No abstract

Background. Radiofrequency (RF-) assisted liver resection devices like the Habib sealer induce a necrotic resection plane from which a small margin of necrotic liver tissue remains in situ. The aim of the present paper was to report our long-time experience with the new resection method and the morphological characteristics of the remaining necrotic resection plane. Methods. 64 RF-assisted liver resections were performed using the Habib sealer. Followup was assessed at defined time points. Results. The postoperative mortality was 3,6% and morbidity was 18%. The followup revealed that the necrotic zone was detectable in all analyzed CT and MRI images as a hypodense structure without any contrast enhancement at all time points, irrespectively of the time interval between resection and examination. Conclusion. Liver resection utilizing radiofrequency-induced resection plane coagulation is a safe alternative to the established resection techniques. The residual zone of coagulation necrosis remains basically unchanged during a followup of three years. This has to be kept in mind when evaluating the follow up imaging of these patients.

Central review of the diagnostic imaging and clinical findings of Hodgkin's lymphoma patients shows a considerable number of discrepancies compared with the local evaluation. Thus, meticulous evaluation of all imaging information in close collaboration between the radiation oncologist and diagnostic radiologist is mandatory.

A 65-year-old man presented with recurrent abdominal pain and slight weight loss. Computed tomography (CT) and endoscopic ultrasound (EUS) revealed a hypodense, partially cystic mass located in the pancreatic body and tail that raised the suspicion of pancreatic cancer (• " Fig. 1). No distant metastases were detected and the patient underwent surgical resection of the mass and splenectomy, which was complicated by a bleeding splenic artery aneurysm. Surprisingly, only massive inflammation of the pancreas was found on histological examination of the resected specimen. The patient re-presented 1 year later with jaundice for the first time. EUS demonstrated a pseudocyst within the head of the pancreas. Endoscopic retrograde cholangiopancreatography (ERCP) revealed an isolated stenosis of the distal common bile duct (• " Fig. 2 a). This was successfully treated with regularly exchanged endoprotheses, leading to a complete normalization of laboratory parameters. The patient returned 2 years later with fever and jaundice. This time ERCP showed a purulent cholangitis with a stricture of the biliary bifurcation as well as several stenotic intrahepatic bile ducts (• " Fig. 2 b). Brush cytology raised a suspicion of cholangiocarcinoma. Serum IgG4 levels, antinuclear antibody (ANA), antineutrophil cytoplasmic antibody (ANCA), anticarbonic anhydrase II and antilactoferrin antibodies were all within the normal range; however, there was peripheral eosinophilia, which can be associated with autoimmune pancreatitis (AIP) [1]. Histological re-examination of the surgical specimen revealed an impressive lymphoplasmacytic infiltration of the resected pancreas with IgG4-positive cells (• " Fig. 3 a, b). This led finally to the correct diagnosis of AIP type 1 with metachronous autoimmune cholangitis. The patient was treated according to the recently published diagnostic algorithms [2 -4] with long-term, slowly tapered prednisone, with resulting improvement in his clinical symptoms, biliary strictures (• " Fig. 2 c), blood eosinophilia, and laboratory parameters. In summary, distinguishing AIP from pancreatic cancer remains a pitfall for clinicians; in some cases, surgical resection remains the treatment of choice because IgG4 levels can be elevated in 10 % of pancreatic cancers [5].