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Exophytic benign and malignant hepatic tumors: CT imaging features.

Kim HJ, Lee DH, Lim JW, Ko YT, Kim KW - Korean J Radiol (2008 Jan-Feb)

Bottom Line: The beak sign and the feeding artery of a tumor are useful diagnostic indicators of exophytic hepatic tumors.Two- or three-dimensional reformation images are also helpful for diagnosis.The CT features of exophytic hepatic tumors are similar to those of the usual intrahepatic tumors except for their location.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kyung Hee University Medical Center, Dongdaemun-Gu, Seoul, Korea. radhjkim@khu.ac.kr

ABSTRACT
Our objective is to describe the CT features of exophytic hepatic tumors those may pose a diagnostic challenge because of the uncertainty of tumor origin. The beak sign and the feeding artery of a tumor are useful diagnostic indicators of exophytic hepatic tumors. Two- or three-dimensional reformation images are also helpful for diagnosis. The CT features of exophytic hepatic tumors are similar to those of the usual intrahepatic tumors except for their location.

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Related in: MedlinePlus

A 57-year-old woman with an exophytic hepatocellular carcinoma with duodenal invasion.A. A contrast-enhanced CT scan during hepatic arterial phase shows a large necrotic mass, compressing the lateral wall of the duodenum (D). The solid portion of this mass (arrow) shows iso-density in comparison with the liver parenchyma.On a contrast-enhanced CT scan during portal venous phase, the solid portion of this mass (arrow) shows low density in comparison with the liver parenchyma. The beak sign (arrowhead) is noted in its contact surface with the right lobe. The fine nodular hepatic surface suggests liver cirrhosis. The lateral wall of the duodenum (D) is not definite.
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Figure 8: A 57-year-old woman with an exophytic hepatocellular carcinoma with duodenal invasion.A. A contrast-enhanced CT scan during hepatic arterial phase shows a large necrotic mass, compressing the lateral wall of the duodenum (D). The solid portion of this mass (arrow) shows iso-density in comparison with the liver parenchyma.On a contrast-enhanced CT scan during portal venous phase, the solid portion of this mass (arrow) shows low density in comparison with the liver parenchyma. The beak sign (arrowhead) is noted in its contact surface with the right lobe. The fine nodular hepatic surface suggests liver cirrhosis. The lateral wall of the duodenum (D) is not definite.

Mentions: Hepatocellular carcinoma (HCC) is the most common primary malignant hepatic tumor. Exophytic growth or pedunculation is not a novel finding of HCCs. It has been reported that exophytic HCCs constitute 0.2-4.2% of all HCCs (14, 15). It is well known that HCC may show retroperitoneal extension and thus mimic a right adrenal tumor (16). However, exophytic growth of HCCs may be seen in any lobe or segment of the liver. This tumor may invade the duodenum and mimic a duodenal gastrointestinal stromal tumor (Fig. 8). Bile duct and portal vein invasion are late presentations in usual intrahepatic HCCs and they may be seen in exophytic HCCs. Most intraductal masses are contiguous with the parenchymal HCCs (17). Therefore, an exophytic hepatic mass contiguous with a bile duct mass is a similar finding to a usual intrahepatic HCC with bile duct invasion, except for location (Fig. 9). On dynamic CT, an intraductal HCC shows high density during hepatic arterial phase and washout during portal venous phase. Therefore, typical enhancement pattern of HCC, surrounding cirrhotic liver, and bile duct dilatation by the mass may be clues for the diagnosis of an exophytic HCC.


Exophytic benign and malignant hepatic tumors: CT imaging features.

Kim HJ, Lee DH, Lim JW, Ko YT, Kim KW - Korean J Radiol (2008 Jan-Feb)

A 57-year-old woman with an exophytic hepatocellular carcinoma with duodenal invasion.A. A contrast-enhanced CT scan during hepatic arterial phase shows a large necrotic mass, compressing the lateral wall of the duodenum (D). The solid portion of this mass (arrow) shows iso-density in comparison with the liver parenchyma.On a contrast-enhanced CT scan during portal venous phase, the solid portion of this mass (arrow) shows low density in comparison with the liver parenchyma. The beak sign (arrowhead) is noted in its contact surface with the right lobe. The fine nodular hepatic surface suggests liver cirrhosis. The lateral wall of the duodenum (D) is not definite.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627168&req=5

Figure 8: A 57-year-old woman with an exophytic hepatocellular carcinoma with duodenal invasion.A. A contrast-enhanced CT scan during hepatic arterial phase shows a large necrotic mass, compressing the lateral wall of the duodenum (D). The solid portion of this mass (arrow) shows iso-density in comparison with the liver parenchyma.On a contrast-enhanced CT scan during portal venous phase, the solid portion of this mass (arrow) shows low density in comparison with the liver parenchyma. The beak sign (arrowhead) is noted in its contact surface with the right lobe. The fine nodular hepatic surface suggests liver cirrhosis. The lateral wall of the duodenum (D) is not definite.
Mentions: Hepatocellular carcinoma (HCC) is the most common primary malignant hepatic tumor. Exophytic growth or pedunculation is not a novel finding of HCCs. It has been reported that exophytic HCCs constitute 0.2-4.2% of all HCCs (14, 15). It is well known that HCC may show retroperitoneal extension and thus mimic a right adrenal tumor (16). However, exophytic growth of HCCs may be seen in any lobe or segment of the liver. This tumor may invade the duodenum and mimic a duodenal gastrointestinal stromal tumor (Fig. 8). Bile duct and portal vein invasion are late presentations in usual intrahepatic HCCs and they may be seen in exophytic HCCs. Most intraductal masses are contiguous with the parenchymal HCCs (17). Therefore, an exophytic hepatic mass contiguous with a bile duct mass is a similar finding to a usual intrahepatic HCC with bile duct invasion, except for location (Fig. 9). On dynamic CT, an intraductal HCC shows high density during hepatic arterial phase and washout during portal venous phase. Therefore, typical enhancement pattern of HCC, surrounding cirrhotic liver, and bile duct dilatation by the mass may be clues for the diagnosis of an exophytic HCC.

Bottom Line: The beak sign and the feeding artery of a tumor are useful diagnostic indicators of exophytic hepatic tumors.Two- or three-dimensional reformation images are also helpful for diagnosis.The CT features of exophytic hepatic tumors are similar to those of the usual intrahepatic tumors except for their location.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Kyung Hee University Medical Center, Dongdaemun-Gu, Seoul, Korea. radhjkim@khu.ac.kr

ABSTRACT
Our objective is to describe the CT features of exophytic hepatic tumors those may pose a diagnostic challenge because of the uncertainty of tumor origin. The beak sign and the feeding artery of a tumor are useful diagnostic indicators of exophytic hepatic tumors. Two- or three-dimensional reformation images are also helpful for diagnosis. The CT features of exophytic hepatic tumors are similar to those of the usual intrahepatic tumors except for their location.

Show MeSH
Related in: MedlinePlus