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To report the preliminary result of empiric embolization for angiographycally-negative lower gastrointestinal bleeding (LGIB) by using the pharmaco-induced vasospasm technique with or without the adjunctive use of intra-arterial multi-detector computed tomography (MDCT). 23 LGIB patients with positive MDCT findings but negative angiographic results underwent empiric pharmaco-induced vasospasm therapy. The presumed bleeding artery was semi-selectively catheterized, and a segment of bowel was temporarily spasmed with bolus injection of epinephrine and immediately followed by 4-h’ vasopressin infusion. The rebleeding, primary and overall clinical success rates were reported. MDCT showed 19 bleeders in the SMA territory and 4 bleeders in the IMA territory. Early rebleeding was found in 6 patients (26.1%): 2 local rebleeding, 3 from new-foci bleeding and 1 uncertain. Of the 10 small bowel bleeding patients, only 1 out of the 7 who underwent intra-arterial MDCT showed rebleeding, whereas 2 out of the 3 without intra-arterial MDCT rebled. No patients exhibited procedure-related major complications, including bowel ischemia and cardiopulmonary distress. The overall clinical success rate was 91.3% (21/23) with a 30-day mortality rate of 26.1% (2 of the 6 patients had early rebleeding). Empiric pharmaco-induced vasospasm therapy, when localized with/without adjunctive intra-arterial MDCT, seems to be a safe and effective method to treat angiographically-negative LGIB patients.

To evaluate the kinetic patterns of benign and malignant breast lesions using contrast-enhanced digital mammogram (CEDM). Women with suspicious breast lesions on mammography or ultrasound were enrolled. Single-view mediolateral oblique (MLO) CEDM of an affected breast was acquired at 2, 3, 4, 7, and 10 min after injection of contrast agent. Three readers visually and semi-quantitatively analyzed the enhancement of suspicious lesions. The kinetic pattern of each lesion was classified as persistent, plateau, or washout over two time intervals, 2-4 min and 2-10 min, by comparing the signal intensity at the first time interval with that at the second. There were 73 malignant and 75 benign lesions in 148 patients (mean age: 52 years). Benign and malignant breast lesions showed the highest signal intensity at 3 min and 2 min, respectively. Average areas under receiver operating characteristic (ROC) curve for diagnostic accuracy based on lesion enhancement at different time points were 0.73 at 2 min, 0.72 at 3 min, 0.69 at 4 min, 0.67 at 7 min, and 0.64 at 10 min. Diagnostic performance was significantly better at 2, 3, and 4 min than at 7 and 10 min (all p < 0.05). A washout kinetic pattern was significantly associated with malignant lesions at 2-4 min and 2-10 min frames according to two of the three readers' interpretations (all p [less than or equal to] 0.001). Applications of optimal time intervals and kinetic patterns show promise in differentiation of benign and malignant breast lesions on CEDM.

Purpose To evaluate the survival outcomes of huge HCC (tumor size ≥ 10 cm) after surgical resection (SR) with or without neoadjuvant hepatic arterial infusion chemotherapy (HAIC). Patients and methods 119 huge HCC patients underwent SR in our Hospital (2010–2020). A new HAIC regimen (cisplatin, leucovorin, mitomycin-C and 5-FU infusion for 5 days plus 10 ml lipiodol microvascular embolization) was adopted as the neoadjuvant therapy in 25 patients. Treatment responses were evaluated based on mRECIST criteria. The objective response rate (ORR), disease free survival (DFS), recurrence survival (RS) and overall survival (OS) were compared between the SR-only and neoadjuvant HAIC groups. Results Of the 119 patients, 65 patients were Vp2, 9 patients were Vp3 and 4 patients were Vp4. In the subgroup analysis, neoadjuvant HAIC group revealed significantly more severe clinical status. Of the neoadjuvant HAIC patients, ORR was 66.7%. Postoperative tumor recurrence was noted in 75% and 58.3% of the SR and neoadjuvant groups, of them 56.5% and 20.8% developed in ≤ 12 months. The median DFS, RS and OS in each group were 10 vs. 41 months ( p  = 0.016), 36 vs. 91 months and 46 vs. 96 months, respectively. Subgroup analysis revealed no significant survival difference of the RS in both patient groups with tumor recurrence ≤ 12 months (17 vs. 14 months) or > 12 months/without recurrence (not reached vs. 113 months). Conclusion Our new regimen HAIC acted as an effective neoadjuvant therapy in reducing early recurrence rate and prolonged DFS of huge HCC after surgical resection.

