Tumor thrombosis of the portal vein was identified retrospectively with computed tomography (CT) in four patients aged 66-77 years with gastric adenocarcinoma. Surgical, clinical, histopathologic, laboratory, and imaging findings were analyzed. Three patients showed an elevated alpha-fetoprotein (AFP) level (230-1,560 ng/mL [230-1,560 micrograms/L]). Immunohistochemical study revealed that AFP was produced by gastric carcinoma in two patients. Multiple metastatic foci in the liver appeared on CT and ultrasound (US) scans in all four patients. Echogenic thrombus was identified in three. There were no CT or US features that enabled differentiation of neoplastic from nonneoplastic thromboses. Angiography showed tumor vessels in only one patient: The thrombus was hypervascular in the arteriocapillary phase of celiac angiography but could not be differentiated from a much more common tumor thrombus seen in hepatocellular carcinoma. Nevertheless, gastric carcinoma should be considered a possibility in the diagnosis of portal venous tumor thrombosis, even if the serum AFP level is elevated and a liver tumor is identified.
We report an unusual case of multilocular cystic cavernous hemangioma of the liver. The patient was a 61-year-old woman without liver disfunction but who had multicystic mass lesions in the liver. Although cavernous hemangiomas are usually accurately diagnosed by the various imaging modalities, our case showed atypical features.
Twenty-seven consecutive cases with a prospective diagnosis of cancer of the gallbladder were analyzed to clarify the computed tomographic (CT) and ultrasonographic features, behavior, and prognosis of intraluminal papillary carcinoma (n = 7) of the organ. With CT and ultrasonography, these intraluminal carcinomas were further classified into 3 subtypes: single polyp, multiple polyp, and jam-packed gallbladder. Preoperative diagnosis, evaluation of local invasiveness, and detection of metastatic lesions were reliably done. Carcinomas of this type were locally less invasive, less frequently metastasized, and resulted in a longer survival than the other massive and thickened-wall carcinomas.
Magnetic resonance (MR) features of five primary malignant mesenchymal neoplasms (plasmocytoma, leiomyosarcoma, undifferentiated sarcoma, epithelioid hemangioendothelioma, and angiosarcoma) of the liver were reported. All tumors were hypointense on T1-weighted images and hyperintense on T2-weighted images. No halo and intravenous extension were noted. A target appearance was revealed in epithelioid hemangioendothelioma. MR findings of angiosarcoma were essentially the same as those of cavernous hemangiomas (markedly hyperintense with hypointense linear septa on T2-weighted images). MR findings of these rare hepatic malignancies were nonspecific, although they were quite different from those of typical hepatocellular carcinomas. This study suggested that MR differentiation of primary hepatic mesenchymal tumors from other common benign and malignant neoplasms was difficult; however, the number of studied cases was limited.
Direct communication between portal branches and the hepatic vein [macroscopic intra-hepatic portal-hepatic venous shunt (IPHVS)] is a rare entity. We have recently studied five patients with this condition. Magnetic resonance imaging (MRI) clearly demonstrated in each case the portal-hepatic venous shunt due to "flow void." Multiple diffuse shunts were present in one case and a solitary shunt was demonstrated in the others. The solitary shunt was either tubular, focally dilated or racemose in configuration. The MRI findings and clinical significance of this rare entity are discussed.
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