Hepatocellular carcinoma - imaging methods and imaging guided therapy.

The imaging modality choice depends on the clinical question in hepatocellular carcinoma (HCC); when HCC is suspected, then ultrasound serves as imaging at the first line, followed by computed tomography. When specialized differential dia-gnosis or bio-logical behaviour of HCC is a clinical issue, magnetic resonance imaging with a use of hepatospecific contrast agent or hybrid imaging using positron emission tomography and computed tomography or positron emission tomography and magnetic resonance imaging with the application of 18F-fluorodeoxglucose or 18F-fluorocholine are exploited. In the therapy of HCC, it is possible to use locally destructive methods of interventional radiology, especially radiofrequency ablation or transarterial chemoembolization, or radioembolization, as the case may be.

Porcine Liver Anatomy Applied to Biomedicine.

Currently, there are at least 70 pure domestic pig breeds, but only certain breeds are used in biomedical research. The domestic pig liver is suitable for preclinical research because its size, physiology, and anatomy are similar to that of the human liver; in addition, there is a high degree of genetic similarity between the two species. For planning experiments and identifying improvements in both invasive and noninvasive methods of liver disease management, the morphological similarities and dissimilarities of the pig liver to its human counterpart must be taken into consideration along with sexual dimorphism and interindividual and interspecific variability. Recent histological evaluations based on stereological methods enable precise quantitative morphological estimates and guarantee their unbiased accuracy. The results thereof are crucial for revealing and assessing histological changes and can contribute to the optimization of study designs. New trends in computed tomography data processing have also been introduced. This review article summarizes the newest trends and findings in the field of porcine liver anatomy and histology as applicable to preclinical research.

Chromophobe renal cell carcinoma with neuroendocrine and neuroendocrine-like features. Morphologic, immunohistochemical, ultrastructural, and array comparative genomic hybridization analysis of 18 cases and review of the literature.

Chromophobe renal cell carcinoma (CRCC) with neuroendocrine differentiation (CRCCND) has only recently been described. Eighteen cases of CRCC with morphologic features suggestive of neuroendocrine differentiation were selected from among 624 CRCCs in our registry. The tissues were fixed in neutral formalin, embedded in paraffin, cut into 4- to 5-µm-thick sections, and stained with hematoxylin and eosin. As CRCC with neuroendocrine features, tumors with following morphology were suggested: (1) trabecular/palisading/ribbon-like, gyriform, insular, glandular, and solid pattern; (2) uniform polygonal cells formed in small islets; and (3) cribriform pattern in combination with palisading. Selected cases were further analyzed using immunohistochemistry, electron microscopy, array comparative genomic hybridization, and fluorescence in situ hybridization. Cases were classified as CRCCND or CRCC with neuroendocrine-like features (CRCCND-L) based on the immunohistochemical expression of neuroendocrine markers: CRCCND, 4 cases, age range 49 to 79 years, size ranged from 2.2 to 22 cm, and CRCCND-L, 14 cases, age range 34 to 74 years, size range 3.8 to 16.5 cm. Follow-up information was available for 11 of 18 patients aged 0.5 to 12 years. Two of 4 CRCCNDs showed aggressive clinical course with metastatic spreading. Chromophobe renal cell carcinomas with neuroendocrine differentiation were focally positive for CD56 (4/4), synaptophysin (4/4), chromogranin A (1/4), and neuron-specific enolase (3/4). All 14 CRCCND-Ls were mostly negative or very weakly focally positive for some of the aforementioned markers. All 18 tumors were positive for cytokeratin 7 and CD117. Ultrastructural analysis showed poorly preserved neuroendocrine granules only in 2 of 4 analyzed CRCCNDs. Losses of chromosomes 1, 2, 6, and 10 were found in all analyzable CRCCNDs, whereas multiple losses (chromosomes 1, 2, 6, 10, 13, 17, and 21) and gains (chromosomes 4, 11, 12, 14, 15, 16, 19, and 20) were found in CRCCND-L.

Portal and mesenteric vein thromboses in a patient with prothrombin G20210 mutation, elevated lipoprotein (a), and high factor VIII.

A 65-year-old man was examined for abdominal pain. Portal and mesenteric vein thromboses were described by ultrasound and computed tomography. No local cause was found. The patient had a positive history of venous thromboembolism. Thrombophilia workup revealed prothrombin G20210A mutation (heterozygous), C677T mutation of methylenetetrahydrofolate reductase gene (homozygous), elevated level of lipoprotein (a), and high level of coagulation factor VIII. Anticoagulation was started and planned for a long-term duration. The etiology of portal vein thrombosis is often multifactorial, with various combinations of systemic factors (inherited or acquired prothrombotic conditions) and local precipitating factors (inflammation, injury to the portal venous system, cancer of the abdominal organs, cirrhosis). The reported prevalence of hypercoagulable states in patients with portal vein thrombosis has been very heterogeneous so far. Some authors support a role of the prothrombin G20210A mutation. In the reported patient, this mutation was revealed in a combination with other hypercoagulable states.