Enucleation Sign: A Computed Tomographic Appearance of Ruptured Hepatocellular Carcinoma

Singhal, Manphool; Sinha, Upasna; Kalra, Naveen; Duseja, Ajay; Khandelwal, Niranjan

doi:10.1016/j.jceh.2016.05.004

Cited by 14 publications

(12 citation statements)

References 11 publications

(13 reference statements)

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“…There are many findings on TPCT which suggest rupture of HCC, such as peripherally located tumor with a contour bulge, discontinuity of the liver capsule, hemoperitoneum, subcapsular hematoma, active extravasation of contrast, and "enucleation sign". [58][59][60][61][62][63] The "enucleation sign" (Figure 2) is defined as separation of tumor content with intraperitoneal rupture into the perihepatic space which is seen as a non enhancing low attenuating lesion with peripheral rim enhancement. [61][62][63] Low attenuation is due to extensive loss of blood from the tumor and arterial vasoconstriction and ischemic changes secondary to hypovolemic shock.…”

Section: Computed Tomography Scanmentioning

confidence: 99%

“…[58][59][60][61][62][63] The "enucleation sign" (Figure 2) is defined as separation of tumor content with intraperitoneal rupture into the perihepatic space which is seen as a non enhancing low attenuating lesion with peripheral rim enhancement. [61][62][63] Low attenuation is due to extensive loss of blood from the tumor and arterial vasoconstriction and ischemic changes secondary to hypovolemic shock. Rim enhancement is due to compressed normal liver parenchyma and does not represent the tumor.…”

Section: Computed Tomography Scanmentioning

confidence: 99%

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Rupture of Hepatocellular Carcinoma: A Review of Literature

Sahu

Chawla

Dhiman

et al. 2019

Journal of Clinical and Experimental Hepatology

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110

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Approximately 700,000 people die of Hepatocellular Carcinoma (HCC) each year worldwide, making it the third leading cause of cancer related deaths. Rupture is a potentially life-threatening complication of HCC. The incidence of HCC rupture is higher in Asia and Africa than in Europe. In Asia approximately 10% of patients with a diagnosis of HCC die due to rupture each year. Spontaneous rupture is the third most common cause of death due to HCC after tumor progression and liver failure. The diagnosis of rupture in patients without history of cirrhosis or HCC may be difficult. The most common symptom of ruptured HCC is abdominal pain (66-100%). Shock at presentation can be seen in 33-90% of cases; abdominal distension is reported in 33%. Abdominal paracentesis documenting hemoperitoneum is a reliable test to provisionally diagnose rupture of HCC, it can be seen in up to 86% of clinically suspected cases. The diagnoses can be confirmed by computed tomography scan or ultrasonography, or both in 75% of cases. Careful pre-treatment evaluation is essential to decide the best treatment option. Management of ruptured HCC involves multidisciplinary care where hemostasis remains a primary concern. Earlier studies have reported a mortality rate of 25-75% in the acute phase of ruptured HCC. However, recent studies have reported a significant decrease in the incidence of mortality. There is also a decrease in the incidence of ruptured HCC due to improved surveillance and early detection of HCC. Transarterial Embolization is the least invasive method to effectively induce hemostasis in the acute stage with a success rate of 53-100%. Hepatic resection in the other hand has the advantage of achieving hemostasis and in the same go offers a potentially curative resection in selected patients. (J CLIN EXP HEPATOL 2019;9:245-256) INCIDENCE The reported incidence of HCC rupture shows a distinct global variation. In the West, the incidence of HCC is increasing but HCC ruptures are relatively uncommon, with an incidence of less than 3%. 12-14 However, in Asia and Africa, the incidence is considerably higher, ranging between 3% and 26%. 14,15 The incidences of ruptured HCC reported from around the globe are 10% from Japan, 12.4% from Thailand, 12.7% from southern Africa, 14.5% from

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Section: Computed Tomography Scanmentioning

confidence: 99%

Section: Computed Tomography Scanmentioning

confidence: 99%

Rupture of Hepatocellular Carcinoma: A Review of Literature

Sahu

Chawla

Dhiman

et al. 2019

Journal of Clinical and Experimental Hepatology

Self Cite

110

View full text Add to dashboard Cite

show abstract

“…The CT findings of ruptured HCC may include hemoperitoneum, HCC with surrounding perihepatic hematoma, active extravasation of contrast material, or the enucleation sign. [ 26 ] Generally, intrahepatic hematoma presents a homogeneous enhancement that could differentiate it from ruptured HCC. However, some benign disease-related ruptures mimic HCC.…”

