Primary hepatic neoplasms in cattle / Neoplasmas hepáticos primários de bovinos

Primary hepatic neoplasms are mostly detected in cattle as incidental findings in slaughterhouses or diagnosed at the necropsy, wherein it may be related to the cause of death. A proper characterization of primary hepatic neoplasms is essential to provide an accurate diagnosis, especially at the slaughter lines, in order to reduce erroneous condemnations. This work aimed to characterize the gross, histological, and immunohistochemical features of primary liver neoplasms detected in slaughtered cattle in Southern Brazil. Nineteen primary hepatic neoplasms were identified. Grossly, these lesions were classified according to their distribution, as focal, multifocal, or diffuse. Histologically, the shape and arrangement of the cells, as well as possible malignant features were evaluated. Immunohistochemistry (IHC) was also performed for biliary epithelium (anti-CK7) and hepatocytes (anti-Hep Par-1) markers. Hepatocellular carcinoma (84.2%) was the most frequently detected hepatic neoplasm, followed by cholangiocarcinoma (15.8%), and these were only identified in adult cows. Hepatocellular carcinomas occurred as solitary masses or multifocal nodules, which on the cut surface were often green. Cholangiocarcinomas occurred as multifocal nodules, occasionally showing an umbilicated appearance. Histologically, hepatocellular carcinomas had mostly trabecular and solid patterns, while cholangiocarcinomas presented mostly a solid arrangement. Upon IHC, all hepatocellular carcinomas were immunolabeled for anti-Hep Par-1, ranging from mild (25%), moderate (31.2%) to marked (43.7%), while immunolabeling for anti-CK7 was detected only in one case of cholangiocarcinoma.(AU)

Os neoplasmas hepáticos primários são detectados em bovinos principalmente como achados incidentais em matadouros ou diagnosticados na necropsia, quando podem estar relacionados à causa da morte. A caracterização adequada dos tumores hepáticos primários é essencial para obter diagnósticos precisos, especialmente nas linhas de abate, com o propósito de reduzir condenações errôneas. Este trabalho teve o objetivo de determinar as características macroscópicas, histológicas e imuno-histoquímicas dos neoplasmas primários do fígado de bovinos abatidos em um matadouro-frigorífico no Sul do Brasil. Dezenove neoplasias hepáticas primárias foram identificadas. Macroscopicamente, os tumores hepáticos foram classificados de acordo com sua distribuição, como focais, multifocais ou difusos. Histologicamente, a forma e o arranjo das células e possíveis características malignas foram avaliados. Também foi realizada imuno-histoquímica (IHQ) para marcadores de epitélio biliar (anti-CK7) e hepatócitos (anti-Hep Par-1). O carcinoma hepatocelular (84,2%) foi o neoplasma hepático mais frequentemente detectado, seguido pelo colangiocarcinoma (15,8%). Esses tumores foram identificados apenas em vacas adultas. Os carcinomas hepatocelulares eram vistos como massas solitárias ou nódulos multifocais que na superfície de corte geralmente eram esverdeados. Os colangiocarcinomas foram observados como nódulos multifocais, ocasionalmente com aspecto umbilicado. Histologicamente, os padrões mais observados nos carcinomas hepatocelulares foram trabeculares e sólidos, enquanto nos colangiocarcinomas o arranjo sólido foi o mais frequente. Na IHQ, todos os carcinomas hepatocelulares foram marcados por anti-Hep Par-1, com marcação que variou de leve (25%), moderada (31,2%) a acentuada (43,7%); imunomarcação para anti-CK7 foi detectada em apenas um caso de colangiocarcinoma.(AU)

Recent Advances in the Image-Guided Tumor Ablation of Liver Malignancies: Radiofrequency Ablation with Multiple Electrodes, Real-Time Multimodality Fusion Imaging, and New Energy Sources

