Case Report: Review of CT Findings and Histopathological Characteristics of Primary Liver Carcinosarcoma

Objectives: The aim of the present study was to describe the computed tomography (CT) characteristics of primary liver carcinosarcoma (PLCS) and to explore the pathological basis for the diagnosis of primary hepatocellular carcinoma sarcoma.Methods: Three male patients with PLCS were included in the present retrospective research, and the age was ranged from 52 to 63 years. The plain CT scan and third-stage enhancement scan were performed on patients. The pathological characteristics were analyzed. Stomachache was the main clinical symptoms of the three patients. Cirrhosis background was confirmed in one patients, and chronic Hepatitis B background was confirmed in other two patients.Results: According to the results of CT, the inner diameter of the tumors ranged from 8.6 to 27.0 cm. The fibrous pseudocapsule around the tumor tissues was observed in two patients. Tumor tissues from all three patients were composed of sarcomatous and carcinomatous components. For carcinomatous components, hepatocellular carcinoma was observed in one patient and cholangiocarcinoma was observed in the other two patients. For sarcomatous components, angiosarcoma was observed in two patients and malignant fibrous histiocytoma was observed in another one patient. The tumor tissues were visualized as heterogeneous low density with large sheets of necrotic cystic lesions or thick-walled areas of multilocular cystic lesions using the plain CT scan. Edge-to-center filling and strengthening lesions, mild to moderate enhanced parenchyma at the arterial phase, and isodensity between the tumor parenchyma and the surrounding liver parenchyma at the portal vein phase or delayed phase were observed using the third-stage enhancement scan.Conclusions: CT characteristics observed in the present study were of great benefit for the diagnosis of PLCS.

Download Full-text

Hepatocellular Carcinoma: Diagnosis and Surveillance

10.5772/intechopen.99839 ◽

2021 ◽

Author(s):

Aditya Kale

Keyword(s):

Hepatocellular Carcinoma ◽

Clinical Symptoms ◽

Risk Groups ◽

Liver Parenchyma ◽

Arterial Phase ◽

Imaging Features ◽

Tumor Biopsy ◽

Mri Contrast ◽

Surveillance Programs ◽

Regenerative Nodules

Hepatocellular carcinoma arises commonly on the background of liver cirrhosis. Patients presenting with clinical symptoms have advanced stage and often are unsuitable for curative therapies. Diagnosis of hepatocellular carcinoma is commonly performed by multiphase computed tomography (CT) and / or magnetic resonance imag¬ing scans (MRI). Contrast enhanced ultrasound and MRI with hepatobiliary contrast agents are better in characterizing small lesions. Tumor markers play an adjunct role in diagnosis. For HCC in cirrhotic liver biopsy is seldom required and diagnosis is based on typical imaging features of non-rim arterial phase hyperenhancement and washout on delayed phase and pseudocapsule appearance. This is due to differential blood supply of liver parenchyma, regenerative nodules and tumor. Biopsy is only required in noncirrhotic liver, vascular liver diseases, atypical imaging features. Surveillance programs involving high risk groups can help in early detection of lesions which are amenable for curative therapies. Biannual ultrasound with or without alfa fetoprotein are commonly used surveillance tests. Multidisciplinary teams provide platform for care coordination, reassessments of clinical course, and fine changes in treatment plans required for management of this complex group of patients.

Download Full-text

Contrast-Enhanced Ultrasound to Monitor Early Recurrence of Primary Hepatocellular Carcinoma after Curative Treatment

BioMed Research International ◽

10.1155/2018/8910562 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Lian-Feng Liu ◽

Zhan-Ling Ding ◽

Jian-Hong Zhong ◽

Hong-Xue Li ◽

Jun-Jie Liu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Recurrent Disease ◽

Intrahepatic Recurrence ◽

Primary Hepatocellular Carcinoma ◽

Curative Treatment ◽

Arterial Phase ◽

Contrast Enhanced Ultrasound ◽

Enhancement Pattern ◽

Recurrent Hepatocellular Carcinoma ◽

Contrast Enhanced

Objective. To evaluate contrast-enhanced ultrasound (CEUS) for monitoring early intrahepatic recurrence of primary hepatocellular carcinoma (HCC) after curative treatment. Methods. We prospectively analyzed 97 patients (124 nodules) with primary HCC who underwent hepatic resection or radiofrequency ablation and subsequently experienced intrahepatic recurrence. Patients were assessed with conventional ultrasound and CEUS. They were also assessed with contrast-enhanced computed tomography (CECT) and/or magnetic resonance imaging (MRI). The image characteristics of CEUS of recurrent hepatocellular carcinoma and high-grade dysplastic nodules (HGDNs) were analyzed. In addition, the ability of CEUS and CECT/MRI to assess internal artery vascularization in recurrent disease was compared. Results. CEUS of recurrent hepatocellular carcinoma showed hyperenhancement in the arterial phase in 96 of 99 nodules, and it showed hypo- or isoenhancement for portal venous and delayed phases. The most common enhancement patterns were “fast-in and slow-out” and “fast-in and fast-out”. Based on the arterial hyperenhancement of lesions and with clinical data such as patient history of HCC and increased level of serum alpha-fetoprotein, the diagnostic accuracy of CEUS for recurrent HCC was significantly higher than that based on the enhancement pattern of “fast-in and fast-out”. CEUS of HGDNs showed local or global hyperenhancement during the arterial phase, isoenhancement during the portal venous phase, and isoenhancement or slight hypoenhancement during the delayed phase. The enhancement pattern was “fast-in and slow-out”. In some cases, it was difficult to differentiate HGDNs from recurrent disease using CEUS. Vascularization in recurrent disease was significantly higher when assessed by CEUS than when assessed with CECT/MRI (P < 0.05). For detecting recurrent disease, CEUS showed sensitivity of 97.0%, specificity of 68.0%, positive predictive value of 92.3%, and negative predictive value of 85.0%. The corresponding parameters for CECT/MRI were 71.7%, 72.0%, 88.8%, and 39.1%. Conclusion. Intrahepatic recurrent HCC and HGDNs with diameter ≤ 3.0 cm have a characteristic appearance on CEUS. This imaging modality may be effective for monitoring early intrahepatic recurrence after curative treatment of primary HCC.

