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Hepatocellular carcinoma typically metastasizes within the liver and may involve extrahepatic sites such as the lungs, adrenal glands, and bones at advanced stages. However, hepatocellular carcinoma metastasis to the thyroid is very uncommon and tumor-to-tumor metastasis from a hepatocellular cancer to a thyroid neoplasm is extremely rare. In this report, we present a case of a 70-year-old man with a hepatocellular carcinoma metastasizing to oncocytic thyroid carcinoma, emphasizing the importance of clinical history and of a multidisciplinary approach, as well as the usefulness of site-specific immunohistochemical markers, in diagnosing and managing cases of Rosai's metastasis, especially when donor and recipient neoplasms share similar histologic features.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Neoplasias da Glândula Tireoide , Humanos , Carcinoma Hepatocelular/secundário , Carcinoma Hepatocelular/patologia , Carcinoma Hepatocelular/diagnóstico , Masculino , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/secundário , Idoso , Biomarcadores Tumorais/análise , Imuno-Histoquímica , Adenoma Oxífilo/patologia , Adenoma Oxífilo/secundárioRESUMO
BACKGROUND: Benign nerve sheath tumors presenting as solitary retroperitoneal masses (RBNSTs) pose a complex diagnostic challenge for multidisciplinary teams regarding differential diagnosis, staging, and treatment planning. This article reviews the role played by different imaging techniques in assessing RBNSTs and elucidates their typical pathological features with a particular emphasis on the correlation between imaging and histological findings. Furthermore, some examples of retroperitoneal tumors that merit consideration in the process of differential diagnosis based on cross-sectional investigations (CSIs) are reported. The correlation between tissue architecture and appearance on imaging can help increase the accuracy of differential diagnosis with other retroperitoneal neoplasms at CSIs. CRITICAL RELEVANCE STATEMENT: This educational review critically examines the correlation between imaging and histological features in solitary retroperitoneal benign nerve sheath tumors, offering valuable insights for improving the accuracy of differential diagnosis in clinical radiology. KEY POINTS: RBNSTs are challenging to diagnose because they lack specific radiological features. Differential diagnosis of RBNSTs from other retroperitoneal neoplasms on imaging is complex. Surgical removal of RBNSTs is recommended for an accurate diagnosis.
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Patients presenting with acute colonic obstruction are usually evaluated in the emergency department and multiple specialties are involved in the patients' management. Pre-treatment evaluation is essential in order to establish the correct endoscopic indication for stent implantation. Contrast-enhanced imaging could allow the exclusion of benign causes of colonic obstruction and evaluation of the length of malignant stricture. Endoscopic stenting is the gold standard of treatment for palliative indications whereas there are still concerns about its use as a bridge to surgery. Different meta-analyses showed that stenting as a bridge to surgery improves short-term surgical outcomes but has no role in improving long-term outcomes. Multidisciplinary evaluation is also essential in patients that may be started on or are currently receiving antiangiogenic agents because endoscopic stenting may increase the risk of perforation. Evidence in the literature is weak and based on retrospective data. Here we report on how to correctly evaluate a patient with acute colonic malignant obstruction in collaboration with other essential specialists including a radiologist, surgeon and oncologist, and how to optimize the technique of endoscopic stenting.
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Metastasis to the gastrointestinal tract is a rare instance in the natural history of breast cancer, usually in association with lobular histology and widespread dissemination of disease. We report the case of a 74-year-old woman with a history of invasive lobular carcinoma presenting with a pancreatic metastasis mimicking a primary pancreatic adenocarcinoma; we also present a systematic review of the relevant literature. The presentation of pancreatic metastasis in the setting of breast cancer is unspecific, and histology is of paramount importance for a correct diagnosis; surgical metastasectomy could be of some benefit in the correct clinical setting.