Radiofrequency ablation (RFA) has emerged as an effective loco-regional treatment modality for malignant hepatic tumors. Indeed, studies have demonstrated that RFA of early stage hepatocellular carcinomas can provide comparable overall survival to surgical resection. However, the incidence of local tumor progression (LTP) after RFA is significantly higher than that of surgical resection. Thus, to overcome this limitation, multiple electrode radiofrequency (RF) systems that use a multi-channel RF generator have been developed, and they demonstrate better efficiency in creating larger ablation zones than that using the conventional RFA with a single electrode. Furthermore, RFA with multiple electrodes can allow the “no-touch” ablation technique which may also help to reduce LTP. Another technique that would be helpful in this regard is multi-modality-ultrasound fusion imaging, which helps to not only more accurately determine the target lesion by enabling the RFA of small, poorly visible or invisible tumors, but also improve the monitoring of procedures and determine the appropriateness of the ablation margin. In addition, new energy sources, including microwave and cryoablation, have been introduced in imaging-guided tumor ablation. In this review, these recently introduced ablation techniques and the results of the most current animal and clinical studies are discussed.

Imaging features of hepatic epithelioid angiomyolipomas on real-time contrast-enhanced ultrasound / 中华超声影像学杂志

Objective To evaluate the imaging features of hepatic epithelioid angiomyolipoma (EAML) on contrast-enhanced ultrasound (CEUS). Methods The imaging features of pathologically proved hepatic EAML lesions in 17 patients who had undergone baseline ultrasound and CEUS examinations were evaluated retrospectively. Results All of the cases were single lesion.70.6% (12/17) of the lesions were hypoechoic on ultrasound and 82.4% (14/17) of the lesions were heterogeneous.Flow signals were detected in 88.2% (15/17) of the lesions and 82.4% (14/17) of the lesions showed ringlike or arc arterials peripherally on color Doppler flow imaging (CDFI).The value of RI was 0.38-0.56.On CEUS,all lesions exhibited remarkable hyperenhancement in the arterial phase. 29.4% (5/17) of the lesions showed branched enhancement,70.6% (12/17) of the lesions showed diffusely entire enhancement.Strong ring-like enhancement peripherally was detected in 29.4% (5/17) of the lesions.88.2% (15/17) of the lesions were detected homogeneously enhancement during the peak period on CEUS. Washout of contrast agent and hypoechogenicity to surrounding liver tissue during portal or late phase were observed in 41.2% (7/17) and 64.7% (11/17) of the cases retrospectively.Conclusions The combination of real-time CEUS and baseline US can improve the correct diagnosis of hepatic EAML.

Tumor fibroso solitario del lóbulo caudado del hígado / Solitary fibrous tumor of the liver caudate lobe

Introduction: Solitary fibrous tumor of the liver (SFTL) constitutes such a rare finding that it has been published only as case reports and to the present date there are only 45 cases published in English medical literature. This article describes the case of a patient treated at our institution with SFTL. Case report: A male 59-years-old patient was diagnosed with a SFTL incidentally found in a computed abdominal tomography taken by another causes, tumor was originating from the caudate lobe. The patient was asymptomatic. At surgery, the tumor was observed originating directly from the caudate lobe through a pedicle measuring approximately 3 cm. The tumor was resected sectioning its implantation pedicle and ligating all arterial, venous and biliary vessels. The SFTL was well encapsulated, measured 15 x 9 x 6 cm and weighted 794 g. The histological diagnosis was a SFTL and was confirmed by immunohistochemistry with monoclonal antibodies that reacted positively to CD34 and vimentin and negatively to CD117, S100, smooth-muscle α-actin and desmin. Conclusions: SFTL is an uncommon tumor. The present case is the first reported in Chilean medical literature and presented all the habitually described radiologic, surgical and pathological characteristics.

Introducción: El tumor fibroso solitario del hígado (TFSH) constituye un hallazgo tan raro que se ha publicado únicamente como reportes de caso y hasta el presente se encontraron sólo 45 casos publicados en la literatura inglesa. El presente artículo describe el caso de un paciente que fue tratado en nuestra institución por un TFSH. Reporte de caso: Paciente masculino de 59 años de edad al que, en una tomografía abdominal computarizada que se tomó por otras causas, se encontró en forma incidental un gran tumor hepático localizado en el lóbulo caudado del hígado. El paciente no refería síntomas relacionados con el tumor. En la cirugía se observó que el tumor se originaba directamente del lóbulo caudado al cual lo unía un pedículo de aproximadamente 3 cm de diámetro transverso. Se seccionó el tumor desde su base de implantación en el hígado ligándose los vasos arteriales y venosos así como los conductos biliares que se encontraron. Este medía 15 x 9 x 6 cm y pesaba 794 g, se encontraba bien encapsulado. El diagnóstico histológico fue el de un TFSH, el cual se confirmó mediante inmunohistoquímica con anticuerpos monoclonales que resultaron positivos para CD34 y vimentina en las células tumorales y negativos para CD117, S100, α-actina de músculo liso y desmina. Conclusiones: El TFSH es un tumor raro. El presente caso de un TFSH es el primero reportado en la literatura médica chilena y presentó las características radiológicas, quirúrgicas y patológicas habitualmente descritas en estos casos.

