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Ng JKM, Leung HHW, Li JJX. Aspiration cytology of liver abscess uncovering metastatic rectal mucosal melanoma-A case report. Cytopathology 2024; 35:163-166. [PMID: 37430463 DOI: 10.1111/cyt.13269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/12/2023]
Abstract
Aspirates of liver abscess are frequently encountered in routine practice and are often of a low index of suspicion. However, necrotic liver metastasis clinically and radiologically mimics liver abscesses, and malignant cells can be obscured in an inflammation-rich background on cytology. It is important to recognise malignant neoplasms in this scenario, in particular uncommon conditions such as metastatic mucosal melanoma.
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Affiliation(s)
- Joanna K M Ng
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Howard H W Leung
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Joshua J X Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Cervoni JP, Alby-Lepresle B, Weil D, Zhong P, Aubin F, Wendling D, Toussirot E, Vuitton L, Carbonnel F, Blondet R, Thévenot T, Calès P, Monnet E, Di Martino V. A pragmatic non-invasive assessment of liver fibrosis in patients with psoriasis, rheumatoid arthritis or Crohn's disease receiving methotrexate therapy. Clin Res Hepatol Gastroenterol 2020; 44S:100003. [PMID: 33602481 DOI: 10.1016/j.clirex.2020.100003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/12/2020] [Accepted: 01/22/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS The reported hepatotoxicity of methotrexate underlines the need for a repeated non-invasive and reliable evaluation of liver fibrosis. We estimated, using a non-invasive strategy, the prevalence of significant liver fibrosis in patients treated by methotrexate and the predictors of significant fibrosis (fibrosis≥F2). METHODS Fibrosis was prospectively evaluated using 9 non-invasive tests in consecutive patients with psoriasis, rheumatoid arthritis, or Crohn's disease. Significant fibrosis was assessed without liver biopsy by defining a "specific method" (result given by the majority of the tests) and a "sensitive method" (at least one test indicating a stage≥F2). RESULTS One hundred and thirty-one patients (66 Psoriasis, 40 rheumatoid arthritis, and 25 Crohn's disease) were enrolled, including 83 receiving methotrexate. Seven tests were performed on average per patient, with a complete concordance in 75% of cases. Fibroscan® was interpretable in only 61% of patients. The best performances (AUROC>0.9) for predicting significant fibrosis were obtained by tests dedicated to steatohepatitis (FibroMeter NAFLD, NFS and FPI). The prevalence of fibrosis≥F2 according to the "specific" or the "sensitive" assessment of fibrosis was 10% and 28%, respectively. Methotrexate exposure did not influence the fibrosis stage. Factors independently associated with significant fibrosis according our "sensitive method" were age, male gender, and metabolic syndrome. CONCLUSION We provided a non-invasive approach for identifying liver fibrosis≥F2 by using 8 biochemical tests and Fibroscan®. In this population, the risk of significant fibrosis was related to age, male gender, and presence of metabolic syndrome, but was not influenced by methotrexate.
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Affiliation(s)
- Jean-Paul Cervoni
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France; CIC-BT, CHRU Jean-Minjoz, 25030 Besançon cedex, France.
| | - Blandine Alby-Lepresle
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Delphine Weil
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Peng Zhong
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - François Aubin
- Service de dermatologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Daniel Wendling
- Service de rhumatologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Eric Toussirot
- CIC-BT, CHRU Jean-Minjoz, 25030 Besançon cedex, France; Service de rhumatologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Lucine Vuitton
- Service de gastroenterologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Franck Carbonnel
- Service de gastroenterologie, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | | | - Thierry Thévenot
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Paul Calès
- Service d'hépatologie et de gastroenterologie, CHRU Angers, 49100 Angers, France
| | - Elisabeth Monnet
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France; CIC-BT, CHRU Jean-Minjoz, 25030 Besançon cedex, France
| | - Vincent Di Martino
- Service d'hépatologie et de soins intensifs digestifs, CHRU Jean-Minjoz, 25030 Besançon cedex, France
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Utilisation de l’élastométrie hépatique comme outil de dépistage de la fibrose hépatique dans un service d’addictologie. Presse Med 2014; 43:e17-31. [DOI: 10.1016/j.lpm.2013.07.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 12/11/2022] Open
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Wong GLH. Transient elastography: Kill two birds with one stone? World J Hepatol 2013; 5:264-274. [PMID: 23717737 PMCID: PMC3664284 DOI: 10.4254/wjh.v5.i5.264] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/01/2013] [Accepted: 03/07/2013] [Indexed: 02/06/2023] Open
Abstract
