- Volume 20, Issue 1, 2024

Clear cell hepatocellular carcinoma (HCC) is a rare subtype of HCC. Histologically, clear cell HCC is characterized by the cytoplasmic accumulation of glycogen with a clear cell appearance, constituting > 80% of tumor cells. Radiologically, clear cell HCC demonstrates early enhancement and washout similar to conventional HCC. Occasionally, enhancing capsule and intratumoral fat are accompanied by clear cell HCC.

A 57-year-old male presented to our hospital with right upper quadrant abdominal pain. Ultrasonography, computed tomography, and magnetic resonance imaging revealed a large mass with a well-defined margin in the right hemiliver. The patient underwent a right hemihepatectomy, and the final histopathology revealed clear cell-type HCC.

Distinguishing clear cell types from other types of HCC solely based on radiological findings is challenging. If hepatic tumors exhibit encapsulated margins, enhancing rims, intratumoral fat, and arterial phase hyperenhancement/washout pattern despite their large size, consideration of clear cell subtypes in the differential diagnosis list will aid patient management, implying better prognosis than not-otherwise-specified HCC.

The liver plays a significant role in the digestive system, and disease in the liver initiates various other problems. The liver is severely affected due to alcohol use, and it initiates various chronic diseases, including Alcohol-Related Liver Disease (ARLD). Alcoholic/Nonalcoholic Fatty Liver Disease (AFLD/NFLD) is a severe medical emergency, and early screening and treatment are necessary to cure the patient. The untreated AFLD/NFLD will cause various problems, including fatigue, weight loss, and discomfort in the abdomen.

This study aims to present a detailed review and investigation of schemes considered in medical clinics to identify the AFLD/NFLD coupled problems and present the merit of the Transient Elastography (TE) combined with Fibroscan® practice to identify liver abnormality.

This research aims to study the clinical significance and the accuracy of TE-supported liver illness screening.

This work aims to collect the recent research works and clinical reports published from 2011 to 2021 from the chosen databases and provide a detailed review using the clinical information discussed in the selected articles.

The essential statistical investigation of the collected data is executed with Review Manager (RevMan^®) software, and the significance of the TE is confirmed using the articles supporting a 2x2 contingency table, and each case is evaluated using a p-score and the Region of Convergence (RoC) curve for 95% confidence intervals.

Scimitar syndrome is a rare developmental anomaly with an incidence of 2/100.000 births. Major components of this disease are partial anomalous pulmonary venous drainage, pulmonary hypoplasia, systemic arterialization of the right basal lung, and dextroposition of the heart. Horseshoe lung and accessory hemidiaphragm are two rarer components of this disease.

In this paper, horseshoe lung and accessory diaphragm associated with Scimitar syndrome have been reported in two cases.

In conclusion, being aware of rare manifestations of rare diseases is important to fully describe the pathologic spectrum of the disease. This will assist in better management and decision-making process.

Absent contractility is a kind of esophageal motility disorder. Patients are often diagnosed by endoscopic ultrasonography or high-resolution manometry (HRM). In this paper, we report two cases of absent esophageal contractility first discovered by transabdominal ultrasonography.

The main symptom of both cases was acid reflux, and the main diagnosis was absent esophageal contractility. They were all discovered by transabdominal ultrasonography. After the treatment of surgery or drugs, the symptoms relieved during follow-up, without any other discomforts.

Transabdominal ultrasound as a primary screening method for absent contractility is proposed in this paper, which is non-invasive, real-time, and fast. Ultrasound is expected to improve the diagnostic efficiency of peristalsis and patient experience in combination with the above invasive examinations. The use of sonography in the diagnosis of absent contractility has seldom been studied. Further investigation is required to determine whether this technique may better assess absent contractility.

Intervertebral disc degeneration (IVD) is now the most prevalent disease in the world; thus, precise intervertebral disc segmentation is essential for the assessment and diagnosis of spinal diseases. Multi-modal magnetic resonance (MR) imaging is more multi-dimensional and thorough than unimodal imaging. However, manual segmentation of multi-modal MRI not only imposes a huge burden on physicians but also has a high error rate.

In this study, we propose a new method that can efficiently and accurately segment intervertebral discs from multi-modal MR spine images, providing a reproducible usage scheme for the diagnosis of spinal disorders.

We suggest a network structure called MLP-Res-Unet that reduces the amount of computational load and the number of parameters while maintaining performance. Our contribution is two-fold. First, a medical image segmentation network that fuses residual blocks and a multilayer perceptron (MLP) is proposed. Secondly, we design a new deep supervised method and pass the features extracted from the encoder to the decoder through the residual path to achieve a new full-scale residual connection.

We evaluate the network on the MICCAI-2018 IVD dataset and obtain Dice similarity coefficient equal to 94.77 (%) and Jaccard coefficient equal to 84.74 (%), while we reduce the amount of parameters by a factor of 3.9 and computation by a factor of 2.4 compared to the IVD-Net.

Experiments show that MLP-Res-Unet improves segmentation performance and creates a simpler model structure while reducing the number of parameters and computation.

Paget's disease of bone (PDB) is the second most frequent metabolic bone disease affecting about 3 percent of the Caucasian population older than 55 years. Its etiopathogenesis is unknown. While viral agents like measles and respiratory syncytial virus has been proposed, the role of genetic susceptibility loci such as SQSTM1/p62 gene mutations have been confirmed. A new inhibitory mechanism against osteoprotegerin (OPG) via autoantibodies has been revealed in a patient with occult celiac disease (CD) with a phenotype similar to juvenile Paget's disease, which suggests an immunological mechanism for Paget's disease-like disorders other than genetic causes. But there is no report in the literature addressing the shared immunological mechanisms underlying classic PDB, CD and psoriasis.

Herein, the case of a 50-year-old Caucasian man being reported with progressive bilateral hearing loss. The patient had a history of total blindness which had developed shortly after a cranial osteotomy for optic nerve decompression without any specific diagnosis 15 years ago. He had also been suffering chronic psoriasis vulgaris. Because of his enlarged skull, a diagnosis of bone Paget's disease was suspected and plain radiographs revealed a polyostotic Paget's disease with characteristic radiologic signs. In searching for his refractory constipation causes, an elevated level of tissue transglutaminase IgA (tTG IgA) antibody was demonstrated. