Article exists only in Russian.

Article exists only in Russian.

Abstract:

The basis of computed tomography diagnosis is the definition of densitometric parameters at different phases of the study.

Aim. Was to perform comparative analysis of computed tomography features of focal nodular hyperplasia and hepatocellular carcinoma.

Materials and methods. During the reseach clinical and morphological comparisons were performed on the base of 36 patients’ CT’s results: 21 patient with hepatocellular carcinoma (HCC) and 15 patient with focal nodular hyperplasia of the liver without associated liver cirrhosis. At the preoperative stage all patients underwent spiral computed tomography with bolus contrast enhancement (on the four phases of the study).

Results. During native phase of computed tomography HCC nodes are more often hipodense irrespective of the degree of histological differentiation and focal nodular hyperplasia - izodense. After intravenous injection of contrast agent, computed tomography picture of hepatocellular carcinoma and focal nodular hyperplasia depended on the phase of the study During the arterial phase tissue of focal nodular hyperplasia in the vast majority of cases was hiperdense relative to the surrounding liver parenchyma. Hepatocellular carcinoma had similar values much less frequently in contrast to the focal nodular hyperplasia. The venous phase was characterized by the presence of hiperdense characteristics in focal nodular hyperplasia areas and, conversely, in hepatocellular carcinoma tissue signs of hiperdense were not observed. Hyperdence formations in delayed phase of computed tomography indicate the presence of focal nodular hyperplasia, and vice versa, hypodense are sufficient to prevent its presence.

Conclusion. Estimation of densitometric parameters of focal nodular hyperplasia and hepatocellular carcinoma allows to determine features of computed tomography imaging of tumors at different phases of the examination, and this allows to make a differential diagnosis between them.

Abstract:

Aim: was to study CT semiotic features of hepatocellular carcinoma (HCC) with varying degrees of differentiation in liver, unaffected by cirrhosis.

Materials and methods: the study is based on clinical and morphological comparisons of 29 patients (19 men and 10 women aged 19-68 years) suffering from HCC without associated cirrhosis. In the preoperative period all patients underwent multislice CT with bolus contrast enhancement (on four phases of the study). On CT scans were determined: localization, size, borders and structure of nodes, including features of the accumulation of contrast agent for determining the degree of histological differentiation.

Results: HCC had the appearance of a large solitary node, the average value of the largest diameter and the cross-sectional area amounted to 9.3 cm and 68.4 cm2 respectively in most of examined patients. In the native phase of CT quite distinct contour of the tumor node was determined in 40% of cases at highly differentiated and one-third of moderately differentiated HCC observations, at poorly differentiated variant contour is not expressed.The characteristic feature of CT HCC nodes is the heterogeneous nature of their internal structure, which is best visualized in the arterial phase. Most frequently in observations (in 67.6%) were detected areas of necrosis, rarely observed lesions sclerosis (23.5%) and calcifications (11.8%).

Conclusion: Computed tomographic characteristics of HCC in the absence of cirrhosis depenc on the phase of the study, and the degree of histological differentiation of tumors that should be considered in the differential diagnosis and prognosis of the disease.

References

1.     Siegel R., Ma J., Zou Z., Jemal A. Cancer Statistics, 2014. CA Cancer J Clin 2014; 64: 9-29.

2.     Trevisani F., Frigerio M., Santi V., Grignaschi A., Bernardi M.: Hepatocellular carcinoma in non-cirrhotic liver: a reappraisal. Dig. Liver Dis. 2010; 42: 341-347.

3.     Silva A.C., Evans J.M., McCullough A.E. et al. MR Imaging of hypervascular liver masses: A review of current techniques. RadioGraphics. 2009; 29: 385-402.

4.     Furlan A., Marin D., Vanzulli A. et al. Hepatocellular carcinoma in cirrhotic patients at multidetector CT: hepatic venous phase versus delayed phase for the detection of tumour washout. Brit. J. Radiology. 2011; 84: 403-412.

5.     American College of Radiology website. Liver Imaging Reporting and Data System. www.acr.org/Quality- Safety/Resources/LIRADS. Accessed March 21, 2014

6.     Theise N.D., Curado M.P., Franceschi S. et al. (Eds.) WHO classification of tumours of the digestive system. Lyon: IARC, 2010; 205-216.

7.     Di Martino M., Saba L., Bosco S. et al. Hepatocellular carcinoma (HCC) in non-cirrhotic liver: clinical, radiological and pathological findings. Eur. Radiol. 2014; 24: 1446-1454.

