Contrast-enhanced ultrasonography for the diagnosis of spontaneous necrosis of hepatocellular carcinoma: A report of 2 cases

Ota, Yu; Aso, Kazunobu; Otake, Shin; Okada, Masaya; Shukuda, Kounosuke; Sawada, Koji; Yokoo, Hideki; Tanino, Mishie; Fujiya, Mikihiro; Okumura, Toshikatsu

doi:10.1016/j.radcr.2022.10.019

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…The use of CEUS for evaluating focal liver lesions is recommended by the American Association for the Study of Liver Diseases (9) and the European Association for the Study of the Liver (19). Recently, we reported that CEUS is useful for the diagnosis of spontaneous necrosis in HCC, which is generally difficult to identify (20). CEUS can be used to assess necrosis in HCC with greater sensitivity than CT or magnetic resonance imaging.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced Ultrasonography Features for Diagnosing Pseudoprogression of Hepatocellular Carcinoma with Immunotherapy: A Case Report of the Response after Pseudoprogression

Otake,

Ota,

Aso

et al. 2024

Intern. Med.

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A male patient in his 70s with recurrent hepatocellular carcinoma (HCC) after surgery received atezolizumab plus bevacizumab (Atezo+Bev) therapy. Initial computed tomography (CT) revealed tumor growth along with an increase in tumor markers, and contrast-enhanced ultrasonography (CEUS) showed multiple round avascular areas within the nodules with an appearance similar to a slice of Swiss cheese. Continuation of immunotherapy with consideration of the potential for pseudoprogression produced a dramatic response. Although it is difficult to distinguish between true progression and pseudoprogression, the Swiss cheese-like appearance on CEUS may be important for the early diagnosis of pseudoprogression.

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Section: Discussionmentioning

confidence: 99%

Contrast-enhanced Ultrasonography Features for Diagnosing Pseudoprogression of Hepatocellular Carcinoma with Immunotherapy: A Case Report of the Response after Pseudoprogression

Otake,

Ota,

Aso

et al. 2024

Intern. Med.

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“…The use of CEUS for evaluation of focal liver lesions is recommended by the American Association for the Study of Liver Diseases [14] and the European Association for the Study of the Liver [15]. We recently reported that CEUS is useful for diagnosing spontaneous necrosis in HCC, which is generally difficult to identify [16]. Additionally, we reported that CEUS can help to distinguish pseudoprogression from true progression of immunotherapytreated HCC [17].…”

mentioning

confidence: 99%

Noninvasive Visualization of Tumor Blood Vessels within Hepatocellular Carcinoma by Application of Superb Microvascular Imaging to Contrast-Enhanced Ultrasonography

Ota,

Aso,

Yokoo

et al. 2024

Diagnostics

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The combination or sequential use of systemic therapies, such as lenvatinib and locoregional therapies, can improve the curability rate of hepatocellular carcinoma. This is based on the notion that lenvatinib remodels abnormal tumor vessels into normal vessels, potentially enhancing the efficacy of locoregional therapies. In this case report, we achieved noninvasive visualization of tumor blood vessels by applying superb microvascular imaging (SMI) to contrast-enhanced ultrasonography (CEUS). A man in his 80s with a borderline resectable hepatocellular carcinoma received preoperative therapy using lenvatinib. The patient achieved a complete response after lenvatinib therapy, underwent hepatectomy, and maintained a cancer-free status. CEUS and SMI revealed a decrease in tumor blood vessels at 1 week after lenvatinib administration and a decrease in tumor perfusion at 2 weeks. Although CEUS alone is adequate for noninvasive real-time evaluation of tumor perfusion, it is not sufficient to achieve accurate assessments of tumor blood vessels. We performed a noninvasive time-course evaluation of vascular normalization after lenvatinib administration by applying SMI. The evaluation of vascular normalization with lenvatinib therapy using CEUS and SMI can support the decision to proceed to conversion therapies.

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Unveiling the enigma of spontaneous regression in hepatocellular carcinoma: A case report from a tertiary care center in South India

Benny K,

Tony,

Thanikaivelu

et al. 2024

Int J Hepatobiliary Pancreat Dis

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Introduction: Spontaneous regression in hepatocellular carcinoma (HCC) is an enigma as it is a very rare phenomenon, multiple possible hypotheses were described to support this enigma. Case Report: A 61-year-old man known Type 2 diabetes mellitus and hypertension was evaluated for complaints of unexplained weight loss (40 kg loss in eight months), loss of appetite, along with generalized weakness of three months duration. He underwent computed tomography (CT) scan abdomen that showed arterial phase hyper-enhancing lesion (white short arrow) in left lobe/segment V of liver with washout. His alpha-fetoprotein (AFP) was 12263 IU. He was advised transarterial radioembolization (TARE) and systemic therapy. He did not undergo any treatment due to logistical issues. After three months he underwent a repeat CT scan, which showed decrease in the size of the heterogeneously hypodense space-occupying lesion (SOL) with wall irregularity involving liver segments II, III, IV, and V. His AFP level had fallen to 600 IU. He underwent a diagnostic laparoscopy, intraoperative ultrasound scan, frozen section (a rapid intraoperative histopathological diagnosis) proceeds left hepatectomy (including distal middle hepatic vein) and excision of 2 lesions in the caudate lobe and cholecystectomy under general anesthesia. The left hepatectomy specimen showed a scanty viable tumor (~5%) consistent with moderately differentiated hepatocellular carcinoma and with secondary changes (~95%), including extensive necrosis, xanthogranulomatous inflammation, and hemorrhage. He was followed up for three years with serial CT scan and was found to be disease free with 3 years AFP value of 1.32 IU. Conclusion: We conclude that partial spontaneous resolution of hepatocellular carcinoma (HCC) is rare but a possible phenomenon with multiple mechanisms explaining the enigma and it presents an opportunity for further research. The collection and thorough analysis of clinical data obtained from patients who have experienced spontaneous resolution of HCC will help understand this mysterious phenomenon. It could also lead to the development of new treatment strategies for HCC based on the possible hypothesis.

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Contrast-enhanced ultrasonography for the diagnosis of spontaneous necrosis of hepatocellular carcinoma: A report of 2 cases

Cited by 3 publications

References 16 publications

Contrast-enhanced Ultrasonography Features for Diagnosing Pseudoprogression of Hepatocellular Carcinoma with Immunotherapy: A Case Report of the Response after Pseudoprogression

Contrast-enhanced Ultrasonography Features for Diagnosing Pseudoprogression of Hepatocellular Carcinoma with Immunotherapy: A Case Report of the Response after Pseudoprogression

Noninvasive Visualization of Tumor Blood Vessels within Hepatocellular Carcinoma by Application of Superb Microvascular Imaging to Contrast-Enhanced Ultrasonography

Unveiling the enigma of spontaneous regression in hepatocellular carcinoma: A case report from a tertiary care center in South India

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