We report a case of a rare variant of hepatocellular carcinoma (HCC) developed in a non-cirrhotic liver in a 64 yearold patient

D Wendum

Journal of the Belgian Society of Radiology

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Scirrhous variant of hepatocellular
 carcinoma: a case-report
D. Wendum, O. Scatton, B. Bessoud,
O. Rosmorduc, J.F. Fléjou1
We report a case of a rare variant of
hepatocellular carcinoma (HCC) devel-
oped in a non-cirrhotic liver in a 64 year-
old patient.
A 64-year-old patient was admitted
because of abdominal pain associated to
a liver mass. CT-scan showed large hypo-
vascular nodules in the right liver lobe.
Alpha-fetoptotein levels were very high
(58000 ng/ml). There was no sign sug-
gesting chronic liver disease. No primary
carcinoma was found (in particular no
gastric or ovarian carcinoma). After
transarterial chemoembolization and
 portal embolization, a right hepatectomy
was performed. Histopathological analy-
sis of the liver specimen showed a
 moderately differentiated HCC with
fibrous stroma with no diagnostic criteria
for fibrolammelar HCC (Scirrhous HCC).
The tumour cells expressed Heppar-1,
glypican-3, AFP and also cytokeratin 19.
The nontumoral liver showed no fibrosis,
no steatosis or iron deposition.
The diagnosis of primary liver carcino-
mas with fibrous stroma, the diagnostic
criterias of fibrolamellar HCC and the
 significance of cytokeratin 19 expression
in HCC will be discussed.
1. Service de Radiologie,  Hôpital Saint
Antoine, Paris, France.
Mesenteric lesions: anatomo-radiologi-
cal correlations 
E. Danse, C. Sempoux, R. Detry,
A. Mourin1
Two cases of mesenteric lesions are
reported. The first one concerns a 60 old
woman for whom a calcified mesenteric
mass was detected on abdominal CT
required for a non specific pelvic pain.
Small bowel enema was performed
before surgery. The mass was totally
removed. Pathology concluded to a calci-
fying fibrous tumor of the mesentery. The
second case concerns a 83 old man com-
plaining of abdominal pain and weight
loss. A ill-defined solid mesenteric mass
was found together with ascites and
enlarged lymph nodes. Surgical explo-
ration was performed and macrobiopsies
were taken. The final diagnosis was scle-
rosing mesenteritis. Imaging findings are
presented with close correlation with
macroscopic and microscopic illustra-
tions of the lesions. 
This presentation is the opportunity to
review the imaging findings suggestive
of mesenteric diseases and to correlate
these findings with pathological data. 
duodenum by the abdominal aorta and
the overlying superior mesenteric artery.
A conservative treatment with high
caloric drinks, small meals and prokinet-
ics was started in order to gain weight
and reverse the precipitating factor. Over
the following months the patient gained
weight and the symptoms resolved. 
In conclusion: a rare case of sub -
obstruction due to compression of the
duodenum by the superior mesenteric
artery also called Wilkie syndrome.
1. Department of Radiology, UZGent,
Ghent, Belgium.
Imaging features of caroli disease and
syndrome: a restropective analysis in
8 patients
H. Lefere, F. Claus, M. Thijs, G. De
Hertogh, C. Verslype, W. Laleman,
D. Vanbeckevoort, W. Van Steenbergen1
Segmental, nonobstructive dilatation
of intrahepatic bile ducts is referred to as
Caroli disease (CD). When associated
with congenital hepatic fibrosis, the term
Caroli syndrome (CS) is used. These
 disease entities share a common patho-
genetic mechanism called ductal plate
malformation. 
The clinical and radiological records of
8 patients admitted between 1992 and
2009 with pathologically proven CD or CS
were reviewed. Available imaging studies
were retrospectively scored for the pres-
ence of central dot signs*, the degree of
intra- and extrahepatic bile duct dilata-
tion, intrahepatic calculi and secondary
signs of portal hypertension such as
splenomegaly and oesophageal varices.
(*The ‘central dot sign’ is defined in Caroli
patients in the literature as a bundle or dot
of strong contrast enhancement within a
dilated intrahepatic bile duct.)
Two patients had the ‘pure form’
Caroli disease, whereas in the other six
cases the diagnosis of Caroli syndrome
was made. Age at diagnosis ranged from
3 to 74 years. Presenting signs and symp-
toms: (hepato)splenomegaly (n = 4),
hematemesis and/or melena (n = 3),
cholangitis (n = 3). There was no evidence
for malignancy in any of these patients. 7
out of 8 patients showed central dot
signs on various imaging modalities. In
the remaining case, where no contrast-
enhanced studies were available, hepatic
lesions very closely resembling central
dots (‘dot-like’ sign) were seen. Right
hepatic lobe predominant disease was
present in 6 cases. Intrahepatic bile cal-
culi were found in three patients.
Secondary signs of portal hypertension
were observed in all but one patient. 
The central dot(-like) sign can be con-
sidered a hallmark sign of Caroli disease 
1. Service d’Imagerie Médicale, UCL
Saint-Luc, Brussels, Belgium.
Accumulation of large amounts of
intraperitoneal soft tissue material,
 mimicking pseudomyxoma peritonei
K. Buccauw, R. Vanslembrouck, K. Op
De beeck, S. Haegeman, M. Thijs,