8.     Gaddikeri S., McNeeley M.F, Wang C.L. et al. Hepatocellular Carcinoma in the Noncirrhotic Liver. AJR. 2014; 203: W34-W47

9.     TNM: classification of malignant tumours, 7th ed. Ed by L.H. Sobin et al. Transl. and ed. A.I. Shchegolev. Moscow: Logosfera, 2011. [In Russ].

10.   Honda H., Onitsuka H., Murakami J. et al. Characteristic findings of hepatocellular carcinoma: an evaluation with comparative study of US, CT, and MRI. Gastrointest Radiol. 1992; 17: 245-249.

11.   Hofer М. CT teaching manual. A systemic approach to CT reading. 3rd ed. Stuttgart et al: Thieme, 2007.

12.   Tumanova U.N., Karmazanovsky G.G., Shchegolev A.I. Densitometric characteristics of hepatocellular carcinoma at spiral computed tomography. Medicinskaja vizualizacija. 2012; 6: 42-50. [In Russ].

13.   Kudo M. Imaging diagnosis of hepatocellular carcinoma and premalignant/borderline lesions. Semin. Liver Dis. 1999; 19: 297-309.

14.   Hayashi M., Matsui O., Ueda K. et al. Progression to hypervascular hepatocellular carcinoma: correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material. Radiology. 2002; 225: 143-149.

15.   Bolondi L., Gaiani S., Celli N. et al. Characterization of small nodules in cirrhosis by assessment of vascularity: the problem of hypovascular hepatocellular carcinoma. Hepatology. 2005; 42: 27-34.

16.   Tumanova U.N., Dubova E.A., Karmazanovsky G.G., Shchegolev A.I. Computed tomographic evaluation of the blood supply hepatocellular carcinoma at the liver. Annaly hirurgicheskojgepatologii. 2013; 4: 53-60. [In Russ].

17.   Tumanova U.N., Dubova E.A., Karmazanovsky G.G., Shchegolev A.I. Comparative analysis of the degree of vascularization hepatocellular carcinoma and focal nodular hyperplasia of the liver according to the computed-tomography and morphological studies. Vestnik Rossijskoj Akademii medicinskih nauk. 2013; 12: 9-15. [In Russ].

18.   Nzeako U.C., Goodman Z.D., Ishak K.G. Hepatocellular carcinoma in cirrhotic and noncirrhotic livers. A clinic- histopathologic study of 804 North American patients. Am. J. Clin. Pathol. 1996; 105: 65-75.

19.   Shimada M., Hashimoto E., Taniai M. et al. Hepatocellular carcinoma in patients with non-alcoholic steatohepatitis. J. Hepatol. 2002; 37: 154-160.

20.   Smalley S., Moertel C., Hilton J. et al. Hepatoma in the noncirrhotic liver. Cancer. 1988; 62: 1414-1424.

Abstract:

Acardiac fetus («acardiac monster», «acardiac vampire») - is rarely encountered pathology of pregnancy in which one of monochorionic fetuses (recipient) is formless mass, with absence of the heart and some internal organs, life and growth of which is related to parasitism on other fetus.

The main reason for the formation of this defect is an abnormal location of placental vessels ir monochorionic twins. Characteristic are the underdevelopment of the upper body of the recipient fetus (underdevelopment of the upper part of chest, the absence of heart or the presence of rudimentary heart) and acephaly

The article presents results of the analysis of the world literature data, and given own observation of acardiac fetus stillborn.

We specify frequency causes, as well as the clinical and morphological features such anomalies. Possibilities of the post-mortem magnetic resonance and computed tomography imaging in determining the type of acardiac fetus. According to results of the analysis, it was the most efficient construction and analysis of volumetric reconstruction of bone tissues.

Conclusion: post-mortem CT and MRI are advisable in some cases as a complement to the postmortem examination.

References

1.     Alderman B. Foetus acardius amorphus. Postgraduate Med. J. 1973; 49: 102-105.

2.     Chi J.G. Acardiac twins. J. Korean. Med. Sci. 1989; 4: 203-216.

3.     Benirschke K. The Monozygotic twinning process, the twin-twin transfusion syndrome and acardiac twins. Placenta. 2009; 3: 923-928.

4.     Obladen M. From monster to twin reversed arterial perfusion: a history of acardiac twins J. Perinat. Med. 2010; 38(3): 247-253.

5.     Dahiya P, Agarwal U, Sangwan K, Sen J. Antenatal diagnosis of twin-reversed arterial perfusion sequence (acardiac amorphous) in a triplet pregnancy: case report. Arch. Gynecol. Obst. 2004; 269: 147-148.

6.     Gillim D.L., Hendriks C.H. Holoacardius: review of the literature and case report. Obstet. Gynecol. 1953; 2: 647-653.

