Metastatic liver lesion

Radiological Appearance of Different Focal Liver Lesions 397 Solid Benign Lesions 397 Metastatic Liver Lesions 399 Lesions in the Cirrhotic Liver 400 Other Lesions 401... 

A recent smdy examined the level of DiAcSpm in colorectal cancer and intraepithelial neoplasia tissues (Kuwata et al. 2013). DiAcSpm was very scant in normal tissues but was markedly increased in resected stage II, HI, and IV colon cancer tissues. The level of DiAcSpm was also maikedly elevated in metastatic liver lesions in individuals with stage IV colon cancer compared to adjacent normal tissue. HPLC analysis indicated that the levels of Af-acetylspermidine and Af-acetylspermine are also increased in cancer tissues. This is the first report that definitively identifies the presence of DiAcSpm in human tissues. Importantly, DiAcSpm is markedly increased in tumor tissue compared to normal tissue. The levels of A/ -acetylspermidine and Af, V -diacetylspermidine were very low or undetectable in normal tissues and were not significantly increased in cancer tissues. 

The axial scans should also be evaluated for pulmonary or liver lesions, possibly indicating metastatic primary malignancy. 

The differential diagnosis for focal liver lesions includes benign and malignant lesions (metastatic, recurrent or primary) and the parenchymal manifestations of arterial abnormalities, infarcts, and abscesses. Infarcts usually appear as round or geographic solid lesions, with central hypoechoic necrotic areas. Abscesses have thick walls and central hypoechoic areas. Infarcts and abscesses may contain intraparenchymal gas (Fig. 4.2.16). 

Cheng, D.-L., Liu, Y.-C., Yen, M.-Y., Liu, C.-Y., Wang, R.-S. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch. Intern. Med. 1991 151 1557-1559... 

Karube, H., Masuda, H., Hayashi, S., Ishii, Y., Nemoto, N. Fatty liver suppressed the angiogenesis in hver metastatic lesions. Hepato-Gastroenterol. 2000 47 1541-1545... 

There are several major advantages in fine needle aspiration. Aspiration biopsy is a nontraumatic procedure and can be repeated easily. This is important during the course of the disease, since this procedure could be used to plan hormonal therapy in metastatic disease (B14). Also, in metastatic disease one could apply the cytochemical technique to several metastatic lesions and thus obtain information on the receptor status of multiple lesions. This technique also has an advantage over surgical biopsies because some metastatic lesions, such as pleural effusions, ascites, or liver metastases, may not be amenable to surgical biopsy. This was demonstrated (L3) by hormonal receptor determination of pleural effusions using thoracoscopic examinations. 

This study also has bearing on the uncommon situation in which metastatic carcinomas are found in the absence of known primary sites. If estrogen receptor protein is found in these metastatic deposits, an occult breast primary lesion is suggested. However, our results suggest that if estrogen receptor protein is not found in the metastases, a breast primary lesion is not ruled out, since a majority of lung and liver metastases from known breast primaries are ERP-. 

Amebiasis is primarily an intestinal disease caused by Entamoeba histolytica, which is a cosmopolitan organism usually transmitted by ingestion of materials contaminated by cysts that descend the GI tract. Trophozoites develop and remain in the colon, caecum, and sigmoidal area. Ulceration of the intestinal wall results, causing symptoms of dysentery. Metastatic lesions sometimes develop in other organs such as the liver (hepatic amebiasis). This is more difficult to treat. Amebicides in use today have all been developed empirically. The nitroimidazoles metronidazole, tinidazole, and the toxic nitro heterocycle niri-dazole (Fig. 7-4) are effective at all sites. 

Fig. 4.9a-g. Hepatoblastoma, a Plain film demonstrates hepatomegaly and multiple round lesions in the chest. Patient with hepatoblastoma in which (bl) US shows highly echogenic lesion posteriorly in the liver scar may be visible and (b2) MR image of same, in the coronal plane, c-e CT of the abdomen depicts heterogeneous enhancement of multiple lesions, with tumor extension into the IVC (arrow). f,g CT of chest reveals multiple metastatic lesions... 

Metastatic lesions exhibit a blood supply that is comparable to that of the primary tumor perhaps with the exception of those secondary lesions in the liver, which are preferentially supplied by the portal system (due to lower perfusion pressure). 

Gellad FE et al. (1990) Vascular metastatic lesions of the spine preoperative embolization. Radiology 176 683-686 Gerunda GE et al. (2000) Role of transarterial chemoembolization before liver resection for hepatocarcinoma. Liver Transpl 6 619-626... 

Neeman Z, Wood BJ (2002) Radiofrequency ablation beyond the liver. Tech Vase Interv Radiol 5(3) 156-163 Ni Y, Miao Y, Mulier S et al (2000) A novel cooled-wet electrode for radiofrequency ablation. Eur Radiol 10(5) 852-854 Ogan K, Jacomides L, Dolmatch BL et al (2002) Percutaneous radiofrequency ablation of renal tumors technique limitations and morbidity. Urology 60(6) 954-958 Pacak K, Fojo T, Goldstein DS et al (2001) Radiofrequency ablation a novel approach for treatment of metastatic pheochromocytoma. J Natl Cancer Inst 93(8) 648-649 Patterson EJ, Scudamore CH, Owen DA et al (1998) Radiofrequency ablation of porcine liver in vivo effects of blood flow and treatment time on lesion size. Ann Surg 227(4) 559-565... 

Liver metastases from breast cancer are associated with poor prognosis. Intravenous chemotherapy is commonly used and can result in regression of tumor lesions (Li et al. 2005). Li et al. (2005) reported the results of TACE and systemic chemotherapy for patients with liver metastases from breast cancer and evaluated the prognostic factors. The 1-, 2-and 3-year survival rates for the TACE group were 63.04%, 30.35%, and 13.01%, and those for the systemic chemotherapy group were 33.88%, 11.29%, and 0%. These data showed that TACE treatment of liver metastases from breast cancer may prolong survival in certain patients. This approach offers new promise for the curative treatment of patients with metastatic breast cancer (Li et al. 2005). 

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