Neoplasmas em suínos: 37 casos / Neoplasia in swine: 37 cases

Neoplasmas em suínos são raros. Esse trabalho descreve os neoplasmas encontrados em suínos na rotina diagnóstica de um laboratório de patologia veterinária localizado na Região Central do Rio Grande do Sul. Durante um período de 49 anos, 2.266 casos de várias afecções em suínos foram encontrados, dos quais 37 (1,6%) eram neoplasmas. Em ordem decrescente de frequência, os seguintes neoplasmas foram encontrados: Linfoma (11/37), nefroblastoma (11/37), melanoma (8/37) e papiloma (2/37). Adicionalmente, um caso de cada um dos seguintes tumores foi observado: Adenoma hepatocelular, carcinoma hepatocelular, colangiocarcinoma, histiocitoma fibroso maligno e sarcoma granulocítico. O aspecto macroscópico e histológico desses tumores é descrito e a sua epidemiologia é comparada com os dados disponíveis na literatura para neoplasia suína.

Neoplasms in swine are rare. This paper describes neoplasms found in swine in the diagnostic routine of a veterinary pathology laboratory in the Central Region of Rio Grande do Sul, Brazil during a 49-year period, during which 2,266 cases of the various affections in swine were diagnosed. Of those 37 cases (1.6%) were neoplasms. In decreasing order of prevalence, the following neoplasms were found: lymphoma (11 out of 37 cases), nephroblastoma (11/37), melanoma (8/37), and papilloma (2/37). Adenoma hepatocelular, carcinoma hepatocelular, cholangiocarcinoma, malignant fibrous histiocytoma, granulocytic sarcoma were each found in one case out of the 37 cases. The gross and histological aspects of these tumors are described and their epidemiology is compared with the data available in the literature for neoplasia in swine.

Hepatectomy: a critical analysis on expansion of the indications / Hepatectomia: uma analise critica da ampliacao das indicacoes

Background: Hepatic resection has evolved to become safer, thereby making it possible to expand the indications. Aim : To assess the results from a group of patients presenting these expanded indications. Method: Were prospectively studied all the hepatectomy procedures performed for hepatic tumor resection. Patients with benign and malignant primary and secondary tumors were included. Were included variables such as age, gender, preoperative diagnosis, preoperative treatment, type of operation performed, need for transfusion, final anatomopathological examination and postoperative evolution. The patients were divided into two groups: group A, with a traditional indication for hepatectomy; and group B, with an expanded indication (tumors in both hepatic lobes, extensive resection encompassing five or more segments, cirrhotic livers and postoperative chemotherapy using hepatotoxic drugs). Results: Were operated 38 patients, and 40 hepatectomies were performed: 28 patients in group A and 10 in group B. The mean age was 57.7 years, and 25 patients were women. Three in group B were operated as two separate procedures. Groups A and B received means of 1.46 and 5.5 packed red blood cell units per operation, respectively. There were three cases with complications in group A (10.7%) and six in group B (60%). The mortality rate in group A was 3.5% (one patient) and in groups B, 40% (four patients). The imaging examinations were sensitive for the presence of tumors but not for defining the type of tumor. The blood and derivative transfusion rates, morbidity and mortality were greater in the group with expanded indications and more extensive surgery. Conclusion: The indications for liver biopsy and portal vein embolization or ligature can be expanded, with special need of cooperation of the anesthesiology department and the use of hepatic resection devices to diminish blood transfusion. .

