Our experience with Radio - Pathological diagnosis of liver lesions in a tertiary health care centre.

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.

Histopathological findings of Fasciola hepatica infection in non-native European hare (Lepus europaeus) in Southern Chile / Achados histopatológicos da infecção por Fasciola hepatica em lebre europeia não-nativa (Lepus europaeus) no Sul do Chile

Abstract Fasciola hepatica is a parasite introduced in America from Europe, being considered of concern for public health and animal production, especially in countries with endemic areas as occur in Chile. In this country, the research has been focused mainly in domestic ruminants, with native and introduced wildlife being largely ignored. Thus, the aim of this study was to report the infection by Fasciola hepatica in an introduced mammal, the European hare, which is distributed along a vast area of the country. One in 42 hares hunted showed histological lesions compatible with F. hepatica, and harbored a parasitic load of 6 liver flukes. This is the first report of this lagomorph acting as host of this helminth in the country and the third in South America. Yet, we found no previous reports regard the pathology of this fluke in the species. Thus, we emphasize the importance of more studies regarding introduced mammals which could be acting as reservoirs for this important fluke.

Resumo Fasciola hepatica é um parasita de origem europeia introduzido na América, de importância em saúde pública e animais de produção, especialmente em países com áreas endêmicas, como ocorre no Chile. Neste país, a pesquisa foi focada principalmente em ruminantes domésticos, com a fauna nativa e introduzida sendo amplamente ignorada. O objetivo desse trabalho é relatar a infecção por Fasciola hepatica em lebre europeia, espécie distribuída em vasta extensão do país. Uma em 42 lebres caçadas, mostrou lesões histológicas compatíveis com infestação por F. hepatica, alojando 6 vermes hepáticos. Este é o primeiro relato deste lagomorfo apresentando este tipo de parasitismo no Chile, o terceiro na América do Sul. No entanto, não encontramos relatos anteriores sobre a patologia deste acaso na espécie. Este relato salienta a importância de mais estudos considerando espécies introduzidas, as quais podem ser reservatórios desse importante parasita.

Occurrence of Capillaria sp. in the liver of sheep (Ovis aries ) in a slaughterhouse in the state of Acre, Brazil / Ocorrência de Capillaria sp. em fígado de ovino ( Ovis aries) em um abatedouro no estado do Acre, Brasil

Abstract Although sheep farming has grown in the state of Acre over the past four decades, little is known about occurrences of helminthiases in the herds of this region. The objective of the study was to assess the occurrences of non-intestinal helminthiasis among sheep slaughtered in Rio Branco. A total of 110 sheep livers were inspected from two slaughter batches (july 2014 and march 2015) in a slaughterhouse in Rio Branco. Livers with macroscopic lesions were photographed and were then subjected to histopathological analysis under an optical microscope. The macroscopic lesions showed small nodes with inflammatory characteristics and areas of fibrosis, which appeared to be calcified, thus suggesting a granulomatous reaction. Of the 110 evaluated livers, we noticed 110 nodules in total; these nodules have an average size of 0.5 cm. The histopathological analysis showed alterations to the architecture of the hepatic lobe, with multiple foci of necrosis and polymorphonuclear cells. Two samples revealed the presence of helminths from Nematode class and Capillaria sp. eggs identified by the typical morphology and morphometry. This seems to be the first report of Capillaria sp. in sheep livers in Brazil, and it serves as an important alert regarding animal health surveillance and control and regarding the Capillaria sp. zoonotic role in humans.

Resumo Embora a ovinocultura tenha despertado o interesse de criadouros no estado do Acre nas últimas quatro décadas, pouco se conhece sobre a ocorrência de helmintoses no plantel de ovinos dessa região. O objetivo do presente estudo foi avaliar a possibilidade de ocorrência de helmintíases não intestinais entre ovinos abatidos no município de Rio Branco. Foram inspecionados 110 fígados de ovinos em dois abates (julho de 2014 e março de 2015) em um abatedouro no município de Rio Branco. Fígados com lesões macroscópicas foram fotografados com posterior análise histopatológica por microscopia de luz. Nas lesões macroscópicas foram encontrados pequenos nódulos apresentando características inflamatórias com áreas de fibrose, aparentemente calcificadas, sugerindo uma reação granulomatosa. Dos 110 fígados avaliados, observou-se 110 nódulos no total; estes nódulos têm um tamanho médio de 0,5 cm. A análise histopatológica mostrou alterações na arquitetura do lóbulo hepático, com múltiplos focos de necrose, além da formação de abscessos hepáticos constituídos por polimorfonucleares. Duas amostras revelaram a presença de helmintos da Classe Nematoda e ovos de Capillaria sp. identificados pela morfologia típica e morfometria. Esse resultado parece ser o primeiro registro de Capillaria sp. em fígado de ovino no Brasil, o que é um importante alerta para a vigilância no controle sanitário animal e o seu papel zoonótico para humanos.

