scholarly journals A Rare Case of Primary Hepatic Adenosquamous Carcinoma Mimicking Liver Abscess

2021 ◽  
Vol 2 (2) ◽  
pp. 52-53
Author(s):  
Wei Liu
Keyword(s):  
Computed Tomography ◽  
Weight Loss ◽  
Liver Abscess ◽  
Adenosquamous Carcinoma ◽  
Clinical Manifestations ◽  
Gamma Glutamyl Transferase ◽  
Fungal Culture ◽  
Imaging Characteristics ◽  
Glutamyl Transferase ◽  
Purulent Fluid

A 61-year-old woman with a 3-week history of chills, fevers to 39°C, anorexia, weight loss, and fatigue was referred to our hospital due to the progressive discomforts over the last week. Her documented medical history was notable for well-controlled type 2 diabetes. Physical examination was unremarkable. Notable laboratory tests of the blood revealed a hemoglobin level of 90 g/L, a white blood cell count of 11.7×109/L with neutrophil 90.7%, albumin 31.6 g/L, gamma glutamyl transferase 331 IU/L, alkaline phosphatase 748 IU/L. Direct microbiologic detection and cultures were negative for hepatitis B and C virus, bacterial and fungal pathogens, and human immunodeficiency virus. A computed tomography scan of the chest was unremarkable. Abdominal contrast-enhanced computed tomography discovered an ill-defined and sub-circular lowdensity region measuring 7.6×6.1cm with patchy enhancement in the right lobe of liver (Figure A), which implied a liver abscess. Empiric antibiotics were changed to meropenem combined with metronidazole on day three of hospitalisation. However, the fever did not alleviate with poorly therapeutic effect. Ultrasound-guided biopsy was performed and purulent fluid was collected to make a definitive diagnosis of the liver mass. Surprisingly, The histopathological detection of a needle biopsy sample confirmed neoplastic necrosis with negative bacterial and fungal culture of the purulent fluid. The patient then underwent right hemihepatectomy and histopathologic examination further revealed that the lesion included a mixture of a poorly differentiated adenocarcinoma with mucin production and squamous cell carcinoma with keratinization, as well as large patchy necrosis (Figure B). On immunostaining, the lesion stained strongly with CK5/6, P63, and P40, and was also partially positive for CK7, CK8/18, and Cam5.2 with negative staining for hepatocyte and alpha-fetoprotein, which were consistent with adenosquamous carcinoma of the liver. Primary hepatic adenosquamous carcinoma is a rare variant of intrahepatic cholangiocarcinoma with approximately 10 cases reported within 5 years.1,2 The pathogenesis of adenosquamous carcinoma of the liver is largely unknown owing to limited data in the literature. Fever, jaundice, weight loss, anorexia, and abdominal pain are the most frequently reported clinical manifestations.3 Adenosquamous carcinoma of the liver usually presents atypical imaging characteristics, which is difficult to distinguish it from liver abscess, hepatocellular carcinoma, and liver metastasis. Adenosquamous carcinoma of the liver is a highly aggressive neoplasm and the median survival time is 6 months after surgery.4 Therefore, preoperative diagnosis is of vital importance to predict a poor prognosis. Despite postoperative chemoradiation, the patient passed away 7 months after surgery.

scholarly journals Hepatic Angiosarcoma Masquerading as Hemangioma: A Challenging Differential Diagnosis

2017 ◽  
Vol 30 (10) ◽  
pp. 750
Author(s):  
Ana Rita Garcia ◽  
João Ribeiro ◽  
Helena Gervásio ◽  
Francisco Castro e Sousa
Keyword(s):  
Computed Tomography ◽  
Malignant Tumors ◽  
Palliative Radiotherapy ◽  
Abdominal Ultrasound ◽  
Gamma Glutamyl Transferase ◽  
Computed Tomography Scan ◽  
Hepatic Angiosarcoma ◽  
Imaging Characteristics ◽  
Glutamyl Transferase ◽  
Tomography Scan

Hemangiomas are usually diagnosed based on ultrasound findings. The presence of symptoms, rapid growth or atipical imagiological findings should make us consider other diagnoses, including malignant tumors such as angiosarcomas. We describe the case of a previously healthy 46-year-old female without a history of exposure to carcinogens who presented with abdominal pain for two months. Diagnostic work-up revealed elevated gamma-glutamyl transferase and lactate dehydrogenase levels. Abdominal ultrasound described a large nodular lesion in the right lobe of the liver described as a hemangioma. One month later, a computed tomography-scan was made and revealed the same lesion, which had grown from 13.5 to 20 cm, maintaining typical imaging characteristics of a hemangioma. A right hepatectomy was performed and pathology revealed an angiosarcoma. After surgery, a positron emission tomography-computed tomography scan showed hepatic and bone metastasis. The patient started taxane-based chemotherapy and lumbar palliative radiotherapy, but died 10 months after surgery. This case shows how difficult it is to diagnose hepatic angiosarcoma relying only on imaging findings. Two abdominal computed tomography -scans were performed and none suggested this diagnosis. Angiosarcoma is a very aggressive tumour with an adverse prognosis. Surgery is the only curative treatment available. However, it is rarely feasible due to unresectable disease or distant metastasis.

scholarly journals Subcutaneous calcification as a supportive radiologic finding for diagnosis of rhinofacial entomophthoromycosis

2019 ◽  
Vol 9 (2) ◽  
Author(s):  
Navarat Vatcharayothin ◽  
Pornthep Kasemsiri ◽  
Cattleya Thongrong ◽  
Chanticha Laohakittikul ◽  
Surapol Suetrong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Early Diagnosis ◽  
Clinical Manifestations ◽  
Fungal Culture ◽  
Radiologic Finding ◽  
Radiologic Findings ◽  
Appropriate Treatment ◽  
Sinonasal Mucosa ◽  
Subcutaneous Calcification ◽  
Radiologic Evidence

Rhinofacial entomophthoromycosis is an uncommon chronic fungal infection of the head and neck. The diagnosis is usually based on clinical manifestations; however, diagnosis of this infection based on early manifestations is difficult and occasionally rhinofacial entomophthoromycosis is mistaken for other diseases. Therefore, computed tomography is introduced to support the diagnosis. Radiologic findings were nonspecific with swelling of the sinonasal mucosa and perinasal region. However, subcutaneous calcification, that was observed in all our cases, may be a supportive radiologic evidence for diagnosis. The diagnosis should be confirmed definitively using histopathology or fungal culture. Early diagnosis allows prompt and appropriate treatment that will achieve excellent outcomes. We suggest that subcutaneous calcification radiologic finding may guide the aware physician to an early diagnosis of rhinofacial entomophthoromycosis.

scholarly journals Liver Transplantation in Progressive Familial Intrahepatic Cholestasis With Normal Gamma-Glutamyl Transferase: Evaluation of Post-Transplant Steatosis and Steatohepatitis

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Mohammad Hossein Anbardar ◽  
Seyed Mohsen Dehghani ◽  
Maryam Poostkar ◽  
Seyed Ali Malek-Hosseini
Keyword(s):  
Liver Transplantation ◽  
Growth Retardation ◽  
Intrahepatic Cholestasis ◽  
Clinical Manifestations ◽  
Gamma Glutamyl Transferase ◽  
Progressive Familial Intrahepatic Cholestasis ◽  
Post Transplant ◽  
End Stage Liver Disease ◽  
Glutamyl Transferase ◽  
End Stage

Background: Progressive familial intrahepatic cholestasis is a disease presenting with severe cholestasis and progressing to the end-stage liver disease later. Liver transplantation is a treatment modality available for progressive familial intrahepatic cholestasis, especially in patients with end-stage liver disease or those who are unsuitable for or have failed biliary diversion. Objectives: To evaluate clinical and pathological characteristics of progressive familial intrahepatic cholestasis patients who had undergone liver transplantation and to determine post-transplant steatosis and steatohepatitis. Methods: We evaluated 111 progressive familial intrahepatic cholestasis patients with normal gamma-glutamyl transferase that performed liver transplantation in Shiraz Transplant Center in Iran between March 2000 and March 2017. Results: The most common clinical manifestations were jaundice and pruritus. Growth retardation and diarrhea were detected in 76.6% and 42.5% of the patients. After transplantation, growth retardation was seen in 31.5% of the patients, and diarrhea in 36.9% of them. Besides, 29.1% of the patients died post-transplant. Post-transplant liver biopsies were taken from 50 patients, and 15 (30%) patients had steatosis or steatohepatitis, five of whom (10%) had macro-vesicular steatosis alone, and 10 (20%) had steatohepatitis. Only one patient showed moderate bridging fibrosis (stage III), and none of them showed severe fibrosis. Conclusions: Liver transplantation is the final treatment option for these patients, and it can relieve most clinical manifestations. However, post-transplant mortality rate was relatively high in our center. Diarrhea, growth retardation, and steatosis are unique post-transplant complications in these patients. The rate of post-transplant steatosis and steatohepatitis in patients with liver biopsy in our study was 30%, with a significant difference from previous studies.

scholarly journals Alcohol state markers- facility and utility for clinical management of alcohol use disorders: study from a tertiary care centre in South India

2021 ◽  
Vol 9 (10) ◽  
pp. 3105
Author(s):  
Liji M. J. ◽  
P. R. Varghese ◽  
Susheela Jacob Innah ◽  
Praveenlal Kuttichira
Keyword(s):  
Alcohol Use ◽  
Clinical Management ◽  
Tertiary Care ◽  
Alcohol Use Disorders ◽  
Clinical Manifestations ◽  
Gamma Glutamyl Transferase ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Alcohol Biomarker ◽  
Glutamyl Transferase

Background: Alcoholism is broadly any drinking of alcohol resulting in significant psychological and physiological health problems. As alcoholism is not a recognized diagnostic entity the detection and monitoring of the clinical manifestations of alcoholism is of great importance in the alcohol use disorders (AUD) treatment. Hence, the use of alcohol biomarkers plays a vital role in the diagnosis, treatment and prognosis of AUDs.Methods: This study aimed to understand the utility of state markers in alcohol related distress, both for diagnosis and prognosis in a tertiary care centre. The relative number and the frequency of the alcohol biomarker tests such as AST (aspartate aminotransferase), ALT (alanine aminotransferase), MCV (mean corpuscular volume) and GGT (gamma-glutamyl transferase) investigated in the hospital departments (32 departments) were collected. Test requests and results in January to March on five consecutive years from 2016 to 2020 were analyzed, by comparing psychiatry department with all other departments and AUD with non-AUD cases.Results: The study findings revealed that, the tests AST, ALT and MCV were well utilized for the AUD treatment procedure in the tertiary care centre, irrespective of the department the patient got admitted. Since GGT was the least preferred test, the figures of GGT could not be analysed because of the exceptionally low number.Conclusions: The utility of the commonly available alcohol biomarker tests is especially useful for the clinical management of AUD patients and these are well utilized in an appreciable manner in the study centre. Development of more accurate, specific, and sensitive panel of biomarker tests may further motivate clinicians to better monitor individuals who suffer from alcoholism.

scholarly journals FGF-21 LEVELS AND LIVER INFLAMMATORY BIOMARKERS IN OBESE SUBJECTS AFTER WEIGHT LOSS.

2021 ◽  
Author(s):  
Irene Cantero ◽  
Itziar Abete ◽  
Vanesa Bullon-Vela ◽  
Ana Belen Crujeiras ◽  
F.Felipe Casanueva ◽  
...  
Keyword(s):  
Weight Loss ◽  
Plasminogen Activator Inhibitor ◽  
Nutritional Intervention ◽  
Energy Restriction ◽  
Fibroblast Growth Factor 21 ◽  
Gamma Glutamyl Transferase ◽  
Plasminogen Activator Inhibitor 1 ◽  
Potential Biomarker ◽  
Set Up ◽  
Glutamyl Transferase

IntroductionPrevious studies have hypothesized Fibroblast growth factor 21 (FGF-21) as a potential biomarker of the inflammation associated to liver diseases, which is also receiving high attention for its potential application concerning the management of obesity and co-morbidities. This study aimed to analyze the response of FGF-21 after a weight loss intervention and the relationships with other putative inflammatory liver biomarkers.Material and methodsSixty-six obese participants from the RESMENA study were evaluated at baseline and after following a 6-months energy restriction treatment. Anthropometrical, body composition by DXA, routine laboratory measurements, which included transaminases and gamma-glutamyl transferase (GGT) were analyzed by standardized methods. Moreover, FGF-21, M30-fragment (M30) and plasminogen activator inhibitor-1 (PAI-I) were analyzed as recognized liver inflammatory related biomarkers with specific ELISA Kits.ResultsMost measurements related with hepatic damage, inflammation and adiposity status improved at the end of the 6-months nutritional intervention. In addition, ΔFGF-21 shifts evidenced statistical relationships with changes in ΔM30, ΔGGT and ΔPAI. The reduction of M30 showed significant associations with changes in transaminases. Furthermore, PAI-I changes were related with ΔM30 and ΔGGT regardless of weight loss. A linear regression model was set up to assess the influence of ΔPAI-I and ΔM30 on the variability of ΔFGF-21 (23.8%) adjusted by weight loss.ConclusionsThese results evidenced interactions of some liver inflammatory mediators, specifically M30 and PAI-I with FGF-21. Thus, more investigation about FGF-21 is required given that this protein could be a biomarker of the obesity-inflammation-liver process.

scholarly journals Clinical and Laboratory Findings of Lead Hepatotoxicity in the Workers of a Car Battery Manufacturing Factory

2016 ◽  
Vol 10 (2) ◽  
pp. 1-6
Author(s):  
Bita Dadpour ◽  
◽  
Reza Afshari ◽  
Seyed Reza Mousavi ◽  
Sina Kianoush ◽  
...  
Keyword(s):  
Liver Function ◽  
Liver Toxicity ◽  
Lead Concentration ◽  
Serum Alkaline Phosphatase ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Liver Function Tests ◽  
Gamma Glutamyl Transferase ◽  
Function Tests ◽  
Glutamyl Transferase

Background: Occupational lead poisoning is common in workers of some industries, but lead hepatotoxicity has rarely been reported. Several animal studies have revealed lead induced liver damage but clinical studies concerning the manifestations of lead induced liver toxicity in humans are scares. This study was designed to investigate the clinical manifestations and pathological parameters of hepatic dysfunction and its relationship with blood and urine lead concentrations in a car battery-manufacturing workers. Methods: This cross sectional study was carried out in Mashhad, Iran, during April-June 2011. One hundred and twelve workers underwent blood and urine sampling for determination of lead concentrations and liver function tests. Clinical signs and symptoms of possible lead hepatotoxicity were investigated. Results: Mean (±SD) age of the workers was 28.78 (±5.17) yr with a daytime work of 8.67 (±1.41) h and mean work duration of 3.89 (±2.40) yr. Mean blood lead concentration (BLC) and urine lead concentration (ULC) were 398.95 (±177.41) µg/l and 83.67(±50) μg/l, respectively. We found no correlation between the clinical findings and BLC or ULC. A weak correlation (R: 0.27, P=0.087) between serum alkaline phosphatase concentration and BLC was obtained. No significant relationship was found between other liver function tests and BLC or ULC. Conclusion: We found no specific clinical and laboratory abnormalities of liver in the workers of car battery manufacturer who had chronic lead toxicity. Further investigations with more specific laboratory tests such as LDH5 and gamma glutamyl transferase (GGT) as well as novel biomarkers of metal induced hepatotoxicity might be helpful in evaluating lead hepatotoxicity.