7.     Bhatnagar K.P, SharmaS.C., Bisker J. The holoacardius: a correlative computerized tomographic, radiologic, and ultrasonographic investigation of a new case with review of literature. Acta genet. med. Gemellot. 1986; 35: 77-89.

8.     Shchegolev A.I., Tumanova U.N., Shuvalova M.P., Frolova O.G. Vrozhdennie poroki kak prichina mertvorozhdeniya[Congenital anomalies as a cause stillbirth]. Mezhdunarodnyj zhurnal prikladnyh i fundamental'nyh issledovanij. 2015; 10 (2): 263-267 [In Russ].

9.     Demikova N.S., Lapina A.S. Vrozhdennie poroki razvitiya v regionah Rossiyskoi Federatsii (itogi monitoringa 2000-2010 gg. [Congenital malformations in regions of the Russian Federation (monitoring results for 2000-2010]. Rossijskij vestnik perinatologii i pediatrii. 2012; 2: 91-98 [In Russ].

10.   Fox H, Butler-Manuel R. A teratoma of the placenta. J. Pathol. Bacteriol. 1964; 88: 137-140.

11.   Thayyil1 S., Chitty L.S., Robertson N.J. et al. Minimally invasive fetal postmortem examination using magnetic resonance imaging and computerised tomography: current evidence and practical issues. Prenat. Diagn. 2010; 30: 713-718.

12.  Tumanova U.N., Fedoseeva V.K., Liapin V.M., Stepanov A.V., Voevodin S.M., Shchegolev A.I. Posmertnaya komp’juternaya tomographia mertvorozhdennikh s kostnoi patologiej [Computed Tomography of Stillborn with Bone Pathology]. Meditsinskaya vizualizatsiya. 2013; 5, 110-120 [In Russ].

13.  Fedoseeva V.K., Tumanova U.N., Liapin V.M. Voevodin S.M., Shchegolev A.I. Vozmozhnosti ispol’zovaniya multispiralnoj komp’juternoi tomografii v posmertnoi diagnostike patologii plodov i novorozhdennikh. [Possibilities of use of a multispiral computer tomography in posthumous diagnosis of pathology of fetus and newborns]. REJR. 2014; 3 (S2): 448 [In Russ].

14.   Aghayev E., Staub L., Dirnhofer R., et al. Virtopsy - the concept of a centralized database in forensic medicine for analysis and comparison of radiological and autopsy data. J. Forensic. Leg. Med. 2008; 15: 135-140.

15.  Kokov L.S., Kinle A.F., Sinitsyn V.Y., Filimonov B.A. Voz- mozhnosti kompyuternoj i magnitno rezonansnoj tomografii v sudebno medicinskoj ehkspertize mekhanicheskoj travmy i skoropostizhnoj smerti obzor literatury. [Possibilities of computed tomography and magnetic resonance imaging in forensic medicalexamination of mechanical trauma and sudden death (a literature review)]. Zhwrnalim. N.V. Sklifosovskogo. Neotlozhnaya meditsinskaya pomoshch. 2015; 2: 16-26 [In Russ].

16.   Moore T.R., Gale S., Benirschke K. Perinatal outcome of forty nine pregnancies complicated by acardiac twinning. Am. J. Obstet. Gynecol 1990; 163: 907-912.

17.   Blickstein I., Keith G.L. Multiple pregnancy. Informa healthcare. 2005.

18.   Coulam С.В., Wright С. First trimester diagnosis of асаrdiас twins. Еагу Ргеgnаnсу 2000; 4: 261-270.

19.   Larsen W.J. Development of the heart. Human embryology. 2nd ed. Churchill Livingstone. 1997; 151-187.

20.   Baergen N.R. Manual of Pathology of the human placenta. 2nd ed. Springer Science+Business Media: LLC, 2011.

21.   Kamitomo М., Kouno S., Ibuka К. et al. First-trimester findings associated with twin reversed arterial perfusion sequence. Fetal Diagn. Ther. 2004; 19: 187-190.

22.  Ajlamazjan E.K., Pavlova N.G., Shelaeva E.V., Bezhenar V.F. Sindrom obratnoj arterialnoj perfuzii pri mnogoplodii obzor literatury i sobstvennyj opyt diagnostiki i fetalnoj hirurgii. [Syndrome of the return arterial perfusion at a mnogoplodiya: review of literature and own experience of diagnostics and fetalny surgery]. Prenat. diagn. 2012; 2: 178-184 [In Russ].

23.   Al-Malt А., Ashmead G., Judge N. et al. Color-ftow and Doppler velocimetry in prenatal diagnosis of acardiac triples. J. Ultrasound Med. 1991; 10: 341-345.

