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M Zins

Publications and source records attributed to M Zins.

At least 55 records · Page 3Linked to original sources
PubMed1996

[Imaging of peripheral cholangiocarcinoma. Comparison with pathological anatomy].

OBJECTIVE: Peripheral cholangiocarcinoma is a rare malignant intrahepatic tumor which originates in the distal bile duct. Our purpose was to identify the imaging characteristics of peripheral cholangiocarcinoma and to establish a correlation with surgical and histopathologic findings. METHODS AND MATERIALS: The imaging data of 16 patients with proven cholangiocarcinoma were retrospectively reviewed by sonography in 13 cases, computed tomography in 13 cases, magnetic resonance imaging in 6 cases, and angiography in 10 cases and correlated with surgical and histopathologic findings. RESULTS: In most cases peripheral cholangiocarcinoma appeared as a single, large (> 10 cm), heterogeneous, and non encapsulated mass. On precontrast computed tomography, the lesions were mostly low density. Enhancement was moderate in the bolus phase and increased in the delayed scan. With magnetic resonance imaging, lesion signals were low intensity in T1-weighted images and variable intensity in T2-weighted images. On angiogram, lesions were often hypovascular. Associated features were frequently observed: portal encasement (69%), lobar atrophy or capsular retraction (43%), dilated intrahepatic bile ducts (30%), extension into the hepatic capsule (23%), and inferior vena cava extension (15%). Radiopathologic comparison showed that imaging modalities accurately identified vascular encasement, but underestimated extrahepatic tumor extension. CONCLUSION: In most cases, peripheral cholangiocarcinoma has a typical appearance which may be helpful in differentiating this disease from other intrahepatic tumors.

Adult↗
PubMed1996

Liver metastases of digestive endocrine tumours: natural history and response to medical treatment.

BACKGROUND: Few data are available about the natural history of liver metastases of digestive endocrine tumours. Moreover, results of studies on treatment with intravenous chemotherapy, hepatic arterial chemoembolization and somatostatin analogues are conflicting. AIMS OF THE STUDY: To assess the progression of liver metastases of digestive endocrine tumours before antitumoral treatment, and to evaluate a stepwise therapeutic strategy in these patients. PATIENTS AND METHODS: 22 patients with histologically-confirmed liver metastases were studied. Primary tumours were carcinoids in nine, gastrinomas in five, non-functioning pancreatic tumours in six and calcitonin-secreting tumours in two patients. The progression of liver metastases was assessed according to the World Health Organization criteria in 10 patients before treatment, and during treatment in all patients. Intravenous (i.v.) chemotherapy with streptozotocin and 5-fluorouracil was used in patients with more than 25% progression in tumour size or with more than 50% liver involvement. Hepatic arterial chemoembolization was performed if i.v. chemotherapy failed, or as a first-choice treatment after 1993. The somatostatin analogues octreotide or lanreotide were used as a third-choice treatment. RESULTS: Progression (+90%, range 28-600%) of liver metastases was identified in the 10 patients studied before treatment, after a median follow-up of 11.5 months. Objective and minor responses were obtained in 2/10 patients (20%) and 1/10 patients (10%) receiving i.v. chemotherapy. Corresponding figures were 3/7 (43%) and 2/7 (29%) for hepatic arterial chemoembolization. No objective response was observed with somatostatin analogues, although 2 patients experienced a minor response. CONCLUSION: Untreated liver metastases of digestive endocrine tumours show an objective increase (their size approximately doubles after 1 year of follow-up). Among the currently available therapeutic modalities, hepatic arterial chemoembolization provides the highest response rates. An increase in patient survival as a result of this procedure remains to be determined.

Antineoplastic Agents↗
PubMed1996

[A rare cause of obstructive jaundice: peripancreatic pseudoaneurysm].

We report the case of a 54-year-old-man with alcoholic calcified chronic pancreatitis complicated by jaundice and abdominal pain. Investigations (Doppler ultrasonography examination and computed tomography scan) showed peripancreatic pseudoaneurysm of the posterior and inferior pancreatico-duodenal artery and a dilatation of the common bile duct. Selective embolization of the pseudoaneurysm resulted in rapid regression of both jaundice and abdominal pain. Common bile diet compression is a rare complication of peripancreatic pseudoaneurysm. Selective embolization seems to be the first line treatment in this indication.

