3D TEE for ASD at MEDIC

INCIDENTAL FOCAL HEPATIC MASS

Findings

CT revealed a hypervascular mass in the sixth segment of the liver during arterial enhancement (Figure 1a). This lesion exhibited slight hypointensity on pre-contrast T1 weighted MRI (Figure 2a). The anterior portion of this lesion demonstrated a similar degree of enhancement  to the surrounding liver parenchyma (Figure 2b, arrow), while the posterior portion exhibited reduced enhancement (Figure 2b, arrowhead).

Diagnosis

The patient underwent the right posterior segmentectomy. The surgical specimen was a well-demarcated, round mass measuring 4.5 cm in diameter (Figure 3a).

Histological diagnosis of both portions was moderately differentiated hepatocellular carcinoma (HCC). However, the microscopic specimen obtained at the junction of the tumour consisted of two different subtypes (Figure 3b): pseudoglandular (Figure 3c) and microtrabecular (Figure 3d). On immunochemical staining, the tumour cells were positive for Glycan, CD13 and CD34, but negative for AFP and CK19.

Discussion

HCC occurs frequently in patients with chronic liver disease, which is related with viral hepatitis B and C. Gd-EOB-DTPA is a newly developed hepatocyte-specific  agent, which transports into the hepatocyte through organic anion transporting polypeptides (OATPs) and is excreted into bile through canalicular multiorganic anion transporters [1, 2]. Because Gd-EOB-DTPA uptake is usually reduced in HCC cells, this agent may help estimate histological grading [3]. To the best of our knowledge, there have been few reports of the simultaneous high and low accumulation of Gd-EOB-DTPA in solitary and moderately differentiated HCC. Recently, it has been proposed that OATP 1B1/3 mediates the uptake of Gd-EOB-DTPA from sinusoid to tumour, whereas the multidrug resistance-associated protein 2 (MRP2) mediates the secretion of Gd-EOB-DTPA from tumour to lumen [4].

Although the histological findings of most tumour cells display some degree of Gd-EOB-DTPA content, HCCs exhibit different levels of enhancement on Gd-EOB-DTPA-enhanced MRI according to the positive expression of the two transporters. Therefore, awareness of these properties may contribute to the accurate diagnosis of HCC.

PEDIATRIC and ADOLESCENT BREAST MASSES

OBJECTIVE. Pediatric breast masses are relatively rare and most are benign. Most are either secondary to normal developmental changes or neoplastic processes with a relatively benign behavior. To fully understand pediatric breast disease, it is important to have a firm comprehension of normal development and of the various tumors that can arise. Physical examination and targeted history (including family history) are key to appropriate patient management. When indicated, ultrasound is the imaging modality of choice. The purpose of this article is to review the benign breast conditions that arise as part of the spectrum of normal breast development, as well as the usually benign but neoplastic process that may develop within an otherwise normal breast. Rare primary carcinomas and metastatic lesions to the pediatric breast will also be addressed. The associated imaging findings will be reviewed, as well as treatment strategies for clinical management of the pediatric patient with signs or symptoms of breast disease.

CONCLUSION. The majority of breast abnormalities in the pediatric patient are benign, but malignancies do occur. Careful attention to patient presentation, history, and clinical findings will help guide appropriate imaging and therapeutic decisions.

VIÊM TÚI MẬT HOẠI TỬ: DẤU HIỆU SIÊU ÂM DÀY VÁCH TÚI MẬT và TĂNG BẠCH CẦU

OBJECTIVE. The purpose of our study was to determine, first, if gallbladder wall striations in patients with sonographic fndings suspicious for acute cholecystitis are associated with gangrenous changes and certain histologic features; and, second, if WBC count or other sonographic fndings are associated with gangrenous cholecystitis.

MATERIALS AND METHODS. Sixty-eight patients who underwent cholecystectomies within 48 hours of sonography comprised the study group. Sonograms and reports were reviewed for wall thickness, striations, Murphy sign, pericholecystic fluid, wall irregularity, intraluminal membranes, and luminal short-axis diameter. Medical records were reviewed for WBC count and pathology reports for the diagnosis. Histologic specimens were reviewed for pathologic changes. Statistical analyses tested for associations between nongangrenous

and gangrenous cholecystitis and sonographic fndings and for associations between wall striations and histologic features.

RESULTS. Ten patients had gangrenous cholecystitis and 57, nongangrenous cholecystitis. One had cholesterolosis. Thirty patients had wall striations: 60% had gangrenous and 42% nongangrenous cholecystitis. There was no association with the pathology diagnosis (p = 0.32). There was no association between any histologic feature and wall striations (p ≥ 0.19).

A Murphy sign was reported in 70% of patients with gangrenous cholecystitis and in 82% with nongangrenous cholecystitis; there was no association with the pathology diagnosis (p = 0.39). Wall thickness and WBC count were greater in patients with gangrenous cholecystitis than in those with nongangrenous cholecystitis (p ≤ 0.04).

CONCLUSION. Gallbladder wall thickening and increased WBC counts were associated with gangrenous cholecystitis; however, there was considerable overlap between the two groups. Wall striations and a negative Murphy sign were not associated with gangrenous cholecystitis.

ĐO ĐỘ XƠ HÓA GAN BẰNG TỐC ĐỘ TRUYỀN ÂM

Đọc thêm "Phát hiện xơ hoá gan bằng cách đo tốc độ truyền âm"

Low-field MRI versus Ultrasound in bone damage in MCP and MTP Rheumatoid Arthritis Joints

Low-field MRI versus ultrasound: which is more sensitive in detecting inflammation and bone damage in MCP and MTP joints in mild or moderate rheumatoid arthritis?

Schmidt WA, Schicke B, Ostendorf B, Scherer A, Krause A, Walther M.