Racional: As ressecções hepáticas evoluíram, tornando-se mais seguras, permitindo ampliação das indicações. Objetivo : Avaliar os resultados com ampliação da indicação. Método : Estudo prospectivo de todas as hepatectomias realizadas para ressecção de tumores hepáticos. Foram incluídos pacientes com tumores primários e secundários, benignos e malignos e anotados idade, gênero, diagnóstico pré-operatório, tratamento realizado no pré-operatório, tipo de operação realizada, necessidade de transfusão, exame anatomopatológico final e evolução pós-operatória. Os pacientes foram divididos em dois grupos: grupo A, aqueles com indicação tradicional de hepatectomia e grupo B, com indicação ampliada (tumor nos dois lobos hepáticos, ressecções extensas de cinco ou mais segmentos, fígados cirróticos e pós-quimioterapia com drogas hepatotóxicas). Resultados: Foram operados 38 pacientes e realizadas 40 operações, 28 no grupo A e 10 no B. A média de idade foi 57,7 anos, sendo 25 mulheres. Três do grupo B foram operados em dois tempos. Os grupos A e B receberam em média 1,46 e 5,5 concentrados de hemácias por operação, respectivamente. Os pacientes do grupo A tiveram três complicações (10,7%) e os do B seis (60%). A mortalidade no grupo A foi de 3,5% (n=1) e no grupo B ocorreram quatro óbitos (40%). Os exames de imagem foram sensíveis para presença de tumor, mas não para definir o tipo. As transfusões, a morbidade e a mortalidade foram maiores no grupo com ampliação das indicações e operações mais extensas. Conclusão: Deve-se indicar a biópsia hepática com maior frequência no pré-operatório, ...

Prevalência e achados epidemiológicos, anatomopatológicos e imuno-histoquímicos dos tumores hepáticos malignos primários de cães da Região Central do Rio Grande do Sul (1965-2012) / Prevalence and epidemiological, pathological and immunohistochemical aspects of primary canine malignant hepatic tumors in Rio Grande do Sul, Brazil (1965-2012)

A prevalência e os aspectos epidemiológicos, anatomopatológicos e imuno-histoquímicos dos tumores hepáticos malignos primários (THMP) em cães foram estudados. De 7.373 cães necropsiados em 48 anos (1965-2012), 64 morreram de THMP, o que corresponde a 0,9% do total de cães que morreram por qualquer causa, 7,8% do total de cães que morreram por tumores em geral e 33,5% do total de cães que morreram por tumores hepáticos. Desses 64 casos de THMP, 51 foram revistos histologicamente, avaliados imuno-histoquimicamente e reclassificados como carcinomas (colangiocarcinomas [n=36], carcinomas hepatocelulares [n=9] e hepatocolangiocarcinoma [n=1]) e sarcomas (hemangiossarcomas [n=5]). Dos cães com colangiocarcinomas e carcinomas hepatocelulares em que a idade estava disponível nos protocolos, 64,7% e 77,8% eram idosos, respectivamente. Na necropsia, colangiocarcinomas caracterizaram-se principalmente por ocorrerem em um padrão multinodular (83,3%), enquanto carcinomas hepatocelulares ocorreram tanto de forma massiva (44,4%) quanto nodular (44,4%). Metástases extra-hepáticas foram vistas em 77,8% e 33,3% dos casos de colangiocarcinomas e carcinomas hepatocelulares, respectivamente, e em relação aos colangiocarcinomas afetaram principalmente pulmões (52,8%), linfonodos (50%) e peritônio (19,4%). Ascite (22,2%) e icterícia (22,2%) foram achados associados ocasionalmente com ambos os tumores. Na histologia, a maior parte dos colangiocarcinomas (86,1%) e dos carcinomas hepatocelulares (55,6%) tinha padrão tubular e trabecular, respectivamente. Na imuno-histoquímica, a maioria (63,9%) dos colangiocarcinomas demonstrou imunomarcação para CK7 e nenhum imunomarcou para Hep Par 1. A maioria (55,6%) dos carcinomas hepatocelulares demonstrou imunomarcação para Hep Par 1 e nenhum imunomarcou para CK7. Os resultados aqui apresentados demonstram uma altíssima prevalência de THMP, principalmente colangiocarcinomas, e servem para auxiliar, através dos achados de necropsia, histologia e imuno-histoquímica, patologistas veterinários no diagnóstico dessa tão comum forma de câncer em cães da Região Central do RS, Brasil.

