scholarly journals Malignant Transformation of an HNF1a-Inactivated Hepatocellular Adenoma to Hepatocellular Carcinoma

2020 ◽  
Vol 14 (3) ◽  
pp. 577-585
Author(s):  
Joris T. Hepkema ◽  
Floris B. Poelmann ◽  
Annette S.H. Gouw ◽  
Robbert J. de Haas ◽  
Evelien W. Duiker ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Malignant Transformation ◽  
Histopathological Examination ◽  
Imaging Techniques ◽  
Hepatocellular Adenoma ◽  
Benign Tumors ◽  
Palpable Mass ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen

Hepatocellular adenomas (HCA) are rare benign tumors of the liver, occurring predominantly in females using oral contraceptives. Our case describes a 66-year-old woman presenting with a palpable mass in her upper abdomen. Contrast-enhanced computed tomography and magnetic resonance imaging showed a large exophytic mass protruding from the caudal border of liver segments IV and V, without visible metastases. Laparoscopic resection of the tumor and gallbladder was performed. Histopathological examination showed a hepatocellular carcinoma with areas of HNF1a-HCA (H-HCA). This case shows that malignant transformation is possible in H-HCA. We present our preoperative decision-making process, as well as the role of imaging techniques in this rare case.

scholarly journals Giant hepatic capillary hemangioma, a diagnostic dilemma: case report

2021 ◽  
Vol 8 (5) ◽  
pp. 704
Author(s):  
Arkadeep Dhali ◽  
Anirban Hazra ◽  
B. Rathna Roger ◽  
Gopal Krishna Dhali ◽  
Avik Sarkar
Keyword(s):  
Histopathological Examination ◽  
Capillary Hemangioma ◽  
Vascular Lesions ◽  
Benign Tumors ◽  
Diagnostic Dilemma ◽  
Contrast Enhanced ◽  
One Year ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen

Hepatic Hemangiomas (HH) are benign tumors of the liver consisting of a blood-filled cavity supplied by the hepatic artery. Most of the HH are asymptomatic and are discovered incidentally during radiological imaging of various unrelated pathology. Typical capillary hemangiomas range from a few millimeters to three centimeters and are unlikely to generate any future symptomatology. However, giant liver hemangiomas (more than 10 cm) are a very rare entity and might become symptomatic, hence requiring prompt intervention. We are reporting this case to make the readers aware of the pitfalls and radiological uncertainties while interpreting vascular lesions of the liver. We reported a case of a 21-year-old female with complaint of awareness of a mass over the right upper abdomen since a period of one year which has been gradually increasing in size. On pre-operative Contrast-Enhanced Computed Tomography, features suggestive of Fibrolamellar variant of Hepatocellular Carcinoma was found which was substantiated by biochemical investigations. However, post-operative histopathological examination revealed a capillary hemangioma.

scholarly journals Huge Retroperitoneal Dermoid: A Presentation

2019 ◽  
Vol 05 (04) ◽  
pp. e142-e145
Author(s):  
Tanweerul Huda ◽  
Mahendra Pratap Singh
Keyword(s):  
Histopathological Examination ◽  
Cystic Teratoma ◽  
Exploratory Laparotomy ◽  
Cystic Mass ◽  
Contrast Enhanced ◽  
Chief Complaints ◽  
Region Contrast ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen

AbstractTeratoma can be defined as a true neoplasm that contains tissues that either are foreign to the primary site of origin or are histologically diverse and represent more than one of the embryonic germ layers. A 20-year-old female patient presented with chief complaints of swelling in the right upper abdomen since childhood and back pain for the past 4 years. Per abdomen, examination revealed a lump of around 15 cm in size in the right hypochondrial region extending to the epigastric region. Contrast-enhanced computed tomography abdomen revealed a 14.3 × 14.1 × 17.4 cm well-defined heterogeneously hypoattenuating nonenhancing complex cystic mass with focal areas of calcifications and fat attenuation in retroperitoneum. The patient was taken up for exploratory laparotomy and a tumor was found in the retroperitoneum, retrocavally and was excised with due care. Histopathological examination features were suggestive of mature cystic teratoma. The postoperative stay was uneventful.

scholarly journals Hepatic Epithelioid Hemangioendothelioma Presenting Synchronously with Hepatocellular Carcinoma