Aneurysm, False↗
PubMed1996

[Hepatic angiomyolipoma simulating hepatocytic tumor. 3 cases].

Hepatic angiomyolipoma is a rare, benign, mesenchymal tumor. We report 3 cases of atypical angiomyolipomas simulating benign hepatic tumors in 3 women free of tuberous sclerosis (Bourneville's disease). Hepatic angiomyolipomas were solitary in 2 cases and multiple in one. At imaging, the 6 lesions were large (7 cm in mean diameter), mainly hypoechoic and heterogeneous. At CT, lesions did not contain fat and were hypervascular. At MR imaging, lesions were hypointense in 4 cases and isointense in one case on T1-weighted sequences, hyperintense and isointense on T2-weighted sequences in four and in one case respectively. Percutaneous biopsy, performed in 2 cases, did not provide a correct diagnosis. Histopathologic examination of the resected specimen showed angiomyolipomas with very low or lacking fat in all 3 patients. All lesions were positive with the HMB-45 antibody. In conclusion, hepatic angiomyolipoma with a low fat component may mimic other hepatic tumors. Diagnosis may be improved by using HMB-45 reactivity on the biopsy specimen.

Adenoma, Liver Cell↗
PubMed1995

Preoperative cyst fluid analysis is useful for the differential diagnosis of cystic lesions of the pancreas.

BACKGROUND/AIMS: It has been suggested that activity of pancreatic enzymes and concentrations of tumoral markers in cyst fluid may help to distinguish pseudocyst, serous, and mucinous cystadenomas. The aim of this study was to prospectively assess the reliability of preoperative biochemical and tumor marker analysis in cyst fluids obtained by fine-needle aspiration for pathological diagnosis. METHODS: Cyst fluid was obtained preoperatively by fine-needle aspiration, and biochemical and tumoral marker values were measured. The diagnosis of cystic tumors (7 serous cystadenomas and 12 mucinous tumors) was established by surgical specimen analysis. Thirty-one pancreatic pseudocysts complicating well-documented chronic pancreatitis were also studied. RESULTS: Carbohydrate antigen 19.9 levels of > 50,000 U/mL had a 75% sensitivity and a 90% specificity for distinguishing mucinous tumors from other cystic lesions. Carcinoembryonic antigen levels of < 5 ng/mL had a 100% sensitivity and an 86% specificity for distinguishing serous cystadenomas from other cystic lesions. Amylase levels of > 5000 U/mL had a 94% sensitivity and a 74% specificity for distinguishing pseudocysts from other cystic lesions. CONCLUSIONS: High carbohydrate antigen 19.9, low carcinoembryonic antigen, and high amylase levels in cyst fluid are very indicative of mucinous tumors, serous cystadenomas, and pseudocysts, respectively.

Amylases↗
PubMed1995

[Hemoperitoneum caused by spontaneous rupture of hepatocellular carcinoma. Value and prognostic factors of hepatic artery embolization].

To assess efficiency and to determine prognostic factors in emergency embolization for intraperitoneal hemorrhage from hepatocellular carcinoma we retrospectively analyzed 12 consecutive procedures. In order to evaluate the extension of tumor thrombus in the intrahepatic portal system before embolization, a portal perfusion rate was defined as the relative patency of the segmental portal veins demonstrated at arteriography. Serum bilirubin level and portal perfusion rate were correlated with length of survival. Successful hemostasis was achieved in all patients. Mean length of survival was 149 days. Two patients are still alive 545 and 195 days, respectively, after the procedure. A significant correlation (p = 0.005) between portal perfusion rate and length of survival was obtained. There was no correlation between serum bilirubin level and prognosis. Emergency embolization is an effective treatment in patients with intraperitoneal hemorrhage from hepatocellular carcinoma. Prognosis depends of portal perfusion rate.

Aged↗
PubMed1995

[Failure factors in X-ray computed tomography-guided biopsy of pulmonary lesions: analysis of 103 consecutive biopsies].