D. Vanbeckevoort1
A 37-year-old man, with no relevant
issues in his medical history, presented
with low abdominal discomfort, weight
loss and red blood loss per anum. The
patient underwent both an ultrasound
and a CT scan which showed an accumu-
lation of large amounts of intraperitoneal
soft tissue material with small amount of
ascites. Subsequently, an exploratory
laparotomy was performed with resec-
tion of this extensive peritoneal soft
 tissue mass, omentectomy, segmental
enterectomy and appendectomy. Rather
surprisingly, this lesion was histological-
ly consistent with a high-risk gastro -
intestinal stromal tumor (GIST). The
patient is further treated with systemic
chemotherapy. 
1. Department of Radiology, UZLeuven,
Leuven, Belgium.
An uncommon cause of proximal intes-
tinal subobstruction : wilkie syndrome
E. Halet, H. Peeters, D. Van De putte,
L. Delrue, M. De Vos1
A 23-year-old Caucasian man with a
history of a hernia operation presented at
the emergency room because of long-
standing complaints of weight loss,
 vomiting and abdominal pain worsening
over time. At time of presentation he was
complaining of diffuse abdominal pain
and vomiting. On physical examination
there was abdominal distention with per-
cussion pain. Routine laboratory tests
were normal. A Ct-scan was performed
showing duodenal dilation and retraction
of the ileum, suggestive for a subobstruc-
tion due to adhesions. A laparascopy was
performed but could not show any adhe-
sions nor internal herniations. Because
the complaints persisted a transit of the
small bowel (Rx SMD) was performed
showing a severely slowed down gastro -
intestinal transit with pendular move-
ments at the proximal duodenum.
Decompression of the duodenum was
associated with a temporary higher
motility. These findings are highly sug-
gestive for a Wilkie syndrome also known
as Superior mesenteric artery syndrome.
It is most commonly caused by loss of
the mesenteric fat pad resulting in a
 compression of the third portion of the
JBR–BTR, 2011, 94: 103-104.
ABSTRACTS OF PAPERS PRESENTED AT THE ANNUAL SESSION OF THE
RESEARCH GROUP ON ABDOMNAL AND DIGESTIVE IMAGING ORGANIZED
IN LIEGE ON FEBRUARY 18, 2011 BY SECTION ABDOMINAL IMAGING
29-abstracts papers2011(2)_Opmaak 1  12/04/11  16:44  Pagina 103
104 JBR–BTR, 2011, 94 (2)
and Caroli syndrome. It was reliably
detected by current imaging techniques
in all patients.
1. Department of Radiology, University
Hospital Gasthuisberg, Leuven, Belgium.
False positive diffusion weighted imag-
ing findings in an oncological setting
B. Op de Beeck, A. Snoeckx,
M.J. Spinhoven, V. Van Marck,
T. Moreels, D. Ysebaert, M. Peeters1
Diffusion Weighted Imaging DWI is a
new powerful technique for detecting
metastases showing higher sensitivity
values than the classical MR sequences
for subcentimetric liver metastases. Little
is known about false positive findings. 
We like to present the selective imag-
ing findings correlated with pathology of
two patients with an oncological history
and false positive DWI findings. 
The first patient had a history of a
Ewing sarcoma treated with chemo-radi-
ation and surgery who also had an asso-
ciated hemochromatosis. The second
patient had a cholangiocarcinoma which
was preoperatively treated with radio-
therapy. In the first patient, multiple
hypervascular nodules without iron over-
load mimicking metastases were found in
the liver. The false positive DWI was
 created by the iron overload in the
 surrounding ‘normal’ liver parenchyma.
The hypothesis for these lesions are
sideronecrotic nodules with nodular
regenerative hyperplasia. The second
patient showed acute radiation induced
hepatitis in the radiation field with inside
two DWI false positive hypovascular
pseudolesions, probably due to vascular
changes creating hypoperfusion with
hypoxia and nutritional ischemia. 
DWI is a very powerful technique for
detecting liver metastases but treatment-
induced microvascular changes may
induce false positive findings. 
1. Department of Radiology, Antwerp
University, Antwerp, Belgium.
Retroperitoneal fat-containing tumours
F. De Munck, E. Vanderlinden,
F. Vandenbroucke, A. Hoorens1
A 30-year-old and 51-year-old woman
presented at the emergency department
with respectively impression of a left
flank mass and unrelenting abdominal
pain. In both patients ultrasonography
showed a large heterogeneous mass
involving almost the entire left flank.
We want to give an overview of the
diagnostic possibilities for such a
tumours.
On abdominal computed tomography
(CT), the masses appeared well-circum-
scribed and contained fat. There was a
heterogeneous contrast captation. The
first patient underwent resection of the
mass. In the second patient a CT-guided
biopsy was performed. Pathologic
 examination of both lesions revealed
fat-containing tumours. 
The first patient had an angiomyolipo-
ma of the kidney and the second patient
had a retroperitoneal dedifferentiated
liposarcoma. Angiomyolipoma is a
tumour composed of varying admixtures
of blood vessels, smooth muscle cells
and adipose tissue; any one or two of
these elements may predominate.
Liposarcoma is one of the most common
soft tissue sarcomas of adult life.
Together with an adrenal myelolipoma,