24.   Izquierdо I., Smith J., Gilson G. еt al. Twin, acardiac, acephalus. Fetus. 1992; 1: 1.

25.   Papa Т., Dao А., Bruner J.P Pathognomonic sign of twin reversed arterial perfusion using color Doppler sonography. J. Ultгаsоund Med. 1997; 16: 501-503.

26.   Sabourin J., DeDoming E., Chandra S., Jain V. Twin reversed arterial perfusion syndrome. J. Obstet. Gynaecol. Can. 2011; 33: 315.

27.   Mccurdy C.M., Childers J.M., Seeds J.W. Ligation of the umbilical cord of an acardiac-acephalous twin with an endoscopic intrauterine technique. Obstet. Gynecol. 1993; 82: S708-S711.

28.   Corbacioglu A., Gul A., Bakirci I.T. et al. Treatment of twin reversed arterial perfusion sequence with alcohol ablation or bipolar cord coagulation. Int. J. Gynaecol. Obstet. 2012; 117: 257-259.

29.   Weichert A., Kalache K., Hein P. et al. Radiofrequency ablation as a minimally invasive procedure in the treatment of twin reversed arterial perfusion sequence in twin pregnancy. J. Clin. Ultrasound. 2012; May 10. doi: 10.1002/jcu.21932.

30.   Tan T.YT., Sepulveda W. Acardiac twin: A systematic review of minimally invasive treatment modalities. Ultrasound Obstet. Gynecol. 2003; 22: 409-419.

31.   Sepulveda W., Sfeir D., Reyes M., Martinez J. Severe polyhydramnios in twin reversed arterial perfusion sequence: successful management with intrafetal alcohol ablation of acardiac twin and amniodrainage. Ultrasound Obstet. Gynecol. 2000; 16: 260-263.

Abstract:

We analyzed literature data and demonstrate own clinical case of stillborn with prune belly syndrome. Development of prune belly syndrome is a rare but severe pathology of the fetus. We have indicated the frequency, causes of development and also clinical and morphological features of this anomaly, including in combination with the cloaca. Noted that such families need genetic testing due to the high of redevelopment of similar anomalies. We showed possibilities of postmortem computed tomography in identifying concomitant pathology, including three dimensional reconstruction of bone tissue. It was concluded that carrying out postmortem CT as complement to the autopsy is expedient.

References

1.     Hubinois P, Valayer J., Cendron J. A series of 34 cases of prune belly syndrome in children. Semaine des Hopitaux. 1983; 59 (40): 2769-2777.

2.     Routh J.C., Huang L., Retik A.B., Nelson C.P Contemporary epidemiology and characterization of newborn males with prune belly syndrome. Urology. 2010; 76 (1): 44-48.

3.     Goswami D., Kusre G., Kumar Dutta H., Sarma A. The prune belly syndrome in a female foetus with urorectal septum malformation sequence: a case report on a rare entity with an unusual association. J. Clinical and Diagnostic Research. 2013; 7 (8): 1727-1729.

4.     Reinberg Y, Manivel J.C., Pettinato G., Gonzalez R. Development of renal failure in children with the prune belly syndrome. J. Urology. 1991; 145 (5): 1017-1019.

5.     Wheatley J. M., Stephens F.D., Hutson J.M. Prune-belly syndrome: ongoing controversies regarding pathogenesis and management. Seminars in Pediatric Surgery. 1996; 5 (2): 95-106.

6.     Williams IV D.H., Fitchev P., Policarpio-Nicolas M.L.C., Wang E., Brannigan R.E., Crawford S.E. Urorectal septum malformation sequence. Urology. 2005; 66 (3), article 657.

7.     Wheeler P.G., Weaver D.D. Partial urorectal septum-malformation sequence: a report of 25 cases. Am. J. Medical Genetics. 2001; 103 (2): 99-105.

8.     Sarhan O.M., Al-Ghanbar M.S., Nakshabandi Z.M. Prune belly syndrome with urethral hypoplasia and vesicocutaneous fistula: a case report and review of literature. Urology Annals. 2013; 5 (4): 296-298.

9.     Smolkin T., Soudack M. Goldstein I., Sujov P., Makhoul I.R. Prune belly syndrome: expanding the phenotype. Clin. Dysmorph. 2008; 17 (2): 133-135.

10.   Thayyil1 S., Chitty L.S., Robertson N.J., Taylor A.M., Sebire N.J. Minimally invasive fetal postmortem examination using magnetic resonance imaging and computerised tomography: current evidence and practical issues. Prenat. Diagn. 2010; 30 (8): 713-718.

