Metastatic liver tumor with tumor thrombi of the portal vein

Tumor thrombi of the portal vein are an important prognostic indicator for primary hepatocellular carcinoma (hepatoma), and their presence is a major criterion in differentiating intrahepatic tumors. We report four cases of metastatic liver tumors with tumor thrombi, one a gastric tumor and the others colorectal cancers, two of which were difficult to differentiate from hepatoma. The angiographic features of hepatoma are reviewed and differentiation between the two is discussed. Angiography showed the vessels of metastatic liver tumors to be of fine to mixed types. Chaotic vessels and pooling are characteristic of hepatomas, and dense tumor stains are observed only in hepatomas. The mean survival period after angiography was 3.8 months, and the prognosis was not favorable in patients having "thread-and-streak" sign on angiography.     

Scoop biopsy of intracaval tumor thrombi: a preliminary report of a minimally invasive technique to obtain large samples

Purpose: the purpose of this study is to safely improve the yield of intracaval biopsy. Materials amd Method: A co-axial system was composed of an inner catheter with a smoothly tapered tip with a shark jaw, and an outer sheath. The biopsy procedure consisted of four steps: (1) the tip was stuck into the target thrombi; (2) the inner sheath was advanced deeply into the target and the jaw was opened within the mass; (3) the outer sheath was advanced to envelope the inner cather; (4) then the system was withdrawn. After simulation experiments seven patients underwent this scoop biopsy. Results: A simulation experiment proved that this technique brought much larger samples with minimal damage of the target surface. Seven patients who had been suspected of intracaval tumor thrombi underwent this procedure and confidental pathological examination without any complications. Conclusion: This scoop biopsy procedure was thought to be helpful in obtaining large samples safely.     

Transcatheter biopsy of lesions obstructing the bile ducts

A method was developed for biopsy sampling of masses obstructing the biliary system in patients with a biliary drainage catheter. The biopsy needle is inserted through the drainage catheter, with fluoroscopic guidance, to the site of the lesion. The technique has been used without complication in more than 30 patients with cancer of the pancreas and bile ducts.     

Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis

Percutaneous insertion of a permanent internal prosthesis for biliary tract decompression was successful in 15 patients with obstructive jaundice. Percutaneous brush biopsy of the obstructing lesion that preceded stent placement in six patients was successful in obtaining diagnostic tissue in four. Both techniques are described in detail with illustrative cases.     

肝细胞癌合并胆管癌栓的影像表现

目的 探讨胆管癌栓的影像表现,以提高影像诊断水平.方法 回顾性分析经手术病理证实的肝细胞癌(HCC)胆管癌栓13例患者资料,其中3例进行了CT和MR检查,2例仅行CT检查,8例仅行MR检查,7例进行了MR胰胆管成像检查,13例均进行了超声检查.采用四格表Fisher 确切概率检验方法比较超声与CT、MR诊断HCC胆管癌栓的准确性.结果 13例HCC肿瘤及胆管癌栓均在CT或MRI上显示.4例胆管癌栓在CT上表现为胆管内软组织块影,动脉期可见癌栓轻度增强,癌栓远端胆管扩张.11例胆管癌栓在T1 WI上均呈稍低信号,T2 WI为稍高信号,增强后可见轻、中度强化.MR胰胆管成像上胆管癌栓表现为:胆管阻塞中断、狭窄或不规则充盈缺损伴有梗阻上方胆管扩张,胆管突然截断或呈"鼠尾"状(5例);肝内胆管扩张,癌栓充满整个胆总管.胆总管不显示(2例).超声检查准确诊断胆管癌栓7例,误、漏诊6例.CT、MRI准确诊断12例,误诊4例,超声与CT、MRI诊断胆管癌栓差异无统计学意义(P=0.270).结论 CT或MRI对诊断HCC合并胆管癌栓及明确癌栓范围有价值.     

Percutaneous biopsy and tumor ablation

This article reviews indications and localization methods for percutaneous biopsy, as well as its complications. The choice of imaging methods for localizing a biopsy is discussed, and the advantages and disadvantages of various biopsy needle types and sizes and those of devices used with the needles are reviewed, including the success achieved with the automated biopsy gun. In the area of image-directed tumor ablation, which has primarily focused on liver tumors, transcatheter embolization and direct tumor ablation are discussed.     

Arteriographic demonstration of intravenous tumor extension.

The arteriographic demonstration of a linear, striated arterial pattern in the anatomic course of the draining vein is reliable evidence of venous extension by a tumor and represents the supply to the intravenous component of the neoplasm. In addition to its previously described occurrence with hypernephromas, this report documents the characteristic angiographic appearance with hepatocellular tumors and a retroperitoneal osteosarcoma as reliable evidence of tumor extension into the inferior vena cava. It is possible that in some cases, the parallel arteries represent markedly enlarged vasa vasorum of the involved venous structure. The frequent invasion of the inferior vena cava by hepatomas and the importance of inferior vena cavography in their angiographic evaluation is also emphasized.     

