Discrete Hypoechoic Ring in Hepatic Cavernous Hemangioma Resembling a Malignant Tumor: Correlation with Histologic Features

Differential diagnoses of hepatic nodules include hepatocellular carcinoma, focal nodular hyperplasia, hepatic adenoma, regenerative nodule, focal fatty changes, and hemangioma. However, differentiation of these nodules can often be difficult. Hemangiomas are frequently encountered during ultrasonogram incidentally and can be diagnosed easily because they have an almost distinctive sonographic appearance: a homogeneous hyperechogenicity and discrete posterior acoustic enhancement. They also sometimes have atypical findings, for example an internal echogenicity including hypoechogenicity, heterogeneous echogenicity, hyperechoic rim, central hypoechogenicity due to various changes (e.g., internal hemorrhage, necrosis, thrombosis, myxomatous change, and fibrosis), and (rarely) calcification. We report herein the case of an atypical hemangioma presenting with a hypoechoic peripheral ring, mimicking a hepatic malignancy. To our knowledge, there have been no other reports demonstrating a cavernous hemangioma with a discrete hypoechoic ring and without a pseudocapsule.

Cryosurgery of Hepatic Malignancy: Is Cryosurgery Appropriate Treatment for hepatic malignancies?

PURPOSE: Hepatic resection has proven to be an effective treatment for primary and secondary malignant hepatic tumors, but the majority of patients cannot be treated with resection. Candidates for cryosurgery are patients who are considered unresectable, but who have no evidence of disease outside the liver. The purpose of cryosurgery is to destroy all present tumors (including a margin of healthy tissue) by freezing them. The purpose of this study was to evaluate clinical outcomes after cryosurgery for hepatic malignancies. METHODS: Freezing is performed using high pressure argon or liquid nitrogen and utilizing the Joule-Thomson effect. Two freeze-thaw cycles performed at each location have been previously documented to increase tissue destruction. Mechanisms of freezing-induced cellular destruction include intracellular and extracellular ice crystal formation, cell membrane damage, cellular dehydration, ischemic damage from thrombosed vessels, and apoptosis. Cryosurgery is performed through open placement of cryoprobes in the tumor, using laparoscopic and percutaneous approaches. The cryosurgery procedure is usually monitored with ultrasonography, computed tomography, and magnetic resonance imaging. RESULTS: Hepatic cryosurgery was performed in 6 patients (follow-up period more than 1 year) at our hospital. We noted no local tumor recurrence, and we achieved effective treatment of hepatic malignancies. CONCLUSION: Hepatic cryosurgery is increasingly recognized as a safe and effective treatment modality for nonresectable patients, or as a modality to be used in conjunction with liver resection.

Actual Half-Life of Alpha-Fetoprotein as a Prognostic Tool in Pediatric Malignant Tumors

In a retrospective study, the prognostic value of monitoring the decay of alpha-fetoprotein (AFP) was assessed. Serum AFP was determined serially in 18 children with malignant germ cell tumors or malignant hepatic tumors: Fifteen children had malignant germ cell tumors (endodermal sinus tumor;7, embryonal carcinoma;3, malignant teratoma;5). Two children had hepatoblastoma and a third had hepatocellular carcinoma. The actual half-life (AHL) of AFP was computed according to the formula after the surgical resection of the tumor. In group 1, which had a complete resection and no recurrence during follow-up (n=13), the AHL of AFP was 4.0+/-0.9 days. In group 2, which had a incomplete resection or recurrence during follow-up (n=5), the AHL of AFP was 24.8+/-20 days. The AHL of group 2 was significantly longer than that of group 1 (p = 0.0026). The increased AHL of AFP indicated the residual active tumor after surgical resection. The AHL of AFP may be more sensitive than the serial monitoring of AFP in detecting the preclinical recurrence after surgical resection of AFP secreting tumors. Treatment strategies can be based on AFP clearance and prospective clinical trials are warranted.