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Adenocarcinoma , Neoplasias da Mama , Carcinoma Lobular , Carcinoma de Células em Anel de Sinete , Neoplasias Pancreáticas , Feminino , Humanos , Idoso , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/patologia , Neoplasias Pancreáticas/diagnóstico , Neoplasias da Mama/patologia , Carcinoma de Células em Anel de Sinete/diagnóstico , Carcinoma de Células em Anel de Sinete/patologia , Pâncreas/patologiaRESUMO
Autoimmune gastritis is a chronic immune-mediated disorder characterized by varied clinical manifestations and that should be endoscopically managed over time, as the gastric atrophy contributes to microenvironmental alterations of the stomach milieu, and an increased cancer risk has been linked to this condition. Here, we report the unusual case of a woman who developed a cardiac high-grade pyloric adenoma in a context of previously undiagnosed autoimmune gastritis with synchronous neuroendocrine cell hyperplastic and dysplastic lesions.
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Despite the progress during the last decade, patients with advanced gastric and esophageal cancers still have poor prognosis. Finding optimal therapeutic strategies represents an unmet need in this field. Several prognostic and predictive factors have been evaluated and may guide clinicians in choosing a tailored treatment. Data from large studies investigating the role of immunotherapy in gastrointestinal cancers are promising but further investigations are necessary to better select those patients who can mostly benefit from these novel therapies. This review will focus on the treatment of metastatic esophageal and gastric cancer. We will review the standard of care and the role of novel therapies such as immunotherapies and CAR-T. Moreover, we will focus on the analysis of potential predictive biomarkers such as Modify as: Microsatellite Instability (MSI) and PD-L1, which may lead to treatment personalization and improved treatment outcomes. A multidisciplinary point of view is mandatory to generate an integrated approach to properly exploit these novel antiproliferative agents.
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OBJECTIVE: This study aimed to assess the feasibility, safety, and efficacy of radiofrequency ablation (RFA) of pancreatic neuroendocrine tumors (PNETs). METHODS: We performed RFA on 10 patients (7 women) aged 38 to 75 years with histologically diagnosed PNETs (secreting in 3 cases) who could not or would not undergo surgical resection. Tumor nodules (diameter, 0.9-2.9 cm; mean [SD], 1.6 [0.5] cm) were located in the head (n = 7) or body (n = 3) of the pancreas. Ultrasound-guided RFA was performed percutaneously (n = 7), endoscopically (n = 1), or intraoperatively (n = 2) using commercially available equipment. Complete ablation was defined as absence of enhancing tissue at the tumor site on contrast-enhanced imaging studies and normalization of previously elevated serum hormone levels. RESULTS: Complete ablation was achieved with 1 (n = 9) or 2 (n = 1) RFA procedures. All neuroendocrine syndromes regressed within 24 hours of treatment. No recurrences were observed during follow-up (range, 12-60 months; median [SD], 34 [14] months). No deaths occurred. Major complications included acute pancreatitis in 3 patients, 2 of whom developed pancreatic fluid collections that were successfully managed with ultrasound-guided drainage and endoscopy. CONCLUSIONS: Radiofrequency ablation is a feasible, safe, and effective option for patients with small PNETs who cannot or do not want to undergo surgical resection.
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Ablação por Cateter/métodos , Tumores Neuroendócrinos/cirurgia , Pâncreas/cirurgia , Neoplasias Pancreáticas/cirurgia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pâncreas/patologia , Projetos Piloto , Reprodutibilidade dos Testes , Resultado do Tratamento , Ultrassonografia/métodosRESUMO
Acoustic radiation force impulse (ARFI) imaging is a new and promising ultrasound-based diagnostic technique that, evaluating the wave propagation speed, allows the assessment of the tissue stiffness. ARFI is implemented in the ultrasound scanner. By short-duration acoustic radiation forces (less than 1 ms), localized displacements are generated in a selected region of interest not requiring any external compression so reducing the operator dependency. The generated wave scan provides qualitative or quantitative (wave velocity values) responses. Several non-invasive methods for assessing the staging of fibrosis are used, in order to avoid liver biopsy. Liver function tests and transient elastography are non-invasive, sensitive and accurate tools for the assessment of liver fibrosis and for the discrimination between cirrhotic and non-cirrhotic liver. Many published studies analyse ARFI performance and feasibility in studying diffuse liver diseases and compare them to other diagnostic imaging modalities such as conventional ultrasonography and transient elastography. Solid focal liver lesions, both benign and malignant, are common findings during abdominal examinations. The accurate characterization and differential diagnosis are important aims of all the imaging modalities available today. Only few papers describe the application of ARFI technology in the study of solid focal liver lesions, with different results. In the present study, the existing literature, to the best of our knowledge, about ARFI application on diffuse and focal liver pathology has been evaluated and results and statistical analyses have been compared, bringing to the conclusion that ARFI can be used in the study of the liver with similar accuracy as transient elastography in diagnosing significant fibrosis or cirrhosis and has got some advantages in respect to transient elastography since it does not require separate equipment, better displays anatomical structures and measurements can be successfully carried out almost in every patient.