OBJECTIVE: Percutaneous biopsy of pulmonary lesions with use of CT-guidance is well established and relatively safe. Reported accuracy rates are 64%-90% and major complications are rare. To determine the failure factors of CT-guided biopsy of lung lesions, we retrospectively analyzed 103 consecutive procedures. MATERIALS AND METHODS: Fourteen characteristics of the biopsy procedure were analyzed, including size, location, skin-lesion and chest wall-lesion distances, operator experience, procedure type (histology and/or cytology), histologic definite diagnosis, and other. RESULTS: Overall success rate was 88%. Success rate was correlated with the size of the lesion 4.3 +/- 2.9 cm for the positive results versus 2 +/- 1.2 cm for the negative results (p < 0.01). Skin- and chest wall-lesion distances were 5.8 +/- 2.2 and 1.5 +/- 1.8 respectively for positive results and 8.3 +/- 2.9 and 3.7 +/- 2.5 for negative results (p < 0.001). The overall complication rate for pneumothorax was 17%. Chest wall-lesion distances were 3.3 +/- 1.8 cm for complicated procedures and 1.5 +/- 1.9 cm for uncomplicated procedures (p < 0.001). No other factor was significantly correlated with the risk of pneumothorax. CONCLUSION: Small lesion size, long skin- and chest wall-lesion distances are significant predictive failure factors. Long chest wall-lesion distance is significantly correlated with the complication rate for pneumothorax.

Adult↗
PubMed1995

[Diagnosis of cystadenomas and cystadenocarcinomas of the pancreas. Study of 35 cases].

OBJECTIVES: The aims of this study were to assess the circumstances of diagnosis and accuracy of imaging procedures in patients with cystic pancreatic tumours. METHODS: Thirty-five consecutive patients with cystic pancreatic tumours (serous cystadenomas: n = 19, mucinous cystadenomas: n = 9, cystadenocarcinomas: n = 7) were studied from 1988 to 1993. Respective diagnostic values of ultrasonography, endoscopic ultrasonography, CT scan and analysis of cyst fluid were evaluated. RESULTS: The circumstances of diagnosis were abdominal pain (74%), weight loss (23%), jaundice (8%), abdominal mass (6%), asymptomatic (6%). Initial diagnosis of cystadenoma was correctly made by ultrasonography, CT scan and endoscopic ultrasonography in 63%, 77% and 84%, and the type of cystadenoma was correctly diagnosed in 20%, 51% and 55%. A pseudocyst was falsely diagnosed in 28%, 12% and 3%, respectively. After blind review of CT scans and endoscopic ultrasonography records, the type of cystadenoma was correctly diagnosed in 82% by both procedures. Cytological examination of cyst fluid of 18 cystic tumours gave correct diagnosis in 10 cases with sufficient material. A low CEA (P < 0.002), Ca 19.9 (P < 0.003) and absence of mucins (P < 0.002) in cyst fluid was evocative of serous cystadenoma. CONCLUSIONS: Abdominal pain was the main circumstance of diagnosis in cases of pancreatic cystadenomas. The type of cystadenoma was correctly diagnosed in 82% by CT scan and endoscopic ultrasonography. Cytological examination, tumoural marker and mucin levels in cyst fluid were helpful for an accurate diagnosis of cystic tumours.

Adult↗
PubMed1995

[Imaging of cancer of the esophagus: ultrasound-endoscopy or computed tomography?].

The aim of this retrospective study, in 100 patients who had an esophagectomy from 1987 to 1992 for squamous cell carcinoma of the thoracic esophagus, was to determine the accuracy of endoscopic ultrasonography (EUS) and computed tomography (CT) in the preoperative staging of esophageal squamous cell carcinoma (SCC). The EUS report were compared to the pathological findings for the T stage. Both EUS and CT reports were compared with surgical and pathological findings for N stage (N0/N1) and mediastinal extension. In the 100 patients, EUS accuracy for T stage was 80%; EUS was more accurate for N stage than CT (71% vs 55% respectively; p < 0.02), and as accurate as CT for mediastinal extension (86% vs 85%). In the 26 SCC estimated superficial by EUS (all passed through), EUS accuracy was 92% for T stage and 77% for the distinction between mucosal and submucosal tumours; for N stage, EUS and CT accuracies were equivalent (77% vs 81%). In the 44 SCC passed and estimated advanced by EUS, EUS accuracy for T stage was 68%; EUS was more accurate than CT for N stage (77% vs 48%, p < 0.01) and as accurate as CT for mediastinal extension (86 vs 84%). In the 30 SCC not passed by EUS, accuracies of EUS and CT were equivalent for N stage (57% vs 47%) and for mediastinal extension (73% vs 73%). This study suggests that: a) for SCC estimated superficial by EUS, EUS does not differentiate reliably mucosal from submucosal tumors and CT is useless; b) routine EUS seems unnecessary for SCC not passed through by endoscopy; c) CT is still useful in patients with advanced SCC, mainly for detection of distant metastases.