Intoxicação por Senecio brasiliensis em bezerros: padrão e evolução de lesões hepáticas / Senecio brasiliensis poisoning in calves: pattern and evolution of hepatic lesions

Intoxicações por plantas do gênero Senecio representam uma importante causa de morte em bovinos no Rio Grande do Sul e estima-se que mais de 50% das mortes causadas por plantas tóxicas devem-se à intoxicação por Senecio spp. Nesse trabalho, são descritos os aspectos epidemiológicos, clínicos e anatomopatológicos de um surto de intoxicação natural por Senecio brasiliensis em bezerros e a caracterização e evolução das lesões hepáticas durante o surto. Um lote com 206 bovinos, fêmeas, sem raça definida, foi desmamado com aproximadamente quatro meses de idade e soltos em campo nativo com 25 hectares, contendo grande quantidade de Senecio brasiliensis em diferentes estágios. Os bovinos permaneceram nesse campo durante três meses e posteriormente foram transferidos para outra área. Na nova área, seis bezerras, com idades entre sete a oito meses, começaram a apresentar sinais clínicos de emagrecimento, fraqueza, diarreia e edema subcutâneo de declive na região submandibular. Os seis bovinos morreram em um período de 15 dias e um deles foi necropsiado. Macroscopicamente, foi visualizado o primeiro dos três padrões distintos de lesão hepática dos bovinos desse surto, que se caracterizava por um fígado aumentado de tamanho, com os bordos arredondados e com superfície capsular e de corte alaranjada. Histologicamente havia acentuada degeneração vacuolar hepatocelular difusa, bilestase, megalocitose e leve proliferação de ductos biliares e fibrose periportal. Dois meses após o início do surto, constatou-se que em um período de 20 dias adoeceram mais 28 bezerras e, dessas, 14 morreram. Os bovinos acometidos nessa segunda visita tinham idades entre nove a 10 meses. O principal sinal clínico observado foi fotossensibilização, e incluía graus variados de fotofobia, lacrimejamento, salivação excessiva, descarga ocular mucopurulenta, secreção nasal e glossite diftérica ventral. Das 14 bezerras mortas, realizou-se a necropsia de duas delas, sendo visualizado o segundo padrão de lesão hepática nesse surto (Padrão 2). Os fígados estavam com a superfície capsular lisa e esbranquiçada e moderadamente diminuídos de tamanho. Ao corte observou-se leve irregularidade do parênquima e áreas mais claras intercaladas com áreas avermelhadas. O aspecto histológico incluía acentuada fibrose periportal, marcada proliferação de ductos biliares, megalocitose, áreas multifocais de necrose de hepatócitos, hemorragia e lesões veno-oclusivas. A atividade sérica da GGT foi avaliada em 15 bovinos afetados nessa segunda visita à propriedade. Desses, 13 bezerras testadas apresentaram alterações nos valores, que variaram de 26-175 U/L. Em uma terceira visita à propriedade, sete meses após o início do surto, mais 27 bezerras adoeceram em um período de 40 dias e, dessas, 23 morreram, sendo três submetidas à necropsia. Evidenciou-se o terceiro padrão de lesão hepática. O fígado dos três bovinos estava diminuído de tamanho e acentuadamente firme. A superfície capsular era lisa e esbranquiçada, e a superfície de corte apresentava-se difusamente acastanhada. Lesões histológicas semelhantes ao segundo padrão foram também constatadas no fígado dessas três bezerras. Na quarta visita à propriedade, realizaram-se biópsias hepáticas nos 163 bovinos restantes do lote. Lesões hepáticas características da intoxicação estavam presentes em 103 dos 163 bovinos submetidos à biopsia hepática. Os bovinos afetados foram classificados em grupos de acordo com a severidade e os aspectos morfológicos observados. O diagnóstico de intoxicação nos bovinos desse estudo baseou-se nos achados epidemiológicos, clínicos e anatomopatológicos, associados ao histórico do consumo da planta e evolução das lesões.(AU)