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Técnicas de Imagem por Elasticidade , Hepatopatias/diagnóstico por imagem , Fígado/diagnóstico por imagem , Animais , Biópsia , Humanos , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Valor Preditivo dos Testes , Prognóstico , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Acoustic Radiation Force Impulse Elastography is a new method for non-invasive evaluation of liver fibrosis. AIM: To evaluate the impact of elevated alanine aminotransferase levels on liver stiffness assessment by Acoustic Radiation Force Impulse Elastography. METHODS: A multicentre retrospective study including 1242 patients with chronic liver disease, who underwent liver biopsy and Acoustic Radiation Force Impulse. Transient Elastography was also performed in 512 patients. RESULTS: The best Acoustic Radiation Force Impulse cut-off for predicting significant fibrosis was 1.29 m/s in cases with normal alanine aminotransferase levels and 1.44 m/s in patients with alanine aminotransferase levels>5 × the upper limit of normal. The best cut-off for predicting liver cirrhosis were 1.59 and 1.75 m/s, respectively. Acoustic Radiation Force Impulse cut-off for predicting significant fibrosis and cirrhosis were relatively similar in patients with normal alanine aminotransferase and in those with alanine aminotransferase levels between 1.1 and 5 × the upper limit of normal: 1.29 m/s vs. 1.36 m/s and 1.59 m/s vs. 1.57 m/s, respectively. For predicting cirrhosis, the Transient Elastography cut-offs were significantly higher in patients with alanine aminotransferase levels between 1.1 and 5 × the upper limit of normal compared to those with normal alanine aminotransferase: 12.3 kPa vs. 9.1 kPa. CONCLUSION: Liver stiffness values assessed by Acoustic Radiation Force Impulse and Transient Elastography are influenced by high aminotransferase levels. Transient Elastography was also influenced by moderately elevated aminotransferase levels.
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Alanina Transaminase/sangue , Cirrose Hepática/diagnóstico por imagem , Fígado/diagnóstico por imagem , Adulto , Idoso , Área Sob a Curva , Biópsia , Estudos de Coortes , Técnicas de Imagem por Elasticidade , Feminino , Humanos , Fígado/patologia , Cirrose Hepática/sangue , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos RetrospectivosRESUMO
OBJECTIVE: The objective of our study was to evaluate the MDCT features of incidentally detected neuroendocrine tumors (NETs) of the pancreas, identify features that can predict tumor biology or aggressiveness and long-term outcome, and determine the incidence of "nonbenign" behavior. MATERIALS AND METHODS: In this retrospective study, 60 histologically verified pancreatic NETs incidentally detected with contrast-enhanced MDCT were included. Various MDCT features such as size, morphology, enhancement, and presence of calcifications were evaluated and were correlated with tumor biology on histopathology. The sensitivity, specificity, predictive values, and accuracy were calculated for MDCT features in predicting nonbenign biology and risk of recurrence. RESULTS: A total of 32 of 60 (53%) NETs were nonbenign: most were large (mean, 29.1 mm) with a solid or complex pattern. NET size of 3 cm or larger yielded a positive predictive value of 61% for nonbenign tumors and 100% when calcification was present. In 12 patients with recurrence, 92% of NETs were nonbenign. The presence of calcification, local invasion, main pancreatic duct dilatation, vascular invasion, and lymph node enlargement along with angioinvasion and a Ki-67 index greater than 2% on histology were associated with a nonbenign diagnosis and a higher risk of recurrence. CONCLUSION: Approximately 50% of incidental NETs show uncertain or malignant behavior. Solid tumors 3 cm or larger are commonly nonbenign; however, about 30% of tumors smaller than that size cutoff can be malignant. Nonbenign tumors and those with invasive features on MDCT have a higher incidence of recurrence.
