Aim. To study the vascularity and malignancy degrees of hepatocellular carcinoma using spiral computed tomography angiography considering its morphological differentiation and tumor size. Methods. A comprehensive clinical and radiological examination of 300 patients (males - 170 (56.6%), females - 130 (43.4%), mean age 52.0±3.2 years) with hepatocellular carcinoma, who were picked out from 2550 patients with malignancies treated in 2005-2013, was performed. Liver cirrhosis was diagnosed in 70 (23.33%) out of 300 patients with hepatocellular carcinoma. The features of tumor bloodflow were assessed using color Doppler ultrasonography and spiral computed tomography angiography (by 4 phases of examination) considering tumor size and tumor morphological differentiation. Results. According to the morphological study results of samples from 123 patients, high-grade differentiated hepatocellular carcinoma was diagnosed in 40 patients, moderately differentiated - in 53, poorly differentiated - in 30 patients. A correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. The difference in high-grade differentiated hepatocellular carcinoma maximal computed tomography density increment gradients at arterial phase compared to liver parenchyma maximal computed tomography density increment was 17 Hounsfield units in tumors sized up to 5 cm and 12 Hounsfield units in 32 (80%) of 40 patients with tumors sized over 5 cm. Thus, high-grade differentiated hepatocellular carcinoma was associated with increased vascularity in 80.0%, normal vascularity - in 8.0%, low vascularity - in 12.0% of cases. The difference in moderately differentiated hepatocellular carcinoma computed tomography density increment gradients compared to liver parenchyma was assessed as 20 and 25 Hounsfield units in tumors with the corresponding size in 45 (89.4%) out of 53 patients. Moderately differentiated hepatocellular carcinoma was associated with increased vascularity in 89.4%, normal vascularity - in 4.0%, low vascularity - in 6.6% of cases. Poorly differentiated hepatocellular carcinoma was associated with increased vascularity only in 7 out of 30 patients. Conclusion. The correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. Increased vascularity was observed in high-grade differentiated and moderately differentiated hepatocellular carcinoma, low vascularity - mainly in poorly differentiated hepatocellular carcinoma.
Choosing a treatment option for uterine fibroids is today one of the most relevant problems in gynecological practice. Thanks to the success of modern medicine and the increased level of the population’s culture, female patients seek medical help without waiting for the tumor to acquire significant sizes. However, in practice, there are cases when fibroids reach gigantic sizes. Hysterectomy is a traditional approach to treating uterine fibroids of these sizes according to the current clinical guidelines. The introduction of new high-tech treatments, such as uterine artery embolization, has led to a revision of radical surgery, by giving preference to alternative approaches especially in cases where the patient desires to preserve the reproductive organ. The paper describes a clinical case that confirms an individual approach to choosing a treatment option towards organ-sparing surgery for giant uterine fibroids. The use of endovascular embolization of the uterine arteries as a treatment for giant uterine fibroids is shown to be justified as an organ-sparing surgery if the patient desires to preserve reproductive function.
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