Aged↗
PubMed1994

Hepatic adenoma: MR findings in 51 pathologically proved lesions.

PURPOSE: To describe the magnetic resonance (MR) imaging features of hepatic adenoma and correlate these findings with histopathologic findings. MATERIALS AND METHODS: MR findings of 51 pathologically proved hepatic adenomas in 29 consecutive patients were retrospectively analyzed. T1- and T2-weighted spin-echo (SE) images were obtained in all patients, and contrast material-enhanced MR images were obtained in 16 patients. RESULTS: At pathologic analysis, a peripheral rim, observed in 16 (31%) hepatic adenomas, corresponded to pseudocapsule, and tumor heterogeneity, observed in 26 (51%) lesions, corresponded to hemorrhagic necrosis and peliosis. Hyperintensity on T1-weighted SE images was observed in 30 (59%) adenomas; 10 (67%) of 15 hepatic adenomas were hyperintense on contrast-enhanced gradient-echo images, and 13 (45%) of 29 were hyperintense on delayed contrast-enhanced T1-weighted SE images. CONCLUSION: Presence of a peripheral rim, heterogeneity, and hyperintensity are common features of hepatic adenoma.

Adenoma↗
PubMed1992

Focal nodular hyperplasia of the liver: MR imaging and pathologic correlation in 37 patients.

Thirty-seven patients with 48 lesions of focal nodular hyperplasia (FNH) underwent preoperative magnetic resonance (MR) examination and surgical resection. Sixteen lesions were imaged at 0.5 T with T1- and T2-weighted spin-echo sequences; 32 lesions were imaged at 2 T with T1-and T2-weighted spin-echo and gradient-recalled-echo sequences. Contrast material-enhanced MR imaging was performed in 20 lesions. MR imaging failed to depict six tumors that were less than 3 cm in diameter. Typical appearance was present in 18 of the 42 (43%) lesions seen at MR. Atypical lesion features included no scar (n = 15), hypointense scar on T2-weighted images (n = 7), pseudocapsule (n = 6), strong hyperintense lesion on T2-weighted images (n = 3), diffuse hyperintensity on T1-weighted images (n = 3), and heterogeneous lesion (n = 1). Comparison between findings at MR imaging and at histopathologic examination was performed in 38 lesions: There was good correlation between presence and size of the scar on both examinations. In 13 of 20 (65%) of the hyperintense scars on T2-weighted images, edema was prominent, whereas in five of the seven (71%) hypointense scars on T2-weighted images, edema was absent or low.

Adult↗
PubMed1992

US-guided percutaneous liver biopsy with plugging of the needle track: a prospective study in 72 high-risk patients.

The efficiency, accuracy, and safety of ultrasound-guided liver biopsy with plugging of the needle track were prospectively assessed in 72 patients at high risk for hemorrhage. Seventy-eight biopsy procedures were performed in 72 consecutive patients prospectively classified into four different groups on the basis of coagulation parameters. Sixty-two patients (86%) had severe or moderately severe coagulation disorders. Fifty-four biopsy procedures were performed in 50 patients with diffuse liver disease, and 24 were performed in 24 patients with focal liver lesions. The biopsy track was embolized with gelatin particles and thrombin. Biopsy specimens adequate for histologic diagnosis were obtained in 69 of the 72 patients (96%). In focal lesions, accuracy and sensitivity in the diagnosis of malignancy were 75% and 89%, respectively. Two serious bleeding complications (2.8%) were encountered in two of the patients with major coagulation disorders. Liver biopsy with plugging of the needle track is a practical technique and is a feasible alternative to the transjugular approach. Respective indications for both methods depend on the severity of coagulation disorders and the presence of focal lesions.

Adult↗
PubMed1987

[Prognostic value of estradiol and progesterone receptors in stage I and II breast cancer with an adjuvant treatment].