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Tumores Neuroendócrinos/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Calcinose/diagnóstico por imagem , Meios de Contraste , Feminino , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/cirurgia , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Sensibilidade e EspecificidadeRESUMO
AIM: The aim of this international multicenter study was to evaluate the reliability of Acoustic Radiation Force Impulse (ARFI) elastography for predicting fibrosis severity, in patients with chronic hepatitis C. PATIENTS AND METHODS: We compared ARFI to liver biopsy (LB) in 914 patients (10 centers, 5 countries) with chronic hepatitis C. In each patient LB (evaluated according to the METAVIR score) and ARFI measurements were performed (median of 5-10 valid measurements, expressed in meters/second - m/s). In 400 from the 914 patients, transient elastography (TE) was also performed (median of 6-10 valid measurements, expressed in kiloPascals - kPa). RESULTS: Valid ARFI measurements were obtained in 911 (99.6%) of 914 cases. On LB 61 cases (6.7%) had F0, 241 (26.4%) had F1, 202 (22.1%) had F2, 187 (20.4%) had F3, and 223 (24.4%) had F4 fibrosis. A highly significant correlation (r=0.654) was found between ARFI measurements and fibrosis (p<0.0001). The predictive values of ARFI for various stages of fibrosis were: F ≥ 1 - cut-off>1.19 m/s (AUROC=0.779), F ≥ 2 - cut-off>1.33 m/s (AUROC=0.792), F ≥ 3 - cut-off>1.43 m/s (AUROC=0.829), F=4 - cut-off>1.55 m/s (AUROC=0.842). The correlation with histological fibrosis was not significantly different for TE in comparison with ARFI elastography: r=0.728 vs. 0.689, p=0.28. TE was better than ARFI for predicting the presence of liver cirrhosis (p=0.01) and fibrosis (F ≥ 1, METAVIR) (p=0.01). CONCLUSION: ARFI elastography is a reliable method for predicting fibrosis severity in chronic hepatitis C patients.
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Técnicas de Imagem por Elasticidade/métodos , Técnicas de Imagem por Elasticidade/estatística & dados numéricos , Hepatite C Crônica/diagnóstico por imagem , Hepatite C Crônica/epidemiologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/epidemiologia , Comorbidade , Feminino , Humanos , Internacionalidade , Masculino , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
AIM: To describe the typical CEUS pattern of pancreatic lesions and to evaluate the diagnostic accuracy of Contrast-enhanced ultrasound (CEUS) in their characterization. MATERIALS AND METHODS: All US and CEUS examinations of focal pancreatic masses performed in six centers during a period of five years were reviewed. Inclusion criteria were: focal pancreatic mass pathologically proved, visible at ultrasound (US) and studied with CEUS. All lesions were then evaluated for size, aspect and enhancement pattern. Sensitivity, specificity, positive and negative predictive values with 95% CIs were calculated to define diagnostic accuracy of CEUS in respect to pathology. Diagnostic confidence of US and CEUS, discerning between benign and malignant lesions, were represented by using ROC (receiver operating characteristics) curves. Agreement was evaluated by means of k statistics. RESULTS: 1439 pancreatic lesions were included. At CEUS the lesions were divided into solid (89%) and cystic (12%) masses and classified into six and eight categories, respectively. Among the solid lesions, adenocarcinomas were characterized with an accuracy of 87.8%. Among the cystic lesions, cystic tumors were diagnosed with an accuracy of 97.1%. ROC curve area increased from 0.637 for US to 0.877 for CEUS (p<0.0001). Inter-observer agreement was slightly higher for solid (k=0.78) than cystic (k=0.62) lesions. In none of the centers side effects were reported. CONCLUSION: CEUS is accurate in the characterization of pancreatic lesions. CEUS should be considered as a complementary imaging method for pancreatic lesions characterization.