Assessment of liver fibrosis and steatosis is crucial in chronic liver diseases in order to determine the prognosis, the need of treatment, as well as monitor disease progression and response to treatment. Liver biopsy is limited by its invasiveness and patient acceptability. Transient elastography (TE, Fibroscan®) is a non-invasive tool with satisfactory accuracy and reproducibility to estimate liver fibrosis and steatosis. TE has been well validated in major liver diseases including chronic hepatitis B and C, non-alcoholic fatty liver disease, alcoholic liver disease, primary biliary cirrhosis, and primary sclerosing cholangitis. As alanine aminotransferase (ALT) is one of the major confounding factors of liver stiffness in chronic hepatitis B, an ALT-based algorithm has been developed and higher liver stiffness measurements (LSM) cutoff values for different stages of liver fibrosis should be used in patients with elevated ALT levels up to 5 times of the upper limit of normal. Otherwise falsely-high LSM results up to cirrhotic range may occur during ALT flare. TE is also useful in predicting patient prognosis such as development of hepatocellular carcinoma (HCC), portal hypertension, post-operative complications in HCC patients, and also survival. Unfortunately, failed acquisition of TE is common in obese patients. Furthermore, obese patients may have higher LSM results even in the same stage of liver fibrosis. The new XL probe, a larger probe with lower ultrasound frequency and deeper penetration, increases the success rate of TE in obese patients. The median LSM value with XL probe was found to be lower than that by the conventional M probe, hence cutoff values approximately 1.2 to 1.3 kPa lower than those of M probe should be adopted. Recent studies revealed a novel ultrasonic controlled attenuation parameter (CAP) of the machine is a useful parameter to detect even low-grade steatosis noninvasively. CAP may also be used to quantify liver steatosis by applying different cutoff values. As both LSM and CAP results are instantly available at same measurement, this makes TE a very convenient tool to assess any patients who are suspected or confirmed to suffer from chronic liver diseases.
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Das K, Sarkar R, Ahmed SM, Mridha AR, Mukherjee PS, Das K, Dhali GK, Santra A, Chowdhury A. "Normal" liver stiffness measure (LSM) values are higher in both lean and obese individuals: a population-based study from a developing country. Hepatology 2012; 55:584-93. [PMID: 21952989 DOI: 10.1002/hep.24694] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Accepted: 09/14/2011] [Indexed: 12/19/2022]
Abstract
UNLABELLED The liver stiffness measure (LSM) needs to be explored in ethnically and anthropometrically diverse healthy subjects (to derive an acceptable normal range) and also in patients with liver disease. In view of this objective, LSM was performed by transient elastography (TE) using FibroScan in 437 healthy subjects with normal alanine aminotransferase (ALT) levels, recruited from a free-living population of the Birbhum Population Project (BIRPOP; www.shds.in), a Health and Demographic Surveillance System (HDSS), and from 274 patients with liver disease attending the Hepatology Clinic of the School of Digestive and Liver Diseases (SDLD; Institute of Post Graduate Medical Education & Research [IPGME&R], Kolkata, India) including 188 with nonalcoholic fatty liver disease (NAFLD) and 86 with chronic hepatitis of viral and other etiologies. Liver biopsy was performed in 125 patients. The range of normal values for LSM, defined by 5th and 95th percentile values in healthy subjects, was 3.2 and 8.5 kPa, respectively. Healthy subjects with a lower body mass index (BMI; < <18.5 kg/m(2)) had a higher LSM compared with subjects who had a normal BMI; this LSM value was comparable to that of obese subjects (6.05 ± 1.78 versus 5.51 ± 1.59 and 6.60 ± 1.21, P = 0.016 and 0.349, respectively). Liver disease patients without histologic fibrosis had significantly higher LSM values compared with healthy subjects (7.52 ± 5.49 versus 5.63 ± 1.64, P < 0.001). Among the histologic variables, stage of fibrosis was the only predictor for LSM. LSM did not correlate with inflammatory activity and ALT in both NAFLD and chronic hepatitis groups. CONCLUSION LSM varies between 3.2 and 8.5 kPa in healthy subjects of South Asian origin. Both lean and obese healthy subjects have higher LSM values compared with subjects with normal BMI. Liver stiffness begins to increase even before fibrosis appears in patients with liver disease.
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Affiliation(s)
- Kausik Das
- Department of Hepatology, Institute of Post Graduate Medical Education & Research, Kolkata, India
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Cholongitas E, Tsochatzis E, Goulis J, Burroughs AK. Noninvasive tests for evaluation of fibrosis in HCV recurrence after liver transplantation: a systematic review. Transpl Int 2010; 23:861-70. [PMID: 20704691 DOI: 10.1111/j.1432-2277.2010.01142.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Noninvasive tests (NIT) for evaluation of hepatic fibrosis have not been evaluated extensively in liver transplantation. We systematically reviewed the literature regarding NIT after liver transplantation. We identified 14 studies evaluating NIT based on serum markers and/or liver imaging techniques: 10 studies assessed NIT in recipients with recurrent HCV infection for fibrosis and four studies evaluated predictors of progression of fibrosis in recurrent HCV. Transient Elastography (TE) had good discrimination for significant fibrosis (median AUROC: 0.88). Among the serum NIT, APRI had good performance (median AUROC: 0.75). TE performed better than serum (direct and indirect) NIT for significant fibrosis with median AUROC 0.88 (vs. 0.66, P < 0.001), median sensitivity 0.86 (vs. 0.56, P = 0.002), median NPV 0.90 (vs. 0.74, P = 0.05) and median PPV 0.80 (vs. 0.63, P = 0.02). TE compared to indirect serum NIT, had better performance, but was not superior to APRI score. Finally, direct, compared to indirect NIT, were not significantly different except for specificity: median: 0.83 vs. 0.69, respectively, P = 0.04. In conclusion, NIT could become an important tool in clinical management of liver transplant recipients, but whether they can improve clinical practice needs further evidence. Their optimal combination with liver biopsy and assessment of collagen content requires investigation.
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Affiliation(s)
- Evangelos Cholongitas
- The 4th Department of Internal Medicine, Medical School of Aristotle University, Greece. Royal Free Hospital, London, UK
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Balabaud C, Bioulac-Sage P. Cirrhosis: what else? ACTA ACUST UNITED AC 2010; 34:252-4. [PMID: 20537484 DOI: 10.1016/j.gcb.2010.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 03/02/2010] [Indexed: 12/22/2022]
Abstract
When the term cirrhosis was coined two centuries ago by Laennec, it designates by definition an end stage irreversible liver disease. Nowadays this word encompasses a whole range of disorders including some degree of reversibility for the early stage. It is therefore of prime importance to define the stages of the fibrotic process, based on the integration of knowledge about liver structure and function. In addition to morphological data, modern imaging techniques coupled to non-invasive biomarkers will probably help to better define and denominate this heterogeneous entity.
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Affiliation(s)
- C Balabaud
- Service d'Hépatologie, Hôpital St-André, CHU de Bordeaux, 33075 Bordeaux, France.
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Poynard T, Lebray P, Ingiliz P, Varaut A, Varsat B, Ngo Y, Norha P, Munteanu M, Drane F, Messous D, Bismut FI, Carrau JP, Massard J, Ratziu V, Giordanella JP. Prevalence of liver fibrosis and risk factors in a general population using non-invasive biomarkers (FibroTest). BMC Gastroenterol 2010; 10:40. [PMID: 20412588 PMCID: PMC2864202 DOI: 10.1186/1471-230x-10-40] [Citation(s) in RCA: 162] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 04/22/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND FibroTest and elastography have been validated as biomarkers of liver fibrosis in the most frequent chronic liver diseases and in the fibrosis screening of patients with diabetes. One challenge was to use them for estimating the prevalence of fibrosis, identifying independent risk factors and to propose screening strategies in the general population. METHODS We prospectively studied 7,463 consecutive subjects aged 40 years or older. Subjects with presumed advanced fibrosis (FibroTest greater than 0.48) were re-investigated in a tertiary center. RESULTS The sample characteristics were similar to those of the French population. FibroTest was interpretable in 99.6%. The prevalence of presumed fibrosis was 2.8%, (209/7,463), including cirrhosis in 0.3% (25/7,463); 105/209 (50%) subjects with presumed fibrosis accepted re-investigation. Fibrosis was confirmed in 50, still suspected in 27, indeterminate in 25 and not confirmed with false positive FibroTest or false negative elastography in 3 subjects. False negative rate of FibroTest estimated using elastography was 0.4% (3/766). The attributable causes for confirmed fibrosis were both alcoholic and nonalcoholic fatty liver disease (NAFLD) in 66%, NAFLD in 13%, alcohol in 9%, HCV in 6%, and other in 6%. Factors independently associated (all P < 0.003) with confirmed fibrosis were age, male gender, waist circumference, HCV antibody and alcohol consumption estimated using carbohydrate-deficient transferrin, enabling efficient screening-oriented strategies to be compared and proposed. CONCLUSIONS Biomarkers have permitted to estimate prevalence of advanced fibrosis around 2.8% in a general population aged 40 years or older, and several risk factors which may be used for the validation of selective or non-selective screening strategies.
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Affiliation(s)
- Thierry Poynard
- APHP-UPMC-Liver Center, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Pascal Lebray
- APHP-UPMC-Liver Center, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Patrick Ingiliz
- APHP-UPMC-Liver Center, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Anne Varaut
- APHP-UPMC-Liver Center, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | | | - Yen Ngo
- APHP-UPMC-Liver Center, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Pascal Norha
- APHP-UPMC-Liver Center, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | | | | | - Djamila Messous
- Biochemistry Unit, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Françoise Imbert Bismut
- Biochemistry Unit, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | | | - Julien Massard
- APHP-UPMC-Liver Center, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
| | - Vlad Ratziu
- APHP-UPMC-Liver Center, Assistance Publique Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France
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Poynard T, Munteanu M, Ngo Y, Ratziu V. Appropriate evidence-based data overviews demonstrate the diagnostic and prognostic performances of FibroTest in patients with chronic hepatitis C. Aliment Pharmacol Ther 2009; 30:1183-5; author reply 1185-6. [PMID: 19888919 DOI: 10.1111/j.1365-2036.2009.04115.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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