Background: Liver cancer is a major health concern worldwide. Radiofrequency ablation is a safe treatment option that can be guided by either ultrasound, computer tomography (CT), or fluoroscopy. Although ultrasound-guided radiofrequency ablation is commonly used in clinical practice, radiofrequency ablation guided by CT is more precise but requires more time and does not offer real-time monitoring, which may result in complications such as pneumothorax or organ damage. Objectives: In this study, we investigated the effect of ultrasound, CT, and combined ultrasound/CT guidance on patient survival and complication development. Methods: A total of 982 radiofrequency ablation sessions conducted on 553 patients were analyzed. Clinical outcomes were assessed during follow-up to determine the survival and recurrence rates of malignant tumors. Results: Overall, the three guidance approaches exhibited significant differences in terms of tumor size, number, complication development, and treatment duration. However, no significant differences were observed in survival rate. A comparison of the effect of CT guidance and ultrasound guidance on complication development revealed a higher odds ratio for CT guidance in some cases. A comparison of combined ultrasound/CT guidance and ultrasound guidance revealed nonsignificant differences in complication development. A comparison of CT guidance and combined ultrasound/CT guidance revealed a higher odds ratio for CT guidance in some cases. Radiofrequency ablation is a safe and effective treatment for liver tumors. However, CT has an increased incidence of complications. Conclusions: Combined ultrasound/computer tomography guidance is recommended for patients with multiple or large tumors or tumors near the hepatic dome or diaphragm.

A 66-year-old woman presented with an incidental left thyroid nodule during a health examination. She had no voice change, shortness of breath, cough, or dysphagia. Repeated sonography showed a dynamic change of the lesion, which was more evident following soda consumption. A subsequent esophagography confirmed the diagnosis of a Killian–Jamieson diverticulum. This rare left-sided pharyngoesophageal diverticulum is often asymptomatic. On a sonography, air bubbles in the esophageal lumen can cause a ring-down artifact that mimics microcalcifications, which are characteristic of thyroid malignancy, and misdiagnosis may lead to unnecessary interventions, including fine-needle aspiration or thyroidectomy. A dynamic ultrasound, specifically done during soda consumption, offered a simple diagnostic distinction. No surgical intervention was pursued; the patient was monitored in the clinic.

Immunoglobulin G4-related disease (IgG4-RD) is an autoimmune-mediated disorder with heterogeneous multiorgan manifestations. Early identification and treatment of IgG4-RD are crucial for organ function recovery. Rarely, IgG4-RD manifests as a unilateral renal pelvic soft tissue mass that may be misdiagnosed as urothelial malignancy, resulting in invasive surgical intervention and organ damage. Here we present a 73-year-old man who had a right ureteropelvic mass with hydronephrosis detected by enhanced computed tomography. Right upper tract urothelial carcinoma and lymph node metastasis was highly suggested based on the image findings. However, IgG4-RD was suspected due to his past history of bilateral submandibular lymphadenopathy, nasolacrimal duct obstruction, as well as a high serum IgG4 level of 861 mg/dL. The ureteroscopy with tissue biopsy showed no evidence of urothelial malignancy. His lesions and symptoms improved after glucocorticoid treatment. Hence, a diagnosis of IgG4-RD was made, with the phenotype of classic Mikulicz syndrome with systemic involvement. The manifestation of IgG4-RD as a unilateral renal pelvic mass is rare and should be kept in mind. A ureteroscopic biopsy and serum IgG4 level measurement can help in the diagnosis of IgG4-RD in patients with a unilateral renal pelvic lesion.

Purpose: We aimed to study the efficacy and safety of hepatic artery infusion chemotherapy (HAIC) in the treatment of unresectable hepatocellular carcinoma (HCC) with extrahepatic spread (EHS). Materials and Methods: A total of 323 patients with unresectable HCC received HAIC plus lipiodol microvascular embolization. HAIC was performed via puncture of the left subclavian artery with a temporary 4-French angio-catheter placed in the common/proper hepatic artery. The HAIC regimen consisted of a daily infusion of cisplatin (10 mg/m2), mitomycin-C (2 mg/m2), and leucovorin (15 mg/m2), administered over a period of 20–30 min, and then a 5-fluorouracil (5-FU, 100 mg/m2) infusion for the remaining of 22 h of each day, for five consecutive days. Before the temporary catheter was removed, 10 mL of ethiodized oil (Lipiodol, Guerbet, France) was injected to obtain a synergistic effect of chemoinfusion and lipiodol microvascular embolization. Treatment responses were evaluated based on mRECIST criteria. The objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) of patients with EHS were compared to those without. Subgroup analyses of patients with and without major portal vein tumor thrombosis (PVTT) were performed both before and after propensity score matching (PSM). The survival analyses were conducted with the Kaplan–Meier method and compared using the log-rank test. All the statistical analyses were performed by SPSS (version 26.0). Result: The overall ORR was 59.1%. The median OS of the initial cohort and patients positive and negative for EHS were 16.3, 12.0, and 18.0 months, respectively (p = 0.002). In the subgroup analysis, there was no statistical difference in survival in patients with major PVTT between the with-EHS and without-EHS groups (13.0 vs. 15.0 months, p = 0.407). However, the median OS in patients with EHS was significantly shorter than those without EHS (11.4 vs. 19.4 months, p < 0.001) in the subgroup of non-major PVTT patients. After PSM, there were no significant survival differences between the EHS and non-EHS groups in any patient cohort or sub-cohort analysis. Conclusions: For unresectable HCC, controlling intrahepatic tumor progression through HAIC is more important than controlling extrahepatic tumor growth, especially in patients with major PVTT. Personalized locoregional HAIC can be performed in patients with EHS.

