Portal invasion

Fig. 17.6a-d. Epithelioid hemangioendothelioma. MR findings. a Coronal true FISP imaging refers to multiple moderate hyperintense lesions, b In a T2-weighted unenhanced HASTE sequence a retraction of the liver capsule (black arrow) as well as portal infiltration (black arrowhead) and relatively low-hyperintense multiple lesions (white arrow) are depicted. Diffuse hypointense masses are seen on Tl-weighted imaging, d On delayed Gd-enhanced scans, rim enhancement (white arrows), retraction of the liver (black arrow), and portal invasion (black arrowhead) are excellently documented... 

Some forms of invasive candidiasis are dominated by deep organ infection and may never be detected by blood cultures. Chronic disseminated candidiasis or hepatosplenic candidiasis is a unique form of candidemia seen after recovery from neutropenia. Candidemia during the period of neutropenia may be initially localized to the portal circulation with dissemination to contiguous organs. After recovery of neutrophils, an inflammatory response is seen against areas of focal infection in the liver and spleen. This inflammatory response produces abdominal pain that is associated with... 

All of the currently available commercial trace portals, which will be described later, utilize the same underlying theme in the sample collection subsystem for explosive removal and transport. Specifically, the most frequently implemented sample collection concept can be categorized as non-contacting or non-invasive . This definition implies that no part of the portal physically contacts the person to collect an explosive sample. All of these non-contacting trace detection portals use air jets to dislodge explosive particles from the person and use airflow to transport explosives away from the person. 

Alvarez, D., Mastai, R., Lennie, A., Soifer, G., Levi, D., Terg, R. Non-invasive measurement of portal venous blood flow in patients with cirrhosis effects of physiological and pharmacological stimuli. Dig. Dis. Sci. 1991 36 82-86... 

This multifactorial weakness in defence allows bacterial penetration of the ascitic fluid to be effected by (1.) transmural migration in portal hypertension with greater permeability of the intestinal wall, (2.) systemic bacteraemia in terms of haematogenic dispersion (particularly in urinary tract and bronchopulmonary infections), above all in the presence of intrahepatic and extrahepatic shunts (so-called portal vein bacteraemia), (3.) invasion of bacteria via the Fallopian tubes, and (4.) lymphatic flow into the ascitic fluid (e.g. via leaks in the lymph vessels or lymph nodes). 

Tab. 19.7 An overview of semi-invasive and surgical procedures for bleeding oesophageal varices and portal hypertension in chronological order (1874-1994). For reasons of simplification, only the first authors are named in each case. (s. also tab. 16.18 )...

Staphylococci, streptococci In sepsis, toxic liver damage and portal granulocytic infiltration may be observed. Septic bacterial invasion of the liver mainly entails periportal, circumscribed and non-suppurative septic foci (s. fig. 24.1), and occasionally multiple microabscesses as well. (10) Cholestasis usually suggests a severe course of disease likewise, prolonged jaundice points to a poor prognosis as far as the underlying disease is concerned. (1, 2, 4, 6-8)... 

Multiple nodes, limited to one hver lobe, one node > 2 cm, with or without vascular invasion T4 Multiple nodes in more than one liver lobe or a tumour affecting a larger branch of the portal or... 

Koike, Y., Shiratori, Y., Sato, S., Obi, S., Teratani, T., Imamura, M., Yoshida, H., Shiina, S., Omata, M. Des-gamma-carboxy prothrombin as a useful predisposing factor for the development of portal vein invasion in patients with hepatocellular carcinoma — A prospective analysis of 227 patients. Cancer 2001 91 561 —569... 

The oral mucosa provides a near-ideal, non-invasive portal of entry into the systemic circulation, on the basis of four main reasons. First, the oral cavity is relatively permeable. Second, the oral mucosa has a very rich blood supply, with many superficial blood vessels, and this makes it... 

Plasma MMP-9 levels in hepatocellular carcinoma have been reported to be significantly elevated compared with normal controls. Plasma MMP-9 concentration had a sensitivity of 53% and a specificity of 89% for the discrimination between hepatocellular carcinoma and chronic hepatitis or liver cirrhosis. Plasma MMP-9 levels were significantly higher in hepatocellular carcinoma patients with macroscopic portal venous invasion than those without invasion. Plasma MMP-9 levels in cancer patients did not correlate with tumor number, size, volume, or the serum tumor marker a-fetoprotein levels (H3). 

Visualization and evaluation of intrahepatic vascular structures is important because hepatoblastomas can invade or compress the portal and the hepatic veins. Absence of the portal branch or presence of a thrombus supports portal vein invasion. Although the inferior vena cava can be invaded, US examination overestimates the incidence of obliteration of this vessel (Siegel 2001a Kuhn et al. 2004). 

Macroscopically, a mass that involves both the right and left lobes will be found in 70% of cases. On histological analysis HCC will show giant tumor cells with large trabeculae arranged in an acinar pattern. Necrosis and vascular involvement are commonly seen. Often there is vascular invasion of the portal system and less frequently that of the hepatic vein and IVC. A variant of HCC is fibrola-mellar HCC, which will present with a central scar in 76% of patients on macroscopic examination. 

HCC can be represented on US as a hypo- or hyperechogenic mass depending on the amount of fat, or even as a heterogeneous mass with ill-defined borders located in the hepatic parenchyma. It may look identical to a hepatoblastoma. The presence of shadowing fod within the tumor will suggest intra-tumor calcifications. Evaluation of vascular invasion and dilatation of the portal vein will be seen with color Doppler with conventional gray-scale US (Siegel 2000) (Fig. 4.10a). 

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