Poisoning by Senecio spp. plants are an important cause of death in cattle in the State of Rio Grande do Sul, Brazil. It is estimated that over 50% of deaths caused by toxic plants are due to the ingestion of Senecio spp. The epidemiological, clinical and anatomopathological aspects of a spontaneous outbreak of Senecio brasiliensis in calves are described here. Characterization and evolution of liver lesions during the outbreak are also described. Two hundred and six 4-month-old female calves were weaned and placed in a 25-hectare pasture heavily infested by S. brasiliensis at of varying growth stages. The calves remained in this pasture for three months and were later transferred to another area where six calves aged 7-8- month-old developed clinical signs including unthriftiness, diarrhea, and subcutaneous dependent edema in the submandibular region. All these six affected calves died within 15 days from the onset of clinical signs and one of those was necropsied. Grossly the first of three patterns of hepatic lesions described in this report was observed and it was characterized by an enlarged liver, with round borders and an orange hue to the capsular and cut surfaces. Histologically there was marked diffuse vacuolar hepatocellular degeneration, bilestasis, hepatocellular megalocytosis, and mild bile duct proliferation and periportal fibrosis. Two months after the onset of the outbreak, in another visit to the farm, it was observed that an additional 28 calves got sick and 14 died. Affected calves observed in this second on-site visit were 9-10 month-old and their main clinical sign was photosensitization characterized by varying degrees of photophobia, tearing from the eyes, marked drooling, mucopurulent ocular discharge, increased nasal secretion, and ventral diphtheric glossitis. Two of the fourteen calves that died were necropsied and displayed the second pattern of hepatic lesions observed in the outbreak. Liver had smooth and whitish capsular surfaces and a moderate decrease in size. There was moderate irregularity to the cut surface of hepatic parenchyma and pale areas intercalated with red ones. Histologically there was marked periportal fibrosis, marked bile duct proliferation, hepatocellular megalocytosis, focal areas of hepatocellular necrosis, and hemorrhage and veno-occlusive changes. In this second on-site visit, GGT serum activity was determined in 15 affected calves and 13 of them had increased values (26-175 U/L). Seven months after the onset of the outbreak, a third visit was made to the farm when was learned that and additional 27 calves have been affected, 23 of which died within a period of 40 days. At the necropsy of three of these calves the third pattern of hepatic lesions were observed. The liver was decreased in size and markedly firm. The capsular surface was smooth and whitish and the capsular surface was diffusely tan. Histological lesions similar to those observed in the second pattern were seen in in the liver of these three calves. A fourth on-site visit to the farm was made and a liver biopsy was performed in each of the 163 calves remaining in the herd and hepatic lesions characteristic of Senecio poisoning were observed in the liver biopsy of 103 of them. Affected calves were classified in groups according to the severity and morphologic aspects of the observed hepatic lesions. The diagnosis of Senecio poisoning in calves of this study was based on epidemiology, clinical and anatomopathological findings associated with the history of consumption of the plant, and on the chronological development of the lesions.(AU)

Intoxicação por Senecio brasiliensis em bezerros: padrão e evolução de lesões hepáticas / Senecio brasiliensis poisoning in calves: pattern and evolution of hepatic lesions

