Nodular hepatic involvement of multiple myeloma is very rare. We report a case of nodular hepatic involvement of multiple myeloma, mimicking hypervascular hepatocellular carcinoma.
Carcinoma, Hepatocellular/blood supply/*diagnosis ; Diagnosis, Differential ; English Abstract ; Human ; Liver Neoplasms/blood supply/*diagnosis ; Male ; Middle Aged ; Multiple Myeloma/*diagnosis

OBJECTIVEThe purpose of this study was to compare MRI findings of solitary hypovascular hepatic nodules, benign and malignant, to identify their MRI characteristics.

METHODSWe retrospectively assessed solitary hypovascular hepatic nodules ≤ 3 cm in 135 patients, among them there were 55 malignant nodules [29 peripheral nodules of cholangiocarcinoma, PCC, and 26 hepatic metastases, HM] and 80 benign nodules [48 inflammatory myofibroblastic tumors, IMT, and 32 hepatic hemangioma, HG], proved by surgery, biopsy or follow-up imaging. Unenhanced and dynamic enhanced MRI findings of the 135 patients were analyzed retrospectively. Statistical analysis included Chi-square test or Fisher's exact test, and receiver operating characteristic (ROC) curve.

RESULTSThere was significant difference (P < 0.05) between the malignant group and benign group in terms of location, margin, T2WI signal intensity, heterogeneity or homogeneity of the nodule, and type and degree of peritumoral and intratumoral enhancement. Area under the curve at the first film reading by three radiologists was 0.678 ± 0.047, 0.920 ± 0.022 at the second time, and there was a significant difference (Z = 5.22, P < 0.05) between them.

CONCLUSIONSOur data indicated that solitary hypovascular hepatic nodules show unenhanced and dynamic enhanced MRI features. Therefore, MR imaging combined with clinical and biochemical data does provide reliable information for a proper diagnosis of such hepatic lesions and differentiation of malignant from benign nodules.

Cholangiocarcinoma ; pathology ; Diagnosis, Differential ; Hemangioma ; pathology ; Humans ; Liver ; blood supply ; pathology ; Liver Neoplasms ; blood supply ; pathology ; Magnetic Resonance Imaging ; ROC Curve ; Retrospective Studies

Spontaneous extrahepatic rupture of hepatocellular carcinoma (HCC) is a rare but serious complication that occurs with an incidence of between 5 and 15% of patients with HCC. It is thought to be preceded by rapid expansion due to intratumoral bleed-ing. Extrahepatic rupture of HCC has been reported as a rare complication of tran-scatheter arterial embolization (TAE). Although there have been reports of extrahepatic rupture of HCC after TAE, but there is no report regarding intratumoral hemor-rhage into HCC during TAE. We report a unique case of intratumoral hemorrhage into HCC during TAE presumably triggered by TAE. Although a rare complication, intratumoral hemorrhage into HCC after TAE should be considered in any patient with TAE due to HCC.
Carcinoma, Hepatocellular/*blood supply ; Catheterization/*adverse effects ; Embolization, Therapeutic/*adverse effects ; Hemorrhage/*diagnosis/*etiology ; Humans ; Liver Neoplasms/*blood supply ; Male ; Middle Aged ; Rupture, Spontaneous/diagnosis/etiology

Leiomyosarcoma is a rare tumor of the liver. It usually arises from many other organs including uterus, gastrointestinal tract, retroperitoneum, and soft tissues. Primary hepatic leiomyosarcoma progresses very slowly and is not associated with chronic liver disease. When the tumor is detected early enough to be treated by operation, the prognosis is favorable. While several cases of primary hepatic leiomyosarcoma have been reported in Korea, there was no case associated with acute bleeding. We report a 80-year old male patient with huge primary hepatic leiomyosarcoma, who presented with acute bleeding and IVC obstruction. The patient was treated by embolization and IVC stenting.
Acute Disease ; Aged, 80 and over ; Balloon Occlusion ; Hemorrhage/*diagnosis ; Humans ; Leiomyosarcoma/blood supply/*diagnosis/pathology ; Liver Neoplasms/blood supply/*diagnosis/pathology ; Male ; Stents ; Tomography, X-Ray Computed ; Tumor Markers, Biological

OBJECTIVE: To analyze the contrast-enhancement patterns obtained at pulseinversion harmonic imaging (PIHI) of focal hepatic lesions, and to thus determine tumor vascularity and the acoustic emission effect. MATERIALS AND METHODS: We reviewed pulse-inversion images in 90 consecutive patients with focal hepatic lesions, namely hepatocellular carcinoma (HCC) (n=43), metastases (n=30), and hemangioma (n=17). Vascular and delayed phase images were obtained immediately and five minutes following the injection of a microbubble contrast agent. Tumoral vascularity at vascular phase imaging and the acoustic emission effect at delayed phase imaging were each classified as one of four patterns. RESULTS: Vascular phase images depicted internal vessels in 93% of HCCs, marginal vessels in 83% of metastases, and peripheral nodular enhancement in 71% of hemangiomas. Delayed phase images showed inhomogeneous enhancement in 86% of HCCs; hypoechoic, decreased enhancement in 93% of metastases; and hypoechoic and reversed echogenicity in 65% of hemangiomas. Vascular and delayed phase enhancement patterns were associated with a specificity of 91% or greater, and 92% or greater, respectively, and with positive predictive values of 71% or greater, and 85% or greater, respectively. CONCLUSION: Contrast-enhancement patterns depicting tumoral vascularity and the acoustic emission effect at PIHI can help differentiate focal hepatic lesions.
Adult ; Aged ; Carcinoma, Hepatocellular/blood supply/*ultrasonography ; Colon/pathology ; Contrast Media/*administration & dosage ; Diagnosis, Differential ; Female ; Hemangioma/blood supply/*ultrasonography ; Human ; Image Enhancement/*methods ; Liver/pathology/ultrasonography ; Liver Neoplasms/blood supply/secondary/*ultrasonography ; Lung/pathology ; Male ; *Microbubbles ; Middle Aged ; Pancreas/pathology ; Polysaccharides/administration & dosage/diagnostic use ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Stomach/pathology ; Support, Non-U.S. Gov't