The prevalence and epidemiological and immunohistochemical aspects of primary hepatic malignant tumors (PHMT) were reviewed in dogs necropsied in a 48-year period (1965-2012). Out of those7,373 dogs, 64 died due to PHMT, which corresponds to 0.9% of the dogs dying from any cause in the period; 7.8% of dogs which deaths were caused by tumors in general; and 33.5% of all dogs dying from hepatic tumors (primary and metastatic). Out of the 64 cases of PHMT, 51 were reviewed histologically and evaluated by immunohistochemistry; they were diagnosed as carcinomas (36 cholangiocarcinomas, 9 hepatocellular carcinomas and one hepatocholangiocarcinoma) and sarcomas (5 hemangiosarcomas). In those dogs in which the age was possible determined, 64.7% (cholangiocarcinomas) and 77.8% (hepatocellular carcinomas) were old. At necropsy examination cholangiocarcinomas were characterized mainly by a multinodular pattern (83.3%) while hepatocellular carcinomas occurred both as massive (44.4%) or nodular (44.4%) distribution. Extra-hepatic metastasis occurred respectively in 77.8% and 33.3% of the cases of cholangiocarcinomas and hepatocellular carcinomas; metastatic cholangiocarcinomas affected mainly the lungs (52.8%), lymph nodes (50%) and peritoneum (19.4%). Ascites (22.2%) and icterus (22.2%) were observed frequently associated to both tumors. Histologically, most part of the cholangiocarcinomas (86.1%) and of the hepatocellular carcinomas (55.6%) presented respectively a tubular or trabecular type. Immunohistochemistry revealed that the majority (63.9%) of cholangiocarcinomas was positive for CK7 and none was marked for Hep Par 1. The majority (55.6%) of the hepatocellular carcinomas revealed positive reaction for Hep Par 1 and none was marked for CK7. The results presented here demonstrated a very high prevalence of PHMT, especially cholangiocarcinomas, in the dog. The necropsy, histological and immunohistochemical findings reported might be useful to help veterinary pathologists in the diagnosis of this common form of cancer in dogs of the Rio Grande do Sul, Brazil.

Sarcoma indiferenciado (embrionario) de hígado en el adulto / Undifferentiated (embryonal) sarcoma of the liver in adults

We report a 48 years old women presenting with a painful abdominal mass and hepatomegaly. An abdominal CAT scan showed a focal lesion of 14 cm diameter in liver segment 4. The patient was subjected to a left hepatectomy with a normal postoperative evolution. The pathological diagnosis of the surgical piece was an undifferentiated sarcoma. Nine months later, a local relapse was detected and the patient died 22 months after the operation.

Introducción: Los sarcomas indiferenciados (embrionario) del hígado (SIEH) son neoplasias infrecuentes. Se presentan principalmente en edad pediátrica y son considerados de mal pronóstico. En adultos, existen 71 pacientes publicados en el mundo, y en nuestro país no hay casos descritos en este grupo etario. Objetivos: Presentar el caso de una paciente adulta portadora de un SIEH, que fue sometida a cirugía resectiva y realizar una revisión del tema. Caso clínico: Mujer de 48 años de edad, con historia de dolor abdominal, masa palpable en epigastrio y hepatomegalia. Marcadores tumorales negativos, tomografía abdominal revela lesión focal de 14 centímetros en segmento 4. Se aborda quirúrgicamente, biopsia rápida revela tumor sólido maligno indiferenciado, y se realiza hepatectomía izquierda. Evolución postoperatoria favorable. Mediante el análisis histopatológico, histoquímico e inmunohistoquímico se diagnostica un SIEH y se corrobora una resección R0. Al noveno mes de evolución se pesquisa foco de recidiva hepática, inicia progresivo compromiso del estado general, falleciendo 22 meses después de la cirugía. Discusión: Actualmente se recomienda resección completa del tumor seguido de quimioterapia coadyuvante, con lo cual se han logrado sobrevidas libres de enfermedad mayores a 5 años. El dar a conocer las experiencias de casos aislados en esta patología tan infrecuente, permitiría aumentar la casuística mundial, mejorar las técnicas de enfrentamiento, y evaluar el impacto de la quimioterapia en el pronóstico.