11.   Tumanova U.N., Fedoseeva V.K., Liapin V.M., Stepanov A.V., Voevodin S.M., Shchegolev A.I. Computed Tomography of Stillborn with Bone Pathology. Meditsinskaya vizualizatsiya. 2013; 5, 110-120 [In Russ].

12.   Fedoseeva V.K., Tumanova U.N., Liapin V.M. Voevodin S.M., Shchegolev A.I. Possibilities of use of a multispiral computer tomography in posthumous diagnosis of pathology of fetus and newborns. REJR. 2014; 3 (S2): 448[In Russ].

13.   Weber S., Thiele H., Mir S., Toliat M.R., Sozeri B., Reutter H. et al. Muscarinic acetylcholine receptor M3 mutation causes urinary bladder disease and a prune-belly-like syndrome. Am. J. Hum. Genet. 2011; 89: 668-674.

14.   Riccardi V.M., Grum C.M. The prune belly anomaly: heterogeneity and superficial X-linkage mimicry. J. Med. Genet. 1977; 14 (4): 266-270.

15.   Ramasamy R., Haviland M., Woodard J.R., Barone J.G. Patterns of inheritance in familial prune belly syndrome. Urology. 2005; 65 (6): article 1227.

16.   Lockhart J.L., Reeve H.R., Bredael J.J., Krueger R.P. Siblings with prune belly syndrome and associated pulmonic stenosis, mental retardation, and deafness. Urology. 1979; 14 (2): 140-142.

17.   Haeri S., Devers P.L., Kaiser-Rogers K.A., Moylan V.J.Jr., Torchia B.S., Horton A.L., Wolfe H.M., Aylsworth

A.S. Deletion of hepatocyte nuclear factor-1-beta in an infant with prune belly syndrome. Am. J. Perinatol. 2010; 27 (7): 559-563.

18.   Murray P. J., Thomas K., Mulgrew C.J., Ellard S., Edghill E.L., Bingham C. Whole gene deletion of the hepatocyte nuclear factor-1β gene in a patient with the prune-belly syndrome. Nephrology Dialysis Transplantation. 2008; 23 (7): 2412-2415.

19.   Kubota Y, Cho H., Umeda T., Abe H., Kurumi Y, Tani T. Abnormal development of intrinsic innervation in murine embryos with anorectal malformations. Pediatric Surgery International. 2012; 28 (3): 295-298.

20.   Leeners B.,  Sauer I., Schefels J., Cotarelo C.L., Funk A. Prune-belly syndrome: therapeutic options including in utero placement of a vesicoamniotic shunt. J. Clinical Ultrasound. 2000; 28 (9): 500-507.

21.   Drenes F.T., Arap M.A., Giron A.M., Silva F.A.Q., Arap S. Comprehensive surgical treatment of prune belly syndrome: 17 years’ experience with 32 patients. Urology. 2004; 64 (4): 789-793.

22.   Drenes F.T., Lopes R.I., Oliveira L.M., Tavares A., Srougi M. Modified abdominoplasty for patients with the prune belly syndrome. Urology. 2014; 83 (2): 451-454.

23.   Kamel M.H., Thomas A.A., Al-Mufarrej F.M., O’Kelly P., Hickey D.P. Deceased-donor kidney transplantation in prune belly syndrome. Urology. 2007; 69 (4): 666-669.

24.   Bargaje A., Yerger J.F., Khouzami A., Jones C. Cloacal dysgenesis sequence. Ann. Diagn. Pathol. 2008; 12 (1): 62-66.

25.   International statistical classification of diseases and related health problems; tenth revision. Geneva: World Health Organization, 1992. V. 1.

26.   Shchegolev A.I., Tumanova U.N., Shuvalova M.P., Frolova O.G. Congenital anomalies as a cause stillbirth. Mezhdunarodnyj zhurnal prikladnykh i fundamental'nykh issledonjanij. 2015; 10 (часть 2): 263-267 [In Russ].

27.   Shchegolev A.I., Pavlov K.A., Dubova E.A., Frolova O.G. Stillbirth rates in the subjects of the Russian Federation in 2010. Arkhiv patologii. 2013; 2: 20-24 [In Russ].

28.   Tumanova U.N., Fedoseeva V.K.,Ljapin V.M., Bychenko V.G., Voevodin S.M., Shhegolev A.N. Plod-akardius: posmertnaja komp'juternaja i magnitno-rezonansnaja tomografija [Acardiac fetus: postmortem computed and magnetic resonance tomography imaging]. Diagnosticheskaja intervencionnaja radiologija. 2016; 10(2): 23-30 [In Russ].