ABSTRACT
Introduction: The diagnosis of space occupying lesions of liver is always a challenge especially when the lesions are multifocal in location. Imaging modalities, serum markers and pathological investigations will definitely help in arriving at a specific diagnosis for appropriate patient management and prognosis. Aim: The aim of the current study is to know the importance of various imaging modalities in diagnosing the space occupying lesions of liver and to find an association of Radiological with Pathological diagnosis and serum markers. Materials and methods: This retrospective study was performed over period of one year. Clinically suspicious cases for malignancy were assessed by the imaging modalities such as Ultrasonography (USG), Computed Tomography (CT) or Magnetic Resonance Imaging(MRI). Further Radiologically confirmed cases were subjected for Fine needle aspiration (FNA)/biopsy under the USG guidance, while serum markers were retrieved from laboratory investigation archives. Association of Radiological and Pathological diagnosis with serum markers was performed and analyzed. Results: The study was conducted on 70 cases of hepatic lesion. Male to female ratio was 1.5:1 with mean age of 54.47±1.5. Most of cases were diagnosed with MDCT scan. About 95.7% cases were malignancy of which 13.4% were HCC. Among malignant cases, metastatic lesions were more prevalent which were mostly adenocarcinoma. Radiological and pathological diagnosis found to have significant association, only few cases showed the discrepancies. Serum AFP was found to have high levels in 7 cases of HCC, while other 2 HCC cases and metastatic lesions were within normal range. Conclusion: The diagnostic accuracy of hepatic lesion enhances with utility of radiological patterns in conjunction with pathological diagnosis and serum markers. Association of radiological and pathological findings found to have statically significant value in the current study.
ABSTRACT
Background: The liver is a common site for primary and secondary tumors; most often from malignant tumors within the abdomen and from extra-abdominal primary malignant neoplasm, but also for sarcomas and lymphomas. The main indication of fine-needle aspiration cytology (FNAC) of the liver is diagnosis of single or multiple space occupying lesions. This study aims to evaluate the cyto-morphology of primary and secondary neoplasms of liver and non-neoplastic conditions in the smears of ultrasound guided fine needle aspiration of SOL of liver, to evaluate the cytomorphologic features and to evaluate the erroneous diagnosis when compared with cell block preparation of aspirate (tissue diagnosis).Methods: This study is hospital-based prospective study including 57 patients with space occupying lesion of the liver mass. FNAC were carried out under the guidance of sonography and/or computed tomography. The staining performed were conventional for smears of the aspirate. The cell blocks were prepared from the aspirates by the established procedures. The values of correlation were bought out.Results: Males predominated over females. The distribution of cases for cyto-diagnosis were as follows; cirrhosis with hepatic granulosa (3 cases),pyogenic abscess (3 cases), hepatic adenoma (2 cases), Focal nodular hyperplasia (2 cases), hepatoblastoma (1 case), hepatocellular carcinoma (17 cases), adenocarcinoma deposits (20 cases), deposits of small cell carcinoma (3 cases), deposits of ductal carcinoma (2 cases) and 1 case each of deposits of squamous cell carcinoma, non-Hodgkin’s lymphoma, neuroendocrine tumor and adeno-squamous carcinoma. Values of correlation were as follows: sensitivity 97.61%, specificity 100%, PPV 100%, NPV 97.82% and diagnostic accuracy of 98.85%.Conclusions: FNAC is concluded to be first rank diagnostic procedure in diagnosis of SOL of liver of varied etiology with high values of NPV and PPV. It is also concluded that it helps in staging of metastatic malignancies.
ABSTRACT
Background: Differentiation of hepatocellular carcinoma (HCC) from metastatic malignancy in liver may be difficult at times on fine-needle aspiration cytology, especially in case of moderate-to-poorly differentiated tumors. The benefit of cell-block technique is the recognition of histologic pattern of diseases along with application of a wide variety of immunohistochemical (IHC) stains to differentiate hepatic malignancies. In this study, CD10 IHC staining was done on cellblocks prepared from aspirates of clinicoradiologically/cytologically suspected malignant liver neoplasms to differentiate HCC from malignancies metastasizing to liver. Objective: The objective of the study was to assess the diagnostic utility of CD10 IHC stain on cell-block preparation for differentiating primary from Secondary malignancies of liver. Materials and Methods: Formalin-fixed, paraffin-embedded cellblocks of 61 cases (25 cases of HCC and 36 cases of metastatic carcinoma) were prepared from a fine-needle aspirate of the suspected malignant liver neoplasm and immunostained using monoclonal antibody against CD10. Results: Twenty-two (88%) of 25 cases of HCC were positive for CD10 with a canalicular staining pattern. Two (8%) were positive for CD10 with membranous and one (4%) with cytoplasmic staining pattern. Conclusion: CD10 immunostaining on cellblock is useful in discriminating HCC and metastatic carcinoma of the liver with a diagnostic accuracy of 88.52%.
ABSTRACT
Spontaneous venous thrombosis developing in the internal jugular vein is very unusual. The common causes usually include intravenous drug abuse, jugular vein catheterization, neck dissection, a hypercoagulable state associated with malignancies, neck injury or ovarian overstimulation syndrome. A 30-year-old woman with no remarkable past medical history visited our outpatient office due to neck swelling with pain. She underwent CT scan, Doppler sonogram and fine needle aspiration biopsy. We could confirm metastatic lymphadenopathy and internal jugular vein thrombosis. We present here the case of internal jugular vein thrombosis associated with metastatic malignancy.