Poisoning by Senecio spp. plants are an important cause of death in cattle in the State of Rio Grande do Sul, Brazil. It is estimated that over 50% of deaths caused by toxic plants are due to the ingestion of Senecio spp. The epidemiological, clinical and anatomopathological aspects of a spontaneous outbreak of Senecio brasiliensis in calves are described here. Characterization and evolution of liver lesions during the outbreak are also described. Two hundred and six 4-month-old female calves were weaned and placed in a 25-hectare pasture heavily infested by S. brasiliensis at of varying growth stages. The calves remained in this pasture for three months and were later transferred to another area where six calves aged 7-8- month-old developed clinical signs including unthriftiness, diarrhea, and subcutaneous dependent edema in the submandibular region. All these six affected calves died within 15 days from the onset of clinical signs and one of those was necropsied. Grossly the first of three patterns of hepatic lesions described in this report was observed and it was characterized by an enlarged liver, with round borders and an orange hue to the capsular and cut surfaces. Histologically there was marked diffuse vacuolar hepatocellular degeneration, bilestasis, hepatocellular megalocytosis, and mild bile duct proliferation and periportal fibrosis. Two months after the onset of the outbreak, in another visit to the farm, it was observed that an additional 28 calves got sick and 14 died. Affected calves observed in this second on-site visit were 9-10 month-old and their main clinical sign was photosensitization characterized by varying degrees of photophobia, tearing from the eyes, marked drooling, mucopurulent ocular discharge, increased nasal secretion, and ventral diphtheric glossitis. Two of the fourteen calves that died were necropsied and displayed the second pattern of hepatic lesions observed in the outbreak. [...]

Intoxicações por plantas do gênero Senecio representam uma importante causa de morte em bovinos no Rio Grande do Sul e estima-se que mais de 50% das mortes causadas por plantas tóxicas devem-se à intoxicação por Senecio spp. Nesse trabalho, são descritos os aspectos epidemiológicos, clínicos e anatomopatológicos de um surto de intoxicação natural por Senecio brasiliensis em bezerros e a caracterização e evolução das lesões hepáticas durante o surto. Um lote com 206 bovinos, fêmeas, sem raça definida, foi desmamado com aproximadamente quatro meses de idade e soltos em campo nativo com 25 hectares, contendo grande quantidade de Senecio brasiliensis em diferentes estágios. Os bovinos permaneceram nesse campo durante três meses e posteriormente foram transferidos para outra área. Na nova área, seis bezerras, com idades entre sete a oito meses, começaram a apresentar sinais clínicos de emagrecimento, fraqueza, diarreia e edema subcutâneo de declive na região submandibular. Os seis bovinos morreram em um período de 15 dias e um deles foi necropsiado. Macroscopicamente, foi visualizado o primeiro dos três padrões distintos de lesão hepática dos bovinos desse surto, que se caracterizava por um fígado aumentado de tamanho, com os bordos arredondados e com superfície capsular e de corte alaranjada. Histologicamente havia acentuada degeneração vacuolar hepatocelular difusa, bilestase, megalocitose e leve proliferação de ductos biliares e fibrose periportal. Dois meses após o início do surto, constatou-se que em um período de 20 dias adoeceram mais 28 bezerras e, dessas, 14 morreram. Os bovinos acometidos nessa segunda visita tinham idades entre nove a 10 meses. O principal sinal clínico observado foi fotossensibilização, e incluía graus variados de fotofobia, lacrimejamento, salivação excessiva, descarga ocular mucopurulenta, secreção nasal e glossite diftérica ventral.[...]

Histopathological findings of Fasciola hepatica infection in non-native European hare (Lepus europaeus) in Southern Chile

Abstract Fasciola hepatica is a parasite introduced in America from Europe, being considered of concern for public health and animal production, especially in countries with endemic areas as occur in Chile. In this country, the research has been focused mainly in domestic ruminants, with native and introduced wildlife being largely ignored. Thus, the aim of this study was to report the infection by Fasciola hepatica in an introduced mammal, the European hare, which is distributed along a vast area of the country. One in 42 hares hunted showed histological lesions compatible with F. hepatica, and harbored a parasitic load of 6 liver flukes. This is the first report of this lagomorph acting as host of this helminth in the country and the third in South America. Yet, we found no previous reports regard the pathology of this fluke in the species. Thus, we emphasize the importance of more studies regarding introduced mammals which could be acting as reservoirs for this important fluke.