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Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/epidemiologia , Ultrassonografia/estatística & dados numéricos , Feminino , Humanos , Internacionalidade , Masculino , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Sensibilidade e EspecificidadeRESUMO
Early allograft calcifications after kidney transplantation (KT) have already been reported, but the clinical implications of this finding are not clear thus far. Patient-related factors such as age, gender, underlying renal disease, and dialytic modality, seem to be irrelevant. It has been postulated that factors promoting the development of metastatic calcifications, including elevated calcium phosphate product and severe secondary hyperparathyroidism, could play a causal role. Here we report a case of a KT patient who developed early kidney calcifications which were associated with severe allograft dysfunction.
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Calcinose/etiologia , Necrose Papilar Renal/etiologia , Transplante de Rim/efeitos adversos , Rim/patologia , Calcinose/diagnóstico por imagem , Feminino , Humanos , Hiperparatireoidismo/complicações , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Disfunção Primária do Enxerto/etiologia , Tomografia Computadorizada por Raios X , Transplante HomólogoRESUMO
The introduction of contrast-enhanced ultrasonography (CEUS) has led to major improvements in the diagnostic capabilities of ultrasound (US). The innovative use of CEUS for study of the pancreas has created the need for a definition of the most frequent dynamic features of solid and cystic masses. CEUS is less expensive compared to computed tomography and magnetic resonance imaging and is able to significantly improve the accuracy of US, allowing better characterization and staging of pancreatic pathologies.
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Radiofrequency ablation (RFA) of pancreatic neoplasms is restricted to locally advanced, non-resectable but non-metastatic tumors. RFA of pancreatic tumors is nowadays an ultrasound-guided procedure performed during laparotomy in open surgery. Intraoperative ultrasound covers the mandatory role of staging, evaluation of feasibility, guidance and monitoring of the procedure. Different types of needle can be used. The first aim in the evaluation of RFA as a treatment for locally advanced pancreatic ductal adenocarcinoma, in order of evaluation but not of importance, is to determine the feasibility of the procedure. The second aim is to establish the effect of RFA on tumoral mass in terms of necrosis and cytoreduction. The most important aim, third in order of evaluation, is the potential improvement of quality of life and survival rate. Nowadays, only a few studies assess the feasibility of the procedure. The present paper is an overview of RFA for pancreatic adenocarcinoma.
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Adenocarcinoma/cirurgia , Ablação por Cateter/métodos , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Humanos , Necrose , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Qualidade de Vida , Taxa de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of this study was to describe the most reliable measurement procedure for acoustic radiation force impulse technology and to define the normal wave velocity values in a healthy liver. SUBJECTS AND METHODS: Twenty healthy volunteers underwent acoustic radiation force impulse imaging tissue quantification and were enrolled in this prospective study. All patients were examined by two independent operators at the same time. Twenty-four measurements per subject were obtained. Intraoperator and interoperator evaluations were performed. Statistical comparison of all mean data was performed with Student's t test. A value of p < 0.05 was considered significant. A comparative analysis was performed, and interclass correlation coefficients were calculated. RESULTS: The operators obtained 960 measurements. A statistically significant difference was found between the mean shear wave velocity values obtained by one operator deep in the right lobe of the liver and the values obtained on the surface of the right lobe (1.56 vs 1.90 m/s) and between the mean values obtained deep in the right lobe and those obtained deep in the left lobe (1.56 vs 1.84 m/s). The other operator had similar results. The distribution of all mean values obtained by both operators deep in the right hepatic lobe exhibited less dispersion (95% CI, 1.391-1.725) than those obtained on the surface (95% CI, 1.664-2.136). In 77.5% of cases, the shear wave speeds were between 1 and 2 m/s. No statistically significant difference was found in the comparisons performed on the right hepatic lobe by the two operators. The interclass correlation coefficient calculated for measurements deep in the right lobe was 0.87 (p < 0.0001). CONCLUSION: Acoustic radiation force impulse imaging quantification of hepatic tissue is more reproducible when applied to the deeper portion of the right lobe of the liver.