Vascular signals arising from pleura-based lung lesions were studied in 50 patients using pulsed Doppler ultrasonography. Twenty-seven had malignant lesions and 23 benign lesions. In 24/27 of the malignant masses, we observed no Doppler signals: in 2 cases, a low-velocity, turbulent, pulsatile flow was demonstrated; in 1 case pulsed Doppler ultrasonography showed only a low-velocity, continuous flow. In 20/23 of the benign lesions, we found 2 types of Doppler signal waveforms: an irregularly pulsatile, venous-like signal, and a regularly pulsatile, arterial-like waveform. The last 8 patients of our series underwent color Doppler ultrasound examination, which demonstrated the presence of arterial and venous vessels in 4 benign lesions and the absence of blood flow in 4 malignant masses. To our knowledge, we report for the first time the ability of obtaining Doppler signals from a variety of lung lesions. The actual clinical relevance of this application requires further studies.

Adult↗

PubMedDate not supplied

Diagnosis of hepatic lesions: ultrasonically guided fine needle biopsy or laparoscopy?

We compared the results of ultrasonically guided fine needle aspiration biopsy and laparoscopy in 63 patients who underwent both procedures. In this series, fine needle biopsy showed a sensitivity of 75.6% with a 84.1% overall accuracy. Laparoscopy demonstrated a 74.3% sensitivity with an overall accuracy of 82.7%. The combination of both procedures achieved an overall accuracy of 98.4% with a sensitivity of 97.5%. In one case only (hepatic involvement by Hodgkin's lymphoma), both laparoscopy and ultrasonically guided fine needle biopsy failed to establish the diagnosis. In small and deeply located lesions, ultrasonography is the most useful guide for biopsy. Laparoscopy is irreplaceable in the diagnosis of cirrhosis and in hepatic biopsies requiring larger bore needles. With the increasing use of ultrasonically guided fine needle biopsy, laparoscopy finds new indications, particularly in the preoperative staging of small hepatocellular carcinoma.

Adult↗

PubMedDate not supplied

Extrahepatic primary malignant neoplasms associated with hepatocellular carcinoma: high occurrence of B cell tumors.

In a consecutive series of 317 patients with hepatocellular carcinoma (HCC), 32 (10.1%) had 35 extrahepatic primary malignant neoplasms (PMNs) (3 patients had triple cancers). Twenty-five PMNs occurred before the diagnosis of HCC, 7 were synchronous and 3 metachronous. These 35 PMNs were: 6 cancers of the colon, 3 of the stomach, 1 of the rectum, 4 of the breast, 2 of the lung, 1 of the larynx, 3 of the prostate, 1 of the penis, 1 of the urinary bladder, 1 of the uterus, 2 of the skin, and the remaining 10 were immunoproliferative cancers, all of B cell origin (7 non-Hodgkin's lymphoma, 2 multiple myeloma, and 1 chronic lymphocytic leukemia). Thus, in this series, B-lymphocyte-derived neoplasms were the most frequent PMNs associated with HCC. These 10 patients showed no difference for age, male:female ratio, HCC cytotype, presence of cirrhosis, alcohol abuse, markers related to hepatitis B and C virus, and serum level of alpha-fetoprotein when compared with the 22 patients with HCC and other PMNs and the 285 with HCC alone. B cell neoplasms constitute half of the synchronous or metachronous cancers, and must, therefore, be kept in mind in the management of HCC patients.

Aged↗

PubMedDate not supplied

Clinical presentation, diagnostic work-up and therapeutic choices in two consecutive series of patients with hepatocellular carcinoma.

In two consecutive series of patients with hepatocellular carcinoma (HCC), we compared clinico-laboratory and ultrasonographic characteristics, diagnostic work-up, survival of untreated patients and, finally, therapeutic choices. In addition of the clinical examination, we tested for blood serum alpha-fetoprotein levels, HBsAg and anti-HCV antibodies. Ultrasonography was performed in all the patients. In most cases, a pathologic diagnosis was obtained by ultrasound-guided fine-needle biopsy. As curative treatment we considered open surgery, percutaneous alcohol injection and radio frequency thermal ablation. In the second series, we observed an increased number of patients with compensated cirrhosis and with small HCCs, therefore the number of patients undergoing a potentially curative treatment was higher. The percentage of multiple tumours was comparable in two series implying the presence of two kinds of HCC, different ¿ab initio'. The survival rate of untreated patients was better in the second series.

Aged↗

PubMedDate not supplied

Meningeal involvement in multiple myeloma: report of a case with cytologic and immunocytochemical diagnosis.

BACKGROUND: Multiple myeloma (MM) with meningeal involvement is a very rare phenomenon. Only 37 cases of plasma cell neoplasia (MM and plasma cell leukemia) with meningeal involvement have been reported. CASE: A 60-year-old male with stage IIIA light lambda chain MM returned nine months after the diagnosis with back pain, lower right extremity paresthesias and gait disturbance. A lumbar puncture revealed atypical plasma cells in the cerebrospinal fluid (CSF), and immunocytochemical studies showed a cytoplasmic monoclonal light lambda chain. A diagnosis of myelomatous meningitis was made, and the patient received intrathecal chemotherapy and craniospinal irradiation. He died six months after the diagnosis of meningeal disease. CONCLUSION: The present case and a review of the literature show that clinical manifestations of meningeal myeloma are non-specific. MM with meningeal involvement is accompanied frequently by circulating atypical plasma cells or plasma cell leukemia. Atypical plasma cells in the CSF are an important finding for the diagnosis of meningeal myeloma, and their neoplastic nature can be best identified by immunocytochemical analyses. Patients with meningeal myelomatosis can have a good response to treatment initially, but their prognosis is poor.

Fatal Outcome↗