Resumo Fasciola hepatica é um parasita de origem europeia introduzido na América, de importância em saúde pública e animais de produção, especialmente em países com áreas endêmicas, como ocorre no Chile. Neste país, a pesquisa foi focada principalmente em ruminantes domésticos, com a fauna nativa e introduzida sendo amplamente ignorada. O objetivo desse trabalho é relatar a infecção por Fasciola hepatica em lebre europeia, espécie distribuída em vasta extensão do país. Uma em 42 lebres caçadas, mostrou lesões histológicas compatíveis com infestação por F. hepatica, alojando 6 vermes hepáticos. Este é o primeiro relato deste lagomorfo apresentando este tipo de parasitismo no Chile, o terceiro na América do Sul. No entanto, não encontramos relatos anteriores sobre a patologia deste acaso na espécie. Este relato salienta a importância de mais estudos considerando espécies introduzidas, as quais podem ser reservatórios desse importante parasita.

Perdas econômicas pela condenação em matadouro frigorífico de fígados de bovino por fibrose causada por ingestão de Braquiaria spp / Economic losses through condemnation of bovine livers in abattoirs due to fibrosis induced by Brachiaria ingestion

A ingestão crônica de braquiária induz lesões hepáticas em bovinos caracterizadas por fibrose, atrofia do lobo esquerdo, hipertrofia compensatória do lobo direito e proliferação de ductos biliares. Tipicamente, essas lesões são associadas com agregados de macrófagos espumosos no parênquima hepático. Nesse trabalho foram estudados fígados com essas lesões num abatedouro frigorífico do Brasil Central e as perdas econômicas causadas pela condenação de tais fígados afetados foram estimadas. Durante o período estudado, 488.476 bovinos foram abatidos nesse matadouro frigorífico, dos quais 5.295 fígados foram condenados devido à fibrose, e 192 com lesão hepática foram estudados. Cálculos econômicos permitiram inferir que essas condenações representaram uma perda de R$ 108.817,60. Conclui-se que a condenação de fígados em razão de fibrose induzida pela ingestão de braquiária causa uma perda significativa para a indústria de carne e produtos bovinos devido à condenação de 23,6 toneladas de fígado em um ano em apenas um frigorífico, com perdas estimadas acima de R$ 100.000,00.

Chronic ingestion of Brachiaria spp. by cattle causes in the liver fibrosis, atrophy of left lobe, compensatory hypertrophy of the right lobe, and bile duct proliferation. Typically, these lesions are associated with accumulation in the hepatic parenchyma of cluster with foamy macrophages. This study surveyed bovine livers with those lesions in a slaughterhouse in Central Brazil and estimated the economic losses caused by condemnation of such affected livers. During the study period, 488,476 cattle were slaughter in this particular abattoir. From 5,295 livers condemned due to fibrosis, 192 with lesions were sampled and studied. Economic calculations permitted to infer that the condemnations represented a loss of R$ 108,817.60. It is concluded that the condemnation of livers due to brachiaria-induced fibrosis causes significant economic losses for the meat industry due to condemnation of 23.6 tons of beef liver with an estimate annual loss of more than R$ 100,000.00 in a single slaughterhouse.

Potential Serum Markers for Monitoring the Progression of Hepatitis B Virus-Associated Chronic Hepatic Lesions to Liver Cirrhosis

BACKGROUND/AIMS: To screen for serum protein/peptide biomarkers of hepatitis B virus (HBV)-associated chronic hepatic lesions in an attempt to profile the progression of HBV-associated chronic hepatic lesions using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) techniques. METHODS: Using SELDI-TOF MS, serum protein/peptide profiles on the CM10 ProteinChip arrays were obtained from a training group including 26 HBV-associated hepatocellular carcinoma patients with liver cirrhosis (LC), 30 HBV-associated LC patients, 85 patients at different stages of liver fibrosis, and 30 asymptomatic HBV carriers. The most valuable SELDI peak for predicting the progression to LC in HBV-infected patients was identified. RESULTS: A SELDI peak of M/Z 5805 with value for predicting LC in HBV-infected patients was found and was identified as a peptide of the C-terminal fraction of the fibrinogen alpha-chain precursor, isoform 1. CONCLUSIONS: The peptide of the C-terminal fraction of the fibrinogen alpha-chain precursor, isoform 1 with M/Z 5805, may be a serological biomarker for progression to LC in HBV-infected patients.