Section: Discussionmentioning

confidence: 99%

Massive hemoperitoneum and upper gastrointestinal hemorrhage following liver rupture secondary to gallbladder perforation

Xiang

Liu

et al. 2019

Medicine

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Rationale:Available literature states that the common reasons for non-traumatic spontaneous liver rupture are hepatocellular carcinoma, macronodular cirrhosis, hemangioma, and other tumors; gallbladder perforation is not cited as a cause.Patient concerns:The patient presented with sudden-onset right upper quadrant pain with tarry stool for 3 days after eating with dysphoria and increasing thirst; gradually, hemorrhagic shock developed. He had no history of trauma, no background of chronic hepatitis, and no cirrhosis.Diagnosis:Hemorrhage secondary to spontaneous rupture of intrahepatic cholangiocarcinoma.Interventions:Left hemihepatectomy, cholecystectomy, and common bile duct exploration were performed.Outcomes:The patient was diagnosed with massive hemoperitoneum accompanying upper gastrointestinal hemorrhage following liver rupture secondary to gallbladder perforation. The postoperative course was uneventful and the patient was discharged after 10 days of hospitalization.Lessons:If patients present with non-traumatic spontaneous liver rapture accompanying cholelithiasis and gallbladder hematoma, gallbladder perforation should be considered as a differential diagnosis. Misdiagnosis can lead to incorrect treatment.

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“…The enucleation phenomena is well described for erythroid terminal differentiation process and there is also used a term in the literature "enucleation sign" that is specific for enhanced computed tomographic images of the ruptured hepatocellular carcinoma. The definition for this term is "the separation of tumor content with intraperitoneal rupture into the perihepatic space, which is seen as low attenuating lesion from peripheral enhancing rim on arterial phase imaging" [107]. The process observed by Paunescu et al was described as a non-physiological process and it was unrelated with the process described for erythroblast enucleation [106].…”

Section: Magnetic Iron Oxide Nanoparticles Effect On Cancer Cellsmentioning

confidence: 99%

Preclinical Aspects on Magnetic Iron Oxide Nanoparticles and Their Interventions as Anticancer Agents: Enucleation, Apoptosis and Other Mechanism

Moacă¹,

Coricovac²,

MarinelaSoica³

et al. 2018

Iron Ores and Iron Oxide Materials

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The broad area of magnetic iron oxide nanoparticle (M-IONP) applications and their exclusive physico-chemical characteristics (superparamagnetic properties per se, solubility and stability in aqueous solutions, and high bioavailability in vivo) make these nanoparticles suitable candidates for biomedical uses. The most employed magnetic iron oxides in the biomedical field are magnetite and maghemite. Cancer represents a complex pathology that implies multiple mechanisms and signaling pathways, this complexity being responsible for the increased resistance to therapy and the lack of an effective curative treatment. A potential useful alternative was considered to be the use of magnetic iron nanoparticles. The M-IONPs proved to be effective as contrast agents in magnetic resonance imaging, as drug delivery carriers for different therapeutic agents, in magnetic cell separation assays, and are suitable to be engineered in terms of size, targeted delivery and substance release. Moreover, their in vivo administration was considered safe, and recent studies indicated their efficiency as anticancer agents. This chapter aims to furnish an overview regarding the physico-chemical properties of M-IONPs (mainly magnetite, maghemite and hematite), the synthesis methods and their in vitro biological impact on healthy and cancer cell lines, by describing their potential mechanism of action-enucleation, apoptosis or other mechanisms.

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Enucleation Sign: A Computed Tomographic Appearance of Ruptured Hepatocellular Carcinoma

Cited by 14 publications

References 11 publications

Rupture of Hepatocellular Carcinoma: A Review of Literature

Rupture of Hepatocellular Carcinoma: A Review of Literature

Massive hemoperitoneum and upper gastrointestinal hemorrhage following liver rupture secondary to gallbladder perforation

Preclinical Aspects on Magnetic Iron Oxide Nanoparticles and Their Interventions as Anticancer Agents: Enucleation, Apoptosis and Other Mechanism

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