scholarly journals Primary hepatic tuberculosis mimicking malignancy

2019 ◽  
Vol 6 (9) ◽  
pp. 3078
Author(s):  
Murat Akıcı ◽  
Erhan Bozkurt ◽  
Çiğdem Özdemir ◽  
Furkan Kaya
Keyword(s):  
Weight Loss ◽  
Differential Diagnosis ◽  
Granulomatous Inflammation ◽  
Gamma Glutamyl Transferase ◽  
Health Issues ◽  
Endemic Region ◽  
Developing Regions ◽  
Hepatic Tuberculosis ◽  
High Prevalence ◽  
Glutamyl Transferase

Background: One of the most serious health issues in developing regions is tuberculosis (TB), which has high prevalence worldwide. We aimed to investigate 6 cases of primary hepatic tuberculosis that mimics malignancy and to emphasize that differential diagnosis should be considered in Turkey, which is still an endemic region for tuberculosis.Methods: Data of 14 patients who were diagnosed with primary hepatic tuberculosis between January 2008 and January 2018 were retrospectively evaluated.Results: There were 11 females and 3 males among the cases with an average age of 51.3 years old. The most frequent presentations were the upper right quadrant pain and weight loss. Although laboratory values of 12 patients were normal, isolated gamma-glutamyl transferase (GGT) height was found in 2 patients. Granulomatous inflammation was diagnosed with applying percutaneous needle biopsy in 12 patients and laparoscopic liver biopsy in 2 patients. Tissue culture was positive in 2 patients. No recurrence was detected in any of the patients after medical treatment.Conclusions: When abdominal pain, fever, weight loss complaints, and malignancy-like masses in liver are detected during the differential diagnosis of patients who live in endemic areas such as Turkey; hepatic tuberculosis should be considered as a diagnosis.

scholarly journals Metastatic Renal Cell Carcinoma Presenting as Prolonged Pyrexia and Stauffer’s Syndrome: Can a Routine Ultrasound Scan Fail to Detect a Renal Cell Carcinoma?

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
C. L. Fonseka ◽  
A. G. T. A. Kariyawasam ◽  
S. A. G. L. Singhapura ◽  
C. M. de Silva ◽  
T. E. Kanakkahewa ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Weight Loss ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Lung Metastases ◽  
Gamma Glutamyl Transferase ◽  
Ultrasound Scan ◽  
Glutamyl Transferase ◽  
Contrast Ct ◽  
Metastatic Rcc

Background. Prolonged pyrexia and weight loss are recognised paraneoplastic manifestations of renal cell carcinoma (RCC). Stauffer’s syndrome is a rarely described paraneoplastic manifestation, which is described early in the course of RCC. We report a patient who presented with unresolving fever with multiple pulmonary opacities with biochemical evidence of hepatic choleastasis and was later diagnosed to have metastatic RCC with Stauffer’s syndrome. Case Presentation. We report a 54-year-old female who was investigated for a poorly resolving fever and recent weight loss for two months. During her course of illness, she developed bilateral multiple opacifications in the chest radiograph with negative pyogenic, mycobacterial microbiological studies. Despite intravenous antibiotics, her fever continued. She was found to have elevated alkaline phosphatase and gamma-glutamyl transferase and she underwent imaging with ultrasound scan of abdomen twice, which did not reveal demonstrable abnormalities. Later, contrast CT of abdomen and chest was performed and detected a renal cell carcinoma of the right upper pole of the kidney with multiple lung metastases, which was concluded as a metastatic RCC with paraneoplastic Stauffer’s syndrome. Conclusion. Prolonged pyrexia with loss of weight and Stauffer’s syndrome could be features to suggest renal cell carcinoma in the absence of positive microbiological studies. Isoechoic RCC could be missed in routine ultrasonography. When a RCC is suspected in the setting of a pyrexia of unknown origin, ultrasound with doppler or a contrast CT should be requested to aid diagnosis.

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