Contraste hepatobiliar: diagnóstico diferencial das lesões hepáticas focais, armadilhas e outras indicações / Hepatobiliary contrast agents: differential diagnosis of focal hepatic lesions, pitfalls and other indications

A caracterização das lesões hepáticas focais é muito importante. A ressonância magnética é considerada o melhor método de imagem para a avaliação destas lesões, mas não permite o diagnóstico em todos os casos. Os contrastes hepatobiliares aumentam a acurácia diagnóstica da ressonância magnética e diminuem o número de lesões hepáticas indefinidas. Suas principais indicações são a diferenciação entre hiperplasia nodular focal e adenoma, caracterização de carcinoma hepatocelular em pacientes cirróticos, detecção de metástases hepáticas pequenas, avaliação da anatomia biliar e identificação de fístulas biliares pós-operatórias. A utilização dos contrastes hepatobiliares pode reduzir a necessidade de procedimentos diagnósticos invasivos e de avaliação complementar por outros exames de imagem, além de diminuir a necessidade de exames de acompanhamento.

The characterization of focal liver lesions is very important. Magnetic resonance imaging is considered the best imaging method for evaluating such lesions, but does not allow for the diagnosis in all cases. The use of hepatobiliary contrast agents increases the diagnostic accuracy of magnetic resonance imaging and reduces the number of non-specific liver lesions. The main indications for the method include: differentiation between focal nodular hyperplasia and adenoma; characterization of hepatocellular carcinomas in cirrhotic patients; detection of small liver metastases; evaluation of biliary anatomy; and characterization of postoperative biliary fistulas. The use of hepatobiliary contrast agents may reduce the need for invasive diagnostic procedures and further investigations with other imaging methods, besides the need for imaging follow-up.

Precise hepatic pedicle dissection in anatomical hepatic segmentectomy / 中华肝胆外科杂志

Objective To review the important points in the preoperative assessment and the surgical technique in precise hepatic pedicle dissection in anatomical hepatic segmentectomy.Methods 104 patients who underwent anatomical hepatic segmentectomy were divided into two groups according to the different surgical approaches adopted in a prospective and non-randomized manner:the precise hepatic pedicle dissection group (the precise group,n=44) and the conventional hepatectomy group (the conventional group,n=60).The perioperative and follow-up data were analyzed.Patients who had primary liver cancer,including hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma,were analyzed separately.Results (1) There was no perioperative death in the two groups.There was no significant differences in blood loss and transfusion between the 2 groups of patients (P=0.069,0.208; t=1.844,1.266).There was a significantly higher rate of vascular inflow occlusion (P=0.001).There were significantly longer periods of vascular inflow occlusion and operative time (P=0.001,0.001; t=3.849,3.574) in the precise group.There was no significant difference in postoperative complications (P=0.988) and the duration of postoperative hospital stay (P=0.509;t=0.662) between the two groups.(2) In patients with primary liver cancer,there were no significant differences between the precise group (n=29) and the conventional group (n=41) in tumor margin positivity,vascular invasion and pathological staging (P=0.985,0.630,0.769).(3) All patients were followed up for two years.When compared with the conventional group,the disease-free survival (P=0.012),overall survival (P =0.006),and median survival (16.5 ± 4.5mo vs.7.8 ± 3.8mo)were significantly longer in the precise group.Conclusion Precise hepatic pedicle dissection had the same safety and efficacy as conventional method in partial hepatectomy.For primary liver cancer,precise hepatic pedicle dissection had better survival compared to the conventional method when the surgical margin was negative.

To compare the role of Gd-EOB-DTPA dynamic contrast-enhanced MRI with multi-detector row computed tomography (MDCT) in patients with focal liver lesions / 中华肝胆外科杂志

Objective To compare the role of Gd-EOB-DTPA dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with multi-detector row computed tomography (MDCT),and to determine the sensitivity,specificity and accuracy in focal hepatic lesions.Methods A retrospective analysis was conducted on 32 patients with focal hepatic lesions who had undergone MRI and MDCT examinations.These patients were divided into two groups:the CT group and the MRI group.The results were analysed using receiver operating characteristic (ROC) curves.Result There were 185 focal hepatic lesions.The sensitivity,specificity and the area under the ROC curve (AUC) were 86.5％,90.9％,0.855,respectively for the MRI group and they were significantly higher than the CT group (63.6％,54.5％,0.532).For detection of lesions ＜1 cm,the sensitivity,specificity and the area under the ROC curve (AUC) for the MRI group were 90％,86.6％,0.886,respectively,which were also significantly higher than the CT group (50.5％,45.5％,0.500).When combined with pathological findings and follow-up,the diagnostic accuracy was 40.6％ using Gd-EOB-DTPA DCE-MRI.Conclusion Gd-EOB-DTPA DCE-MRI has a higher detection rate,better accuracy and diagnostic value for focal liver lesions (＜1 cm) than MDCT.

Abdominal angiostrongyliasis with involvement of liver histopathologically confirmed: a case report / Angiostrongiliasis abdominal con lesión hepática histopatológicamente confirmada

Human abdominal angiostrongyliasis is a zoonotic disease caused by ingestion of the L3 larvae of Angiostrongylus costaricensis. The human infection gives rise to a pathological condition characterized by acute abdominal pain, secondary to an inflammatory granulomatous reaction, marked eosinophilia and eosinophilic vasculitis. Most commonly this disease is limited to intestinal location, primary ileocecal, affecting the mesenteric arterial branches and intestinal walls. We present one of the few cases reported around the world with simultaneous involvement of the intestines and liver, including proved presence of nematodes inside the hepatic arteriole.

La enfermedad conocida como angiostrongiliasis abdominal humana es una zoonosis causada por la ingestión del estadio larval L3 de Angiostrongylus costaricensis. En el ser humano, esta infección provoca un estado patológico caracterizado por dolor abdominal agudo, secundario a una reacción inflamatoria granulomatosa; eosinofilia marcada y vasculitis eosinofílica. Comúnmente el cuadro se encuentra limitado a una localización intestinal, predominantemente ileocecal, que compromete las ramas de la arteria mesentérica y la pared intestinal. Presentamos uno de los pocos casos reportados alrededor del mundo con hallazgos simultáneos en intestino e hígado; se incluye la demostración histológica del nemátodo dentro de la arteriola hepática.

Realce por contraste de lesões hepáticas em pacientes com cirrose: estudo cruzado comparativo de dois agentes de contraste para RM realizado em uma única instituição. Resultados preliminares / Contrast enhancement of liver lesions in cirrhotic patients: a single institution crossover comparative study of two MR contrast agents. Preliminary results

OBJETIVO: Comparar, prospectivamente, gadopentato de dimeglumina (Gd-DTPA) e gadobenato de dimeglumina (Gd-BOPTA), ambos em dose plena, na detecção de lesões hepáticas focais, por meio de RM em pacientes com doença hepática crônica. MATERIAIS E MÉTODOS: Oito pacientes com cirrose hepática e forte suspeita de um pequeno carcinoma hepatocelular, baseada em RM anterior, foram submetidos a exames de RM contrastada, um com dose plena de Gd-DTPA e outro com dose plena de Gd-BOPTA. Os exames foram realizados com um intervalo de 72 a 108 horas. Dois radiologistas independentes realizaram avaliação às cegas das imagens, considerando número, caracterização e realce das lesões, além de preferências subjetivas. RESULTADOS: Não houve diferença estatisticamente significante entre os dois exames quanto à detecção e caracterização das lesões. Observou-se um incremento de 18 por cento no realce da lesão dominante pelo Gd-BOPTA, em comparação com o Gd-DTPA. Na maioria dos casos, ambos os observadores cegos subjetivamente preferiram as imagens utilizando Gd-BOPTA àquelas com Gd-DTPA, com base no maior realce e melhor definição das margens das lesões. CONCLUSÃO: Em doses plenas equivalentes, Gd-BOPTA e Gd-DTPA são similares na detecção e caracterização de lesões hepáticas focais em pacientes com doença hepática crônica. Entretanto, o Gd-BOPTA foi superior em relação ao realce da lesão, assim como na preferência subjetiva dos observadores.