Background Foreign body granuloma is a rare surgery-related complication that can masquerade as cancer recurrence during postoperative surveillance. It may therefore deceive clinicians and lead to unnecessary interventions. The case presented herein demonstrates how a foreign body granuloma can be misleading in preoperative radiological studies and why this condition should not be ignored in differential diagnoses during surveillance of patients with previous history of abdominal surgery of any kind. Case presentation We report a case of suture granuloma mistaken for recurrent colon cancer, including the clinical history, imaging data, and histopathological photographs. A 60-year-old man was followed up at our institution after open right hemicolectomy 2 years earlier for ascending colon carcinoma. Contrast-enhanced computed tomography and magnetic resonance imaging revealed an infiltrative heterogeneous soft tissue lesion at the right mesenteric root, adjacent to the ileocolic anastomosis. Local recurrence was therefore suspected. We performed exploratory laparotomy, excised the tumor, and sent it for histopathological examination, which confirmed suture granuloma. Conclusions Foreign body granuloma is a rare surgery-related complication that should be considered during surveillance following colectomy. Its radiological features may mimic recurrent lesions, thus misleading clinicians and causing unnecessary interventions or further complications.

Purpose: To report our thrombolytic technique, treatment strategy, and clinical outcomes for porto-mesenteric venous thrombosis (PMVT) in non-cirrhotic patients. Methods: Sixteen acute or chronic non-cirrhotic PMVT patients (mean age: 48.6 years) with imminent intestinal ischemia were enrolled from 2004 to 2020. Eight patients presented thrombus extension into the peripheral mesenteric vein, close to the venous arcade. Transhepatic catheter-directed thrombolysis (CDT) was performed by urokinase infusion (60,000–30,000 IU/h concomitant with heparin 300–400 IU/h), catheter aspiration, and/or balloon dilation/stent placement. Additional intra-arterial mesenteric infusion of urokinase (30,000 IU/h) was given in patients with the peripheral mesenteric venules involved. Transjugular intrahepatic porto-systemic shunt (TIPS) was created in patients with poor recanalization of the intrahepatic portal flow (PV). Results: The transhepatic route was adopted in all patients, with adjunct indirect mesenteric arterial thrombolytic infusion in eight patients. A total of up to 20.4 million IU urokinase was infused for 1–21 days’ treatment duration. TIPS was created in three patients with recanalization failure of the intrahepatic PV. Technical success was achieved in 100% of patients with complete recanalization of 80% and partial recanalization of 20%. No major procedure-related complications were encountered. The 30-day mortality rate was 6.7%. The overall two-year primary patency was 84.6%. Conclusions: CDT can be performed as a primary salvage treatment once the diagnosis is made. CDT via the transhepatic route with tailored thrombolytic regimen is safe and effective for both acute and chronic PMVT. TIPS creation can be preserved in non-cirrhotic PMVT patients if intrahepatic PV recanalization fails.

Background: The prognosis of HCC patients with main portal vein invasion (Vp4) is poor. We retrospectively reviewed the therapeutic outcomes with our new HAIC regimen in treating Vp4 HCC patients. Patients and Methods: Seventy-one patients received the new regimen of combining HAIC (daily infusion of cisplatin (10 mg/m2), mitomycin-C (2 mg/m2) and Leucovorin (15 mg/m2) plus 100 mg/m2 of 5-fluorouracil (5-FU) using an infusion pump for 5 consecutive days) with Lipiodol embolization between 2002 and 2018. Twenty-two patients (31.0%) also received sorafenib. The Kaplan–Meier curve was used to calculate progression-free survival (PFS) and overall survival (OS). The OS of patients with or without additional sorafenib use or extrahepatic spread (EHS) was also compared. Results: Fifty-six patients (78.9%) had Child-Pugh A liver function. The mean maximal tumor size was 10.3 cm. Twenty patients (28.2%) had EHS at their initial diagnosis. The objective response rate according to the Modified Response Evaluation Criteria in Solid Tumors (mRECIST) and median OS were 64.8% and 13 months. The 1-, 2- and 3-year survival rates were 53.1%, 21.5% and 18.7%, respectively. In the subgroup analysis, there were no significant survival difference between patients with HAIC only vs. HAIC plus sorafenib (14 vs. 13 months) and between patients with vs. without EHS (12 vs. 13 months). Conclusions: Our new HAIC regimen is effective in treating Vp4 HCC patients. Additional sorafenib use with our new HAIC regimen provided no survival benefit.