Transarterial chemoembolisation for very early and early stage hepatocellular carcinoma: single-centre experience.

AIM: To evaluate the safety and efficacy of transarterial chemoembolisation (TACE) in patients with very early and early stage hepatocellular carcinoma (VES-HCC). MATERIALS AND METHODS: A retrospective analysis was performed for all TACE procedures done at King's College Hospital, a tertiary liver centre, for VES-HCC during a 5-year period (January 2014-December 2018). Patients with solitary tumours ≤5 cm and patients with 2-3 tumours (each ≤3 cm) were included. RESULTS: Two hundred and thirty-seven eligible patients were included. Technical success was achieved in 233 (98.3%) procedures. TACE using drug-eluting beads (DEB-TACE) was performed in 192 (82.4%) procedures. A complete response was achieved in 109 (45.9%) patients. The recurrence rate was 44% (48 cases), during a median imaging follow-up of 31.9 months (IQR 15.9-44.7). Median overall survival was 71.1 months (95% confidence interval [CI]: 62.9-79.3). Median recurrence-free survival was 58.9 months (95% CI: 47.1-70.7). Sixty-six (27.8%) patients eventually underwent transplantation, and six (2.5%) patients underwent surgical resection. Mild, moderate, and severe adverse events were encountered in 2.9%, 5.4%, and 0.8% of cases, respectively. No 30-day mortality was encountered. CONCLUSION: DEB-TACE is safe and effective for treating VES-HCC patients, who are unsuitable for thermal ablation or surgery, and may offer comparable survival benefit. It can also be used as a bridge to transplantation for these patients.

Safety and efficacy of irreversible electroporation treatment in hepatobiliary and pancreatic tumours: a single-centre experience.

AIM: To report initial experience with irreversible electroporation (IRE) in a single tertiary oncology centre and to describe its role in the management of liver and pancreatic tumours. MATERIALS AND METHODS: The present study was a retrospective review of the technical success rate, complications, and treatment efficacy of patients who had undergone IRE treatment for hepatobiliary and pancreatic tumours between February 2014 to January 2020. The patients were divided into two cohorts: first 30 patients (cohort A) and subsequent 70 patients (cohort B) after a change in protocol. RESULTS: One hundred IRE procedures (n=69 liver lesions; n=28 pancreatic lesions, n=3 nodal disease) were reviewed. The overall technical success rate was 99%. Early and immediate complications were 4% and 3%, respectively. In cohort A, the complete tumour ablation rate was 65% (13/20) for hepatic tumours, 20% (1/5) for locally advanced pancreatic adenocarcinoma, 50% (2/4) for pancreatic neuroendocrine tumours, and 0% (0/1) for nodal metastasis. For cohort B, the rate improved to 87.76% (43/49) for hepatic tumours, 28.57% (4/14) for locally advanced pancreatic adenocarcinoma, 80% (4/5) for pancreatic neuroendocrine, and 50% (1/2) for nodal metastasis. After the initial cohort A, cohort B showed a significant increase in the initial complete ablation rate in hepatic tumours (p=0.028). CONCLUSION: IRE is a complex technique with a steep learning curve. It is safe, effective, and is valuable in the treatment of liver tumours that are unsuitable or considered high risk for conventional thermal ablation. Its role in the management of pancreatic tumours is less clear and requires larger studies.

Case Report of Multiple Bilobar Hepatic Arterio-Portal Fistulas Post-Liver Transplantation Managed Conservatively.

Multiple intrahepatic arterio-portal fistulas are rare. The majority are isolated and occur secondary to liver trauma including iatrogenic interventions such as liver biopsy. Post-liver transplantation 18 cases have been reported, all secondary to an interventional radiological procedure. We report multiple bi-lobar arterio-portal fistulas in a liver transplant recipient recognized 1 year after transplantation. The donor died due to intracerebral bleeding following blunt head and abdominal trauma. In the present case, the etiology is not very clear. The patient was managed conservatively and to date has not required intervention.

Hepatic splenosis presenting as arterialised liver lesion in a patient with NASH.

INTRODUCTION: Splenosis represents the heterotopic autotransplantation of splenic tissue after a traumatic splenic rupture and splenectomy. It is not a rare condition and it is estimated to occur in up to 67% of patients with traumatic splenic rupture. CASE REPORT: We report one case of patient, affected by non alcoholic steatohepatitis (NASH), with a hypervascularised liver lesion, that the final histological examination revealed hepatic splenosis. This is a rare condition that may be misinterpreted as adenoma or hepatocellular carcinoma (HCC). Imaging techniques and features that might contribute to the diagnosis and may avoid invasive treatment are also discussed. Although hepatic splenosis is a rare condition, this diagnosis should be considered in patients with previous history of abdominal trauma and then the diagnosis of splenosis may be confirmed by Tc-99m-DRBC scintigraphy, avoiding biopsy or further surgery.

Role of imaging in the management of pancreatic mass.

Pancreatic cancer is the second commonest malignant gastrointestinal neoplasm. Modern imaging techniques have greatly increased sensitivity in diagnosing and staging pancreatic cancers. Multidetector CT in particular, plays a critical role in local staging and determining the resectability of pancreatic tumours. MR and endoscopic ultrasound are valuable in those groups of patients in whom CT findings alone are inconclusive in tumour characterisation and local staging, particularly vascular involvement. In this article we review the current established concepts and the role of imaging in the multidisciplinary management of pancreatic tumours together with a comprehensive review of the literature.

Vanishing liver tumours.

Spontaneous resolution of liver tumours is a rare, but recognized entity that has been reported to occur within the spectrum of benign and malignant liver tumours occurring in both adult and paediatric population. The aetiology of this unusual phenomenon is not clearly understood. In this article we present case examples of various benign and malignant liver tumours that have regressed spontaneously without treatment together with a review of the literature, and a summary of the current understanding of the pathogenesis of these tumours.

Splenic abnormalities: a comparative review of ultrasound, microbubble-enhanced ultrasound and computed tomography.

The ultrasound appearances of abnormalities of the spleen are reviewed and images compared with computed tomography. Focal lesions, both benign and malignant, trauma, infarction and congenital abnormalities are presented. The use of microbubble ultrasound contrast media as an aid to identifying and characterizing abnormalities is discussed.

Appearance of a type B duplex appendix on barium enema.

Anomalies of the appendix are rare and are usually found in the adult population as an incidental finding during the course of surgery. We describe the appearances of a Type B duplicated appendix demonstrated on a barium enema for the first time. A review of the literature is presented with a discussion of different forms of duplicated appendices and the clinical significance of this finding.