

Regression of multiple hepatocellular adenomas after cessation of oral contraceptive pills : a case report and review of the current literature

2021 ◽  
Vol 84 (3) ◽  
Author(s):  
G Moors ◽  
H Poels ◽  
V Vandecaveye ◽  
T Roskams ◽  
C Verslype
Keyword(s):  
Current Literature ◽  
Hepatocellular Adenoma ◽  
Liver Neoplasm ◽  
Resonance Imaging ◽  
Natural Evolution ◽  
Oral Contraceptive Pills ◽  
Contraceptive Pills ◽  
Magnetic Resonance Imaging Mri ◽  
Benign Liver ◽  
Hepatocellular Adenomas

Hepatocellular adenoma (HCA) is an uncommon benign liver neoplasm usually solitary and identified incidentally on imaging. We report a case of a 50-year old female who was diagnosed with multiple hepatic adenomas of the inflammatory subtype. After discontinuation of oral contraception a decrease of both the number and size of the liver lesions was seen on magnetic resonance imaging (MRI) without the need of further intervention. The major challenge in the clinical management of patients with multiple HCAs resides in the risk assessment for future complications. In the case of multiple HCAs subtype seemed to be more relevant than the actual number of lesions. Because little is known about the natural evolution in patients with multiple HCAs, we performed a review of the current literature with focus on the different subtypes and their clinical relevance.

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