Download Full-text

Delayed response to proton beam treatment of hepatocellular carcinoma

BJR|case reports ◽

10.1259/bjrcr.20180125 ◽

2020 ◽

Vol 6 (1) ◽

pp. 20180125

Author(s):

Chee-Wai Cheng ◽

Mitchell Machtay ◽

Jennifer Dorth ◽

Olga Sergeeva ◽

Hangsheng Xia ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Ct Scan ◽

Proton Beam ◽

Arterial Phase ◽

Delayed Response ◽

Data Set ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

Imaging Response

Hepatocellular carcinoma (HCC) has become one of the leading causes of cancer death worldwide. There has been anecdotal report regarding the effectiveness of proton beam treatment for HCC. In this pre-clinical investigation, the woodchuck model of viral hepatitis infection-induced HCC was used for proton beam treatment experiment. The radiopaque fiducial markers that are biodegradable were injected around the tumor under ultrasound guidance to facilitate positioning in sequential treatments. An α cradle mode was used to ensure reproducibility of animal positioning on the treatment couch. A CT scan was performed first for contouring by a radiation oncologist. The CT data set with contours was then exported for dose planning. Three fractionations, each 750 CcGyE, were applied every other day with a Mevion S250 passive scattering proton therapy system. Multiphase contrast-enhanced CT scans were performed after the treatment and at later times for follow-ups. 3 weeks post-treatment, shrinking of the HCC nodule was detected and constituted to a partial response (30% reduction along the long axis). By week nine after treatment, the nodule disappeared during the arterial phase of multiphase contrast-enhanced CT scan. Pathological evaluation corroborated with this imaging response. A delayed, but complete imaging response to proton beam treatment applied to HCC was achieved with this unique and clinically relevant animal model of HCC.

Download Full-text

An Individually Optimized Protocol of Contrast Medium Injection in Enhanced CT Scan for Liver Imaging

Contrast Media & Molecular Imaging ◽

10.1155/2017/7350429 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Shi-Ting Feng ◽

Hongzhang Zhu ◽

Zhenpeng Peng ◽

Li Huang ◽

Zhi Dong ◽

...

Keyword(s):

Ct Scan ◽

Contrast Medium ◽

Liver Parenchyma ◽

Arterial Phase ◽

Liver Imaging ◽

Liver Ct ◽

Enhanced Ct ◽

Contrast Medium Injection ◽

Injection Protocol ◽

Medium Dose

Objective. To investigate the effectiveness of a new individualized contrast medium injection protocol for enhanced liver CT scan. Methods. 324 patients who underwent plain and dual phase enhanced liver CT were randomly assigned to 2 groups: G1 (n=224, individualized contrast medium injection protocol); G2 (n=100, standard contrast medium injection with a dose of 1.5 ml/kg). CT values and ΔHU (CT values difference between plain and enhanced CT) of liver parenchyma and tumor-liver contrast (TLC) during hepatic arterial phase (HAP) and portal venous phase (PVP) and contrast medium dose were measured. The tumor conspicuity of hepatocellular carcinoma (HCC) between two groups was independently evaluated by two radiologists. Results. The mean contrast medium dose of G1 was statistically lower than that of G2. There were no significantly statistical differences in CT values and ΔHU of liver parenchyma during HAP, TLC values during HAP, and PVP between two groups. The CT values and ΔHU of liver parenchyma during PVP of G2 were significantly higher than those of G1. Two independent radiologists were both in substantial conformity in grading tumor conspicuity. Conclusion. Using the individually optimized injection protocol might reduce contrast medium dose without impacting on the imaging quality in enhanced liver CT.

Download Full-text

Diagnostic Challenges in Primary Hepatocellular Carcinoma: Case Reports and Review of the Literature

Case Reports in Oncological Medicine ◽

10.1155/2015/878763 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5

Author(s):

Monika Pazgan-Simon ◽

Sylwia Serafinska ◽

Justyna Janocha-Litwin ◽

Krzysztof Simon ◽

Jolanta Zuwala-Jagiello

Keyword(s):

Hepatocellular Carcinoma ◽

Case Reports ◽

Primary Hepatocellular Carcinoma ◽

Diagnostic Process ◽

Arterial Phase ◽

Test Results ◽

Contrast Enhanced ◽

Diagnostic Standards ◽

Venous Phase

Hepatocellular carcinoma is the fifth most common malignancy and the third leading mortality cause worldwide. It typically develops secondarily to liver cirrhosis, due to hepatitis B or C infection, alcohol abuse, metabolic disease, and so forth. According to the American Association for the Study of Liver Diseases (AASLD) guidelines, which constitute diagnostic standards, the diagnosis of primary hepatocellular carcinoma (HCC) should be based on contrast-enhanced imaging. Lesion hyperenhancement should be observed throughout the arterial phase, followed by the washout during the venous phase. The diagnosis can also be based on the histopathological evaluation of liver biopsy specimen. Although the standards are clear, we often see patients with advanced HCC in clinical practice, who cannot be offered any effective treatment. Patients with chronic liver disease, presenting with inconclusive and changeable test results, constitute a separate problem. In such cases the diagnostic process is typically long-term and delayed. In this paper we present three case reports where the diagnosis could not be made promptly and the patients died as a result of a delayed diagnostic process.

Download Full-text