阻塞性黄疸:经皮穿刺胆道造影下胆道钳夹活检与毛刷活检对比研究

目的 比较胆道钳夹与毛刷活检的诊断敏感率,探索胆道疾病病理学检查新途径。方法 连续92例阻塞性黄疸接受经皮肝穿胆道造影(PTC)和经皮肝穿胆道引流(PFCD)治疗。PFCD过程中,影像监测下经皮经肝胆道穿刺,向胆道内引入活检钳和毛刷对梗阻段钳夹和毛刷活检,行组织病理学和细胞检查。结果92例钳夹活检患者90例成功获得组织块,技术成功率97．8％(90／92)。钳夹活检敏感率较毛刷活检敏感率高(88．0％比76．2％,X^2=4．251,P=0．039)。结论 PTC下胆道钳夹活检操作简单,创伤小,敏感度高,是一种值得推广的胆道病理学诊断新途径,毛刷活检在胆管癌的诊断方面也具有较高的应用价值。     

Photodiagnosis for frameless stereotactic biopsy of brain tumor

Stereotactic biopsy is a minimally invasive method of reaching a pathological diagnosis. However, it is not always possible with this method to obtain the tissue samples required for an exact pathological diagnosis. The factors that can make histological diagnoses uncertain are the heterogeneity of tumors and/or brain shifts in the case of small tumors. In this study, we investigated the usefulness of fluorescence in determining the existence of tumor components in obtained tissues. Six patients underwent stereotactic biopsy. 5-Aminolevulinic acid (5-ALA) was administered orally prior to operation. Frameless stereotactic biopsies were performed. The obtained samples were irradiated with 405 nm light and all samples showed red light excitation. Intraoperative rapid pathological diagnosis was made in each case by microscopic examination of frozen section samples. The final pathological diagnoses were of three glioblastomas, one astrocytoma grade 3, and two malignant lymphomas. One case was initially thought to be gliosis on rapid pathological diagnosis, but the final pathological diagnosis reached by examination of a permanent HE stained section was astrocytoma grade 3. Another case, finally diagnosed as malignant lymphoma, was initially diagnosed as infiltration of lymphocytes. The discrepancies between rapid and permanent pathological diagnoses might be caused by the destruction of cells. 5-ALA photodynamic diagnosis is not influenced by the destruction of tissues, simply because it does not depend on the structure of tissues. Stereotactic fluorescence biopsy is very useful in that it enables rapid and exact biopsy and obviates the necessity of waiting for an intraoperative report from a pathologist.     

肝动脉化疗栓塞治疗原发病灶切除的胰腺神经内分泌肿瘤肝转移疗效分析

【摘要】 目的 探讨TACE对于已经切除原发病灶的胰腺神经内分泌肿瘤肝转移（neuroendocrine neoplasm liver metastasis, NELM）的疗效。方法 回顾分析2014年6月至2018年6月诊治的21例胰腺NELM患者入组进行研究,所有病例均行原发病灶切除后针对肝脏病灶进行65例次TACE治疗。分析临床疗效,安全性和有效性;根据影像学检查后实体瘤反应评价标准评价病灶疗效;并随访无疾病生存期（PFS）和总生存期（OS）情况。 结果 所有患者均顺利完成TACE治疗,有效率为81.0%（17/21）;影像学评价中17例达到部分缓解,3例病情稳定,1例出现疾病进展;PFS为（16.6±6.5）个月,OS为（28.0±11.8）个月,所有手术均未出现严重并发症。 结论 TACE治疗原发病灶切除后的胰腺NELM安全有效,其可能因降低肿瘤负荷、阻断分泌功能提高总生存率而获得更多获益。     

Fluoroscopic percutaneous brush cytology,forceps biopsy and both in tandem for diagnosis of malignant biliary obstruction

Objectives

To evaluate percutaneous brush cytology, forceps biopsy and a tandem procedure consisting of both, in the diagnosis of malignant biliary obstruction.

Methods

A retrospective review of consecutive patients who underwent biliary brush cytology and/or forceps biopsy between 01/2010 and 09/2014 was performed. The cytology and pathology results were compared to the composite outcome (including radiological, pathological and clinical data). Cost for tandem procedure compared to brush cytology and forceps biopsy alone was calculated.

Results

A total of 232 interventions in 129 patients (70.8?±?11.0 years) were included. Composite outcome showed malignancy in 94/129 (72.9%) patients. Sensitivity for brush cytology, forceps biopsy and tandem procedure was 40.6% (95% CI 32.6–48.7%), 42.7% (32.4–53.0%) and 55.8% (44.7–66.9%) with 100% specificity, respectively. There were 9/43 (20.9%) additional cancers diagnosed when forceps biopsy was performed in addition to brush cytology, while there were 13/43 (30.2%) more cancers diagnosed when brush cytology was performed in addition to forceps biopsy. Additional costs per additionally diagnosed malignancy if tandem approach is to be utilised in all cases was $704.96.

Conclusion

Using brush cytology and forceps biopsy in tandem improves sensitivity compared to brush cytology and forceps biopsy alone in the diagnosis of malignant biliary obstruction.

Key points

? Tandem procedure improves sensitivity compared to brush cytology and forceps biopsy. ? Brush cytology may help to overcome “crush artefacts” from forceps biopsy. ? The cost per diagnosed malignancy may warrant tandem procedure in all patients.