OBJECTIVE: To prospectively compare full dose gadopentetate dimeglumine (Gd-DTPA) with full dose gadobenate dimeglumine (Gd-BOPTA) in the detection of focal hepatic lesions in patients with chronic liver disease on MRI. MATERIALS AND METHODS: Eight patients with hepatic cirrhosis and a strong suspicion for small hepatocellular carcinoma based on prior MRI underwent contrast-enhanced MR examinations, one with full dose Gd-DTPA and one with full dose Gd-BOPTA. The exams were performed from 72-108 hours apart. Two blinded and independent radiologists evaluated images for lesion number, characterization, enhancement, and subjective preference. RESULTS: There was no statistically significant difference between the two studies for lesion detection or characterization. There was 18 percent increased lesion enhancement for Gd-BOPTA, compared to Gd-DTPA, of the dominant lesion. Both blinded readers subjectively preferred the images using Gd-BOPTA over Gd-DTPA in the majority of cases, based on greater lesion enhancement and better edge definition. CONCLUSION: At equivalent full doses, Gd-BOPTA compared similarly with Gd-DTPA in the detection and characterization of focal hepatic lesions in patients with chronic liver disease. However, Gd-BOPTA was superior for increased lesion enhancement and subjective preference of the reader.

Diagnostic Value of Contrast-Enhanced CT Patterns in Focal Hepatic Lesion / 实用放射学杂志

Objective To study the diagnostic value of contrast-enhanced CT patterns in focal hepatic lesions.Methods Contrast-enhanced CT patterns in 44 patients with focal hepatic lesions (54 foci) were retrospectively analysed.Results (1)78% of the hepatocellular carcinoma presented "rapid-filling and rapid-washout" feature.(2)All hepatic hemangioma presented "rapid-filling and slow-washout", progressive opacification from the periphery to center. (3)All cholangiocarcinoma presented "slow-filling and slow-washout" .(4)Metastatic hepatocarcinoma in 14 cases and hepatic abscesses in 5 cases were presented a enhanced ring around the lesion, metastatic hepatocarcinomas showed single ring,however, hepatic abscesses showed multi-ring. (5)Focal nodular hyperplasia in 3 cases and hepatic adenomas in 1 case presented "rapid-filling and slow-washout".Conclusion The contrast-enhanced patterns at spiral CT can fully reflect the blood supply of focal hepatic lesions, it has significant value in diagnosing focal hepatic lesions.

Excisional Therapy of Benign Hepatic Lesions / 한국간담췌외과학회지

BACKGROUND/AIMS: The diagnosis and treatment of benign hepatic lesions remain controversal. The widespread availability of ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI), and their frequent application in evaluating abdominal pain, has resulted in more frequent discovery of incidental benign hepatic lesions. To address these points, the clinical data of patients with benign hepatic lesions treated with surgical resections at our hospital were reviewed retrospectively. METHODS: We reviewed the clinical records of thirty nine patients with benign hepatic lesions who had undergone hepatic resection from January, 1985 to August, 2002 at Hanyang University Hospital. RESULTS: There were 39 patients, whose mean age was 47.0 years. The ages ranged from 24~74 years. There were 14 male patients and 25 female patients. The ratio of male and female was 1:1.8. Major symptoms were right upper quadrant pain, mass, epigastric pain, and non-specific GI symptoms. 22 cases of anatomical resections (10 right lobectomy, 5 left lobectomy, 7 left lateral segmentectomy) and 17 non anatomical resections were done. There were no postoperative deaths in this series. Fourteen patients (35.9%) developed operative complications. All of them were minor complications. During the mean follow up time, symptomatic relief was achieved in patients out of patients who we could contact with opd follow up or telephone interview. Three patients died of massive pleural effusion 4 years after operation, myocardial infarction 14 months after operation, alcoholic liver cirrhosis and diabetes mellitus 33 months after operation. CONCLUSION: Hepatic resection in patients who had benign hepatic lesions in the liver was safe and effective treatment modality if patients were selected with suitable indications.

Drug-induced Hepatic Lesions:Clinical Analysis of 170 Cases / 中国药房

OBJECTIVE:To discuss the clinical features and the general pattern of drug-induced hepatic lesions.METHO-DS:The clinical data of 170 drug-induced hepatic lesion cases collected from Jan.2002 to Apr.2006 in our hospital were analyzed retrospectively.RESULTS:Of the 170 cases,35.29% were induced by Chinese herbal medicines,13.53% by antipsychotic drugs,12.94% by anti-tuberculosis agent;51.18% were hepatocellular damage type,14.12% cholestatic damage type and 34.71% damage of mixed type damage.CONCLUSION:Hepatic lesions resemble viral hepatitis and were of no specificity in clinical features;various drugs can lead to hepatic lesions and to which clinic should attach great importance.