Forty-seven stage T1, 225 stage T2, treated from January 1977 to December 1982 were studied. The median followup is 31 months (18-92) and the median age 57.5 years (26-92). On the 247 axillary clearances performed, there were 53% N- and 47% N+. The dextran coal method was used for the receptors dosage with R 2858 as ligand for estradiol and R 5020 for progesterone: positivity threshold was set at 10 fmoles. The RE+/RP+ group represents 40%, the RE+/RP- group 30%, the RE-/RP- group 7%, the RE-/RP- group 23%. The radio-surgical combination was systematic, with or without conservative treatment, followed by an adjuvant chemotherapy (15%), an hormonotherapy (34%), a chemohormonoprophylaxy (23%), within a protocol balancing the systemic treatment according to the following poor prognosis factors: axillary clearance positivity, grade 3 SBR, cytological grade 3. The crude actuarial survival is 96 +/- 4% (RE+ RP+); 73 +/- 15% (RE+ RP-); 78 +/- 12% (RE- RP-) and the disease-free survival was 84 +/- 9% (RE+ RP+); 68 +/- 15% (RE+ RP-), 67 +/- 14% (RE- RP-) with a significant difference between RE+ RP+ and RE+ RP- (P less than 10(-3)) and RE+ RP+ and RE- RP- (P less than 10(-5)). The crude actuarial survival and the disease free survival are studied according to menopausal status, Scarff-Bloom grade, and N+/N- axillary status. For N- patients, there is no significant difference for the disease-free survival, 84 +/- 14% (RE+ RP+); 85 +/- 11% (RE+ RP-); 79 +/- 15% (RE- RP-), as there is no difference for the five year disease-free survival between N- RE+ RP+ patients (84 +/- 14%) and N+ RE+ RP+ patients (84 +/- 13%).

Adult↗
PubMedDate not supplied

Radiologic features of papillary adenoma and papillomatosis of the biliary tract.

BACKGROUND: The purpose of this study was to describe the imaging findings of papillary adenoma of the bile ducts. METHODS: Imaging modalities including sonography, computed tomography, cholangiography, and endoscopic sonography obtained in five patients with papillary adenoma of the bile duct were retrospectively reviewed and correlated with pathologic findings. RESULTS: In four cases, imaging findings were a dilatation of the bile ducts due to a protruding mass within the lumen of the common bile duct. In one case, the biliary tract obstruction was not due to the mass but to mucus secretion that was detected at sonography, endoscopic sonography, and cholangiography. Multiple lesions were observed in two cases at pathology and not detected preoperatively. All the lesions contained foci of in situ carcinoma or mild dysplasia. CONCLUSION: Imaging is useful in detecting bile duct tumors. Hypersecretion of mucus is rare but highly characteristic of bile duct adenoma.

Adenoma↗
PubMedDate not supplied

Nontumorous attenuation changes on CT arterial portography.

OBJECTIVE: We prospectively studied the frequency and the distribution of nontumorous attenuation changes during CT arterial portography. MATERIALS AND METHODS: Computed tomography arterial portograms were obtained in 67 consecutive patients. The frequency and distribution of nontumorous attenuation changes (pseudolesions, areas of hypo- or hyperperfusion) were analyzed and related to the size of the tumor, the vascular status assessed by Doppler examination, and the presence of chronic liver disease. RESULTS: Pseudolesions were detected in 19 patients (28%). They were typical in 13 cases and atypical (round shaped or located in the caudate or right lobe) in 6. Segmental, lobar, or diffuse perfusion defects were seen in 36 patients (54%). In 56% of the cases, they were adjacent to large tumors and related to compression or thrombosis of intrahepatic portal branches as demonstrated by sonographic and Doppler findings. Areas of hyperperfusion were detected in 14 patients (21%). Of these cases, eight (57%) were peritumoral hyperperfusion. In all cases, the mean diameter of the tumors was large and there was compression of adjacent hepatic vein as demonstrated by sonographic and Doppler findings. CONCLUSION: Nontumorous attenuation changes are common in CT arterial portography. Factors leading to these artifacts include size of the tumor and vascular consequences of the tumor. Sonographic and Doppler studies may play a role in predicting these factors.

Adolescent↗