Hepatectomia parcial em cirurgia pediátrica / Partial hepatectomy in pediatric surgery

OBJETIVO: Embora, atualmente, as indicações de hepatectomias em crianças sejam menos frequentes, em alguns casos elas constituem a melhor opção terapêutica. O objetivo deste trabalho é relatar a experiência de dez anos com grandes ressecções hepáticas em pacientes pediátricos. MÉTODO: Foram analisados os dados de doze pacientes submetidos a lobectomia hepática nos serviços de Cirurgia Pediátrica do Hospital da Clínicas da Faculdade de Medicina da Universidade de São Paulo e do Hospital Santa Lydia, em Ribeirão Preto (SP) de 1985 a 1995. RESULTADOS: Foram realizadas oito lobectomias esquerdas e quatro lobectomias direitas. Dez crianças foram operadas por neoplasia e duas por complicações de traumatismo hepático. A idade das dez crianças portadoras de neoplasia variou de seis dias a dezesseis meses, sendo em média 3,8 meses. O diagnóstico histopatológico foi hemangioendotelioma em cinco (50 por cento), hepatoadenoma em dois (20 por cento), hepatoblastoma em dois (20 por cento) e hepatocarcinoma em um (10 por cento). O peso do tumor correspondeu em média a 7,1 por cento do peso do paciente. A duração média da cirurgia foi de 2 horas e 58 minutos. O seguimento pós-operatório variou até 141 meses, sendo em média 76,5 meses. Sete pacientes receberam transfusão de sangue intra-operatória, correspondente a 23,3 por cento de sua volemia, em média. Um deles apresentou recidiva de tumor, necessitando reoperação. Nenhum dos doze pacientes apresentou complicações pós-operatórias. CONCLUSÃO: A hepatectomia parcial é um procedimento difícil tecnicamente, que, no entanto, pode ser realizado com segurança, mesmo em hospitais que não disponham de recursos tecnológicos sofisticados, desde que o cirurgião esteja bem preparado para enfrentar suas dificuldades.

BACKGROUND: Although less frequent in childhood nowadays, hepatectomies may still be the best choice in some cases. Our objective is to describe a 10-year experience with large hepatic resections in pediatric patients. METHODS: A retrospective review of clinical and surgical data of 12 patients submitted to hepatic lobectomy, at Pediatric Surgery Service of Hospital das Clinicas da Faculdade de São Paulo and Hospital Santa Lydia, Ribeirão Preto (Brazil), between 1985 and 1995. RESULTS: There were eight left lobectomies and four right lobectomies. The indication of surgery were neoplastic diseases in 10 children, and complicated hepatic trauma in two. The age range was six days to 16 months in children with hepatic tumors, and the mean age was 3,8 months. Histopathological diagnosis were hemangioendothelioma in five (50 percent), hepatic adenoma in two (20 percent), hepatoblastoma in two (20 percent), and hepatic carcinoma in one (10 percent). Mean tumor weight was 7,1 percent of body weight. Mean surgical time was 2h 58m. Postoperative follow-up was up to 141 months, and mean follow-up was 76,5 months. Seven patients received intraoperative blood transfusion, corresponding to 23,3 percent of volemy. Only one patient had a late reoperation for resection of a new tumor. There were no postoperative complications. CONCLUSION: Although hepatic lobectomy is a major surgery, and undoubtedly technically difficult, it can be safely performed without expensive devices and sophisticated methods (some of them not always available in common hospitals) if the surgeon is skilled and well prepared for such a procedure.

The study of 3DCRT plan for hepatic tumors / 肿瘤研究与临床

Objective To study the 3D CRT plan for hepatic tumors. Methods The 3DCRT plan of 50 cases of primary or metastasis hepatic cancer were designed according to the request of the doctors for CTV and the restricted receiving dose of the peripheral normal sensitive organs. The best plan was chosen referring the dose-volume histogram. Results By using ICRU dose reference point (the central point of tumor) as the dose 100 % and 80 % ~ 90 % dose line can be surrounded above 90 % of the PTV(planning tumor volume). The degree of 90 % dose line surrounding PTV was related to the scope of target area and its location. Conclusion The focus in different localization can be treated with different design when devise the treatment plan of the hepatic tumors. The reaction to radiotherapy was directly influenced by the volume of dosage of radiation to the normal hepatic tissues, and it also had great influence to the choice of prescription dose and the dose division style.