2021 ◽  
pp. 344-351
Author(s):  
Hiroki Kanno ◽  
Toshihiro Sato ◽  
Ryuta Midorikawa ◽  
Satoki Kojima ◽  
Shogo Fukutomi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Carbohydrate Antigen ◽  
Epithelioid Hemangioendothelioma ◽  
Arterial Phase ◽  
Rapid Progression ◽  
Imaging Findings ◽  
Liver Segment ◽  
Contrast Enhanced ◽  
Well Differentiated ◽  
Enhanced Computed Tomography

Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant tumor with unknown pathogenesis. Herein, we report a case of a hepatic EHE presenting synchronously with a hepatocellular carcinoma (HCC). To the best of our knowledge, this is the second case report of synchronous hepatic EHE and HCC. An 84-year-old man presented with back pain. During examination, a tumor in liver segment 3 was coincidentally detected. Tumor marker (carbohydrate antigen 19-9, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II) levels were elevated. Contrast-enhanced computed tomography revealed perinodular enhancement in the arterial and portal phases. Another tumor was detected in liver segment 2, which was homogeneously enhanced in the arterial phase, followed by washout in the portal and late phases. Based on these imaging findings, we diagnosed the tumor in segment 3 as a solitary cholangiocellular carcinoma and the tumor in segment 2 as a solitary HCC. Lateral sectionectomy of the liver was performed. Microscopically, spindle-shaped and epithelioid cells were present in the tumor in segment 3. On immunohistochemistry, the tumor cells were positive for CD31 and CD34, focally positive for D2-40, and negative for AE1/AE3. Therefore, the tumor in segment 3 was ultimately diagnosed as an EHE and the tumor in segment 2 as a well-differentiated HCC. Preoperative diagnosis of EHE is difficult owing to the lack of specific findings. Intratumoral calcification, halo sign, and lollipop sign are occasionally found in EHE and are useful imaging findings for diagnosis. Clinical behavior is unpredictable, ranging from indolent growth to rapid progression. Clinical or pathological predictors of the course of EHE are urgently required.

scholarly journals Acute Abdomen due to Mutual Tangle of Two Small Paratubal Cysts

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Hiroharu Kobayashi ◽  
Shinichi Shibuya ◽  
Kentaro Iga ◽  
Keiichiro Kato ◽  
Airi Kato ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Histopathological Examination ◽  
Lower Abdominal Pain ◽  
Cystic Teratoma ◽  
Cystic Mass ◽  
Mature Cystic Teratoma ◽  
Contrast Enhanced ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Paratubal Cyst

A 30-year-old woman (gravida 0) visited our hospital with a complaint of right lower abdominal pain. Transvaginal ultrasonography revealed a 5-cm swollen right ovary, which was suspected to be a mature cystic teratoma. Pelvic examination revealed moderate pain. Contrast-enhanced computed tomography showed a 44-mm cystic mass containing fat and calcified material in the right pelvis. Since torsion was suspected, emergent laparoscopic surgery was performed. Intraoperative findings were a swollen right ovary without torsion or congestion. Two small pedunculated 1- and 2-cm diameter paratubal cysts that grew from almost the same place of the ampulla of the right fallopian tube were observed. The thin stalk of the 1-cm paratubal cyst was entangled around the stalk of the 2-cm paratubal cyst, with its head congested. Through a small abdominal laparoscopic incision, the tumor of the right ovary and the two paratubal cysts were excised. Histopathological examination revealed that the right ovarian tumor was a mature cystic teratoma, and the two paratubal cysts had no malignancy. This case showed that only a 2-cm tumor with congestion caused the acute abdomen.

scholarly journals Incidental Detection of Adrenal Myelolipoma: A Case Report and Review of Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Junaid Nabi ◽  
Danish Rafiq ◽  
Fatema N. Authoy ◽  
Ghulam Nabi Sofi
Keyword(s):  
Computed Tomography ◽  
Imaging Techniques ◽  
Diagnostic Study ◽  
Hormone Production ◽  
Adrenal Myelolipoma ◽  
Cross Sectional ◽  
Cect Scan ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen

Introduction. Adrenal myelolipoma is a rare tumor that is benign in nature, usually asymptomatic, unilateral, and nonsecreting. It is composed of variable mixture of mature adipose tissue and hematopoietic elements and develops within the adrenal gland. With the widespread use of cross-sectional imaging modalities such as ultrasonography and computed tomography, the incidental detection of these tumors is increasing in frequency.Case Presentation. We report a case of adrenal myelolipoma in a 63-year-old Kashmiri male, who presented with pain in the right upper abdomen. Physical examination was unremarkable. Ultrasound abdomen showed the presence of a hyperechoic mass in the right suprarenal region with undefined margins. Contrast-enhanced computed tomography (CECT) scan of abdomen revealed a well-defined, round lesion in the right suprarenal region with heterogeneous attenuation suggesting the possibility of myelolipoma. The patient was subjected to right adrenalectomy and his postoperative course was uneventful. The histopathological evaluation of the mass confirmed the initial diagnosis of adrenal myelolipoma.Conclusion. Although mostly discovered as an “incidentaloma”, the diagnosis of adrenal myelolipoma warrants thorough diagnostic study. Imaging techniques such as ultrasonography and CT scans as well as biochemical studies are useful for indicating the best treatment taking into account the size of the mass and possible hormone production. Surgical resection is advocated through extraperitoneal approach as it minimizes postoperative complications and leads to quicker recovery.

scholarly journals Assess the Role of Sonography and MRI in Diagnosing Ovarian Masses

2020 ◽  
Vol 8 (2) ◽  
pp. 41-49
Author(s):  
G. Mahender Reddy ◽  
M. L. Ravindernath ◽  
S.Snehaja Reddy
Keyword(s):  
Histopathological Examination ◽  
Imaging Techniques ◽  
Benign Lesion ◽  
Wall Structure ◽  
Diagnostic Modality ◽  
Color Flow ◽  
Palpable Mass ◽  
Imaging Characteristics ◽  
Ovarian Masses

Background: In order to conduct appropriate surgical treatments, the characterization of ovarian lesions is of considerable significance and can affect patient care. A multidisciplinary approach based on physical assessment, laboratory tests and imaging techniques includes adequate measurement of the adnexal masses. The aim is to assess the role of Sonography and MR in diagnosing ovarian masses, to study imaging characteristics of ovarian masses on USG and Doppler in correlating these findings with MR features. Subjects and Methods: The present study was carried out in the department of radiodiagnosis to determine the efficacy of sonography and MRI in the diagnosis of ovarian masses. The study group comprised 50 patients with clinically suspected ovarian masses and imaging was carried out on all patients with ovarian masses and imaging was carried out on all patients with ovarian masses. All the masses were evaluated on sonography based on the Sassone scoring system. Morphological analysis was performed for each mass based on wall thickness, inner wall structure, septal structure and echogenicity of mass. The color flow was carried out, subsequently; MRI was carried out for each patient. Radiological diagnosis was confirmed after surgery on histopathological examination. Results: The majority of the patients were in the age group of 31-40 years. The most common symptoms noted were pain in the abdomen. The most common clinical finding was a palpable mass. The application of Sassone sonomorphologic score >9 was identified in 8 masses, out of which 7 were malignant and 1 was a benign lesion. The colour flow was detected in 38 out of 50 masses. The presence of flow, type of flow, vessel arrangement, morphology and location were noted and on pulsed Doppler the RI and PI values were calculated. Out of 8 malignant cases, 5 were diagnosed as malignant according to the Caruso score. The overall sensitivity 100 %, specificity is 97.6% and diagnostic accuracy is 98% of MRI which is higher than that of ultrasound and CDS. Conclusion: We conclude that MRI is a superior diagnostic modality in establishing the diagnosis of ovarian masses.

scholarly journals A differently managed Spleen Injury

2016 ◽  
Vol 02 (01) ◽  
pp. 049-051
Author(s):  
G Shoor ◽  
S Rulaniya ◽  
K Mukherjee ◽  
H Sengupta ◽  
A Saraf
Keyword(s):  
Splenic Injury ◽  
Young Male ◽  
Abdominal Ultrasound ◽  
Persistent Pain ◽  
Professional Activity ◽  
Subcapsular Hematoma ◽  
Contrast Enhanced ◽  
Injury Patient ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen

Abstract Introduction: Treatment of symptomatic splenic injury after more than 1 month of the trauma is not very specific. Moreover, here, we are reporting such a case where the patient was treated laparoscopically salvaging the spleen. Case report: A 26-year-old young male presented with persistent pain in the left upper abdomen and back, following a splenic injury while playing football 1 month ago. Abdominal ultrasound showed subcapsular hematoma with intact hilum. Contrast-enhanced computed tomography of whole abdomen showed large subcapsular hematoma grade III with intact hilar vessels. In view of persistent pain and discomfort, which debilitated and restrained him from daily as well as professional activity, even after 1 month of trauma, the patient was planned for diagnostic laparoscopy and proceed, which revealed hemoperitoneum and was aspirated. Omentum was separated from splenic capsule, breech in the capsule was extended, and hematoma was sucked out. The drain was removed on 4th postoperative day after ultrasound to exclude any fresh hemorrhage. The patient soon started daily activity and resumed his job after 15 days. Conclusion: Surgical intervention in a hemodynamically stable splenic-injury patient may sometimes be required depending upon the condition and symptoms of the patient.

scholarly journals Transarterial chemoembolization plus multi-imaging–guided radiofrequency ablation for elimination of hepatocellular carcinoma nodules measuring 3.1 to 5.0 cm: a single-center study

2018 ◽  
Vol 46 (7) ◽  
pp. 2650-2657 ◽  
Author(s):  
Wang Haochen ◽  
Wang Jian ◽  
Song Li ◽  
Lv Tianshi ◽  
Tong Xiaoqiang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Radiofrequency Ablation ◽  
Transarterial Chemoembolization ◽  
Elimination Rate ◽  
Tumor Location ◽  
Significant Prognostic Factor ◽  
Contrast Enhanced ◽  
Single Center Study ◽  
Enhanced Computed Tomography ◽  
Residual Lesions

Objective This study was performed to determine whether transarterial chemoembolization (TACE) plus multi-imaging–guided radiofrequency ablation (MIG-RFA) can completely eliminate 3.1- to 5.0-cm hepatocellular carcinoma (HCC) nodules and identify factors that may influence the complete elimination rate (CER) of this therapy. Methods Patients who underwent TACE+MIG-RFA for initial treatment of HCC from January 2008 to January 2016 were retrospectively reviewed. In total, 162 patients with 216 HCC nodules (3.1–5.0 cm) were enrolled. TACE was performed first; MIG-RFA was performed 2 to 4 weeks later. Contrast-enhanced computed tomography was performed 1, 3, 6, and 12 months after TACE+MIG-RFA. If tumor enhancement was not detected by the end of the 12-month follow-up, the lesion was considered completely eliminated. Additional TACE+MIG-RFA was performed for residual lesions. The CER was calculated 12 months after the last therapy. Factors that may influence the CER were analyzed. Results In total, 207 (95.8%) nodules showed no residual lesions and were completely eliminated after one or more TACE+MIG-RFA sessions. Nine (4.2%) nodules were incompletely eliminated even with repeated TACE+MIG-RFA. Tumor location was the only significant prognostic factor influencing the CER. Conclusions TACE+MIG-RFA can eliminate 3.1- to 5.0-cm HCC nodules; the tumor location may affect the treatment outcome.

Imaging of a Rare Case of Diaphragmatic Tumor

2017 ◽  
Vol 3 (1) ◽  
pp. 25-27
Author(s):  
Ajit Reddy ◽  
Anil K Shukla ◽  
Sowmya Anand ◽  
Nitish Suresh
Keyword(s):  
Rare Case ◽  
Surgical Excision ◽  
Malignant Neoplasms ◽  
Primary Tumors ◽  
Contrast Enhanced ◽  
History Of ◽  
Upper Abdominal ◽  
Diaphragmatic Tumor ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen

ABSTRACT Primary tumors of the diaphragm are quite rare. About 150 cases have been reported in the literature. Fibrosarcomas are the most common malignant neoplasms of the diaphragm; however, only a few (less than 20) cases have been reported to date. We present a case of an extremely rare tumor of the diaphragm. A 65-year-old woman presented with history of vague upper abdominal pain since 2 months and distension for 2 weeks. Ultrasonography features were in favor of a mass arising from left dome of diaphragm with evidence of vascularity on Doppler; lesion was displacing spleen inferiorly. Contrast-enhanced computed tomography scan of the abdomen revealed a mass located in the region of the left dome of diaphragm and deriving blood supply from the branches of abdominal aorta. Surgical excision was planned, keeping in mind the diagnosis of a left diaphragmatic tumor. Laparotomy revealed a left diaphragmatic tumor growing caudally into the upper abdomen. How to cite this article Anand S, Suresh N, Reddy AK, Shukla AK. Imaging of a Rare Case of Diaphragmatic Tumor. J Med Sci 2017;3(1):25-27.

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