EURORAD ESR

Case 12574

Hepatocellular carcinoma recurrence from needle-track neoplastic seeding

Author(s)
Tonolini Massimo, MD1, Crespi Michele, MD2

(1) Radiology Department
(2) Surgery Department
"Luigi Sacco" University Hospital
Via G.B. Grassi 74
20157 Milan, Italy
Email:mtonolini@sirm.org
 
Patient
male, 76 year(s)
 
 
  • Figure 1
    Pre-biopsy multiphase contrast-enhanced multidetector CT (MDCT)
     

    Unenhanced CT acquisition showed a 5x3.5 cm subcapsular mass (demarcated by arrowheads) in the left liver lobe, mildly hypoattenuating compared to the surrounding parenchyma.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    On arterial- (b,c), portal venous (d) and delayed (e) phase images, the lesion (arrowheads) appeared well-demarcated, slightly lobulated, with early hyperenhancement and subsequent contrast washout, a central...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    On arterial- (b,c), portal venous (d) and delayed (e) phase images, the lesion (arrowheads) appeared well-demarcated, slightly lobulated, with early hyperenhancement and subsequent contrast washout, a central...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    On arterial- (b,c), portal venous (d) and delayed (e) phase images, the lesion (arrowheads) appeared well-demarcated, slightly lobulated, with early hyperenhancement and subsequent contrast washout, a central...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    On arterial- (b,c), portal venous (d) and delayed (e) phase images, the lesion (arrowheads) appeared well-demarcated, slightly lobulated, with early hyperenhancement and subsequent contrast washout, a central...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;
     
     
  • Figure 2
    Percutaneous ultrasound-guided biopsy
     

    The subcapsular liver lesion of the left liver lobe (demarcated by arrowheads) appeared mildly hypoechoic compared to the surrounding hepatic parenchyma. Note dotted biopsy track.

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Neoplasia;

    Cytologic sampling was obtained by means of fine-needle aspiration biopsy (note needle tip indicated by thin arrow).

     
    Area of Interest: Liver; Imaging Technique: Percutaneous; Procedure: Biopsy; Special Focus: Neoplasia;
     
     
  • Figure 3
    Post-surgical resection multiphase contrast-enhanced MDCT
     

    Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;
     
     
  • Figure 4
    Follow-up multiphase contrast-enhanced MDCT
     

    Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal course of the surgical site of liver resection (arrows) without signs of local or distant recurrence.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal course of the surgical site of liver resection (arrows) without signs of local or distant recurrence.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal course of the surgical site of liver resection (arrows) without signs of local or distant recurrence.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal course of the surgical site of liver resection (arrows) without signs of local or distant recurrence.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Surgery; Special Focus: Neoplasia;
     
     
  • Figure 5
    Multiphase contrast-enhanced MDCT at recurrence
     

    The palpable mass corresponded to a round 8 cm median well-demarcated lesion (*) with solid unenhanced attenuation values, occupying the subcutaneous fat and anterior abdominal wall. Normal appearance at the surgical...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;

    Dynamic study including arterial-(b,c), portal venous (d,e) and delayed (f) phase acquisitions showed the mass (*) with heterogeneous hypervascularization and "mosaic" washout. Normal appearance at the surgical site...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;

    Dynamic study including arterial-(b,c), portal venous (d,e) and delayed (f) phase acquisitions showed the mass (*) with heterogeneous hypervascularization and "mosaic" washout. Normal appearance at the surgical site...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;

    Dynamic study including arterial-(b,c), portal venous (d,e) and delayed (f) phase acquisitions showed the mass (*) with heterogeneous hypervascularization and "mosaic" washout. Normal appearance at the surgical site...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;

    Sagittal reformatted image from portal venous acquisition showed the heterogeneous mass (*) with "mosaic" washout, centred in the subcutaneous fat, which displaced the thin abdominal wall musculature posteriorly.

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;

    Dynamic study including arterial-(b,c), portal venous (d,e) and delayed (f) phase acquisitions showed the mass (*) with heterogeneous hypervascularization and "mosaic" washout. Normal appearance at the surgical site...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;
     
     
  • Figure 6
    Post-surgical reintervention multiphase contrast-enhanced MDCT
     

    Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal appearances at both the previous site of liver resection (arrows) and recent site of excision (*) of abdominal wall...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal appearances at both the previous site of liver resection (arrows) and recent site of excision (*) of abdominal wall...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal appearances at both the previous site of liver resection (arrows) and recent site of excision (*) of abdominal wall...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;

    Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal appearances at both the previous site of liver resection (arrows) and recent site of excision (*) of abdominal wall...

     
    Area of Interest: Liver; Imaging Technique: CT; Procedure: Biopsy; Special Focus: Neoplasia;
     
     
  • Figure 7
    Chest MDCT 4 months after surgical excision of needle-track recurrence
     

    Axial maximum-intensity projection (MIP, a-b) and coronal reformatted (c) images showed bilateral appearance of several lung nodules (arrows) ranging from tiny to 2.5 cm, consistent with metachronous haematogenous...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    Axial maximum-intensity projection (MIP, a-b) and coronal reformatted (c) images showed bilateral appearance of several lung nodules (arrows) ranging from tiny to 2.5 cm, consistent with metachronous haematogenous...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;

    Axial maximum-intensity projection (MIP, a-b) and coronal reformatted (c) images showed bilateral appearance of several lung nodules (arrows) ranging from tiny to 2 cm, consistent with metachronous haematogenous...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Staging; Special Focus: Neoplasia;
     
     
Unenhanced CT acquisition showed a 5x3.5 cm subcapsular mass (demarcated by arrowheads) in the left liver lobe, mildly hypoattenuating compared to the surrounding parenchyma.
 
On arterial- (b,c), portal venous (d) and delayed (e) phase images, the lesion (arrowheads) appeared well-demarcated, slightly lobulated, with early hyperenhancement and subsequent contrast washout, a central hypoattenuating scar-like area.
 
On arterial- (b,c), portal venous (d) and delayed (e) phase images, the lesion (arrowheads) appeared well-demarcated, slightly lobulated, with early hyperenhancement and subsequent contrast washout, a central hypoattenuating scar-like area.
 
On arterial- (b,c), portal venous (d) and delayed (e) phase images, the lesion (arrowheads) appeared well-demarcated, slightly lobulated, with early hyperenhancement and subsequent contrast washout, a central hypoattenuating scar-like area.
 
On arterial- (b,c), portal venous (d) and delayed (e) phase images, the lesion (arrowheads) appeared well-demarcated, slightly lobulated, with early hyperenhancement and subsequent contrast washout, a central hypoattenuating scar-like area.
 
The subcapsular liver lesion of the left liver lobe (demarcated by arrowheads) appeared mildly hypoechoic compared to the surrounding hepatic parenchyma. Note dotted biopsy track.
 
Cytologic sampling was obtained by means of fine-needle aspiration biopsy (note needle tip indicated by thin arrow).
 
Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating nonenhancing collection (arrows).
 
Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating nonenhancing collection (arrows).
 
Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating nonenhancing collection (arrows).
 
Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating nonenhancing collection (arrows).
 
Unenhanced (a), arterial-(b), portal venous (c,d) and delayed (e) acquisitions showed normal early postoperative appearances at the surgical site of resection, including metallic clips and a hypoattenuating nonenhancing collection (arrows).
 
Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal course of the surgical site of liver resection (arrows) without signs of local or distant recurrence.
 
Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal course of the surgical site of liver resection (arrows) without signs of local or distant recurrence.
 
Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal course of the surgical site of liver resection (arrows) without signs of local or distant recurrence.
 
Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal course of the surgical site of liver resection (arrows) without signs of local or distant recurrence.
 
The palpable mass corresponded to a round 8 cm median well-demarcated lesion (*) with solid unenhanced attenuation values, occupying the subcutaneous fat and anterior abdominal wall. Normal appearance at the surgical site of liver resection (arrows).
 
Dynamic study including arterial-(b,c), portal venous (d,e) and delayed (f) phase acquisitions showed the mass (*) with heterogeneous hypervascularization and "mosaic" washout. Normal appearance at the surgical site of liver resection (arrows).
 
Dynamic study including arterial-(b,c), portal venous (d,e) and delayed (f) phase acquisitions showed the mass (*) with heterogeneous hypervascularization and "mosaic" washout. Normal appearance at the surgical site of liver resection (arrows).
 
Dynamic study including arterial-(b,c), portal venous (d,e) and delayed (f) phase acquisitions showed the mass (*) with heterogeneous hypervascularization and "mosaic" washout. Normal appearance at the surgical site of liver resection (arrows).
 
Sagittal reformatted image from portal venous acquisition showed the heterogeneous mass (*) with "mosaic" washout, centred in the subcutaneous fat, which displaced the thin abdominal wall musculature posteriorly.
 
Dynamic study including arterial-(b,c), portal venous (d,e) and delayed (f) phase acquisitions showed the mass (*) with heterogeneous hypervascularization and "mosaic" washout. Normal appearance at the surgical site of liver resection (arrows).
 
Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal appearances at both the previous site of liver resection (arrows) and recent site of excision (*) of abdominal wall recurrence.
 
Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal appearances at both the previous site of liver resection (arrows) and recent site of excision (*) of abdominal wall recurrence.
 
Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal appearances at both the previous site of liver resection (arrows) and recent site of excision (*) of abdominal wall recurrence.
 
Unenhanced (a), arterial-(b), portal venous (c) and delayed (d) phase acquisitions showed normal appearances at both the previous site of liver resection (arrows) and recent site of excision (*) of abdominal wall recurrence.
 
Axial maximum-intensity projection (MIP, a-b) and coronal reformatted (c) images showed bilateral appearance of several lung nodules (arrows) ranging from tiny to 2.5 cm, consistent with metachronous haematogenous metastases.
 
Axial maximum-intensity projection (MIP, a-b) and coronal reformatted (c) images showed bilateral appearance of several lung nodules (arrows) ranging from tiny to 2.5 cm, consistent with metachronous haematogenous metastases.
 
Axial maximum-intensity projection (MIP, a-b) and coronal reformatted (c) images showed bilateral appearance of several lung nodules (arrows) ranging from tiny to 2 cm, consistent with metachronous haematogenous metastases.
 
 
 
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