they represent the three most common
fat-containing masses in the retro -
peritoneal region. The latter is a benign
tumour composed of mature fat and
interspersed hematopoietic elements
that resemble normal bone marrow. 
Final diagnosis of these retro -
peritoneal fat-containing tumours is
 usually not possible based on imaging
characteristics alone as these lesions
have overlapping features. Demographic
and clinical data, however, will allow
refining the diagnostic options and will
help to determine treatment.
1. Department of Radiology, UZ Brussel
Vrije Universiteit, Brussels, Belgium.
Atypical focal hepatic mass in a young
woman
E. Vanhoutte, J. Soens, E. Willems,
C. Verslype, D. Vanbeckevoort, D. Bielen1
We report the case of a young woman
of 22 years who presented with vague
abdominal complaints and a palpable
epigastric mass. Her medical history
revealed a deep venous thrombosis in
the leg, treated with a vena cava filter and
marcoumar. The initial CT scan in
 portovenous phase demonstrated a large
mass in the left liver lobe with a central
scar, thrombosis of the left portal vein
and mediastinal adenopathy. Additional
triple-phase CT study of the liver showed
a large heterogeneous mass predomi-
nantly hyperdense and with a central
hypodense stellate scar with inlying
 calcifcations. The central scar did not
show any significant enhancement. An
explorative laparoscopy was performed
and biopsies were taken. Histopathologic
examination confirmed the diagnosis of
fibrolamellar hepatocellular carcinoma
(FLC). These distinct imaging features can
help to distinguish FLC from other benign
and malignant lesions such as FNH, giant
hemangioma, conventional HCC and
malignant degeneration of hepatocellular
adenoma. Diagnosing FLC is important,
because in contrast to the benign lesions,
FLC preferentially is treated by surgical
resection. Even an advanced disease of
FLC with lymphadenopathy, invasion of
adjacent organs or limited metastasis
does not preclude curative resection. In
this particular case, medical treatment
was chosen because of the presence of
the mediastinal adenopathy. 
Diagnosing FLC is important because
of the different prognosis and therapy.
Therefore, it should be included in the
differential diagnoses of a large hepatic
mass with central scar and inlying
 calcifications in a young patient with no
underlying liver disease.
1. Department of Radiology, University
Hospital Gasthuisberg, Leuven, Belgium.
CHEST
Lung cancer: how to measure the tumor
and its influence on T staging in the new
TNM classification
C. Mai, F. De Keyzer, J. Verschakelen,
J. Coolen, W. De Wever1
Purpose: In the new TNM classifica-
tion, lung tumor measurement becomes
important for T-stage assessment.
However, no guidelines are proposed
how to measure tumor. Purpose of this
study was to evaluate if tumor measure-
ment on different window settings, with
different imaging techniques, can influ-
ence T- and group-staging in the new TNM
classification. We also compared T stage
assessed with the old classification ver-
sus T stage according to the new TNM
on the old classification with the new T-
and group-stages, we found a different T-
stage in 12 patients (24.5%) and a differ-
ent group-stage in 15 patients (31%).
There was no statistical difference for
tumor measurement done on dedicated
CT and on PET-CT. T-stage was different in
2 patients (8.7%).
Conclusions: Tumor measurement is
statistically different between lung and
mediastinal window on PET-CT and dedi-
cated CT. However, this difference has no
significant influence on T staging and on
group staging in the new TNM classifica-
tion. PET-CT can be used for T-staging in
lung cancer. Stage migration in the new
TNM classification is comparable with
other studies.
1. Department of Radiology, KULeuven,
Leuven, Belgium.
classification, and again we evaluated the
impact on final TNM stage.
Methods and materials: 49 consecutive
lung cancer patients who underwent PET-
CT were retrospectively evaluated. Tumor
size on mediastinal and lung window set-
tings was compared. A possible influence
on T- and group-stage was evaluated. In a
subgroup of 23 patients, the same evalua-
tion was done on a dedicated chest-CT
and compared with the results on PET-CT.
Statistical analysis was done using Bland-
Altman-plot-method, together with a
paired t-test, and the McNemar test.
Results: Tumor measurements on
lung window were larger than on medi-
astinal window, which was statistically
significant (p < 0.05). This led to different
T-stage in 6 patients (12.2%) and different
group-stage in one patient (2%). When
we compared T- and group-stages based
JBR–BTR, 2011, 94: 104.
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Abstracts of papers presented at the annual session of the research group on abdomnal and digestive imaging organized in liege on february 18, 2011 by section abdominal imaging

http://www.jbsr.be/articles/10.5334/jbr-btr.520/galley/517/download/

Abstracts of papers presented at the annual session of the research group on abdomnal and digestive imaging organized in liege on february 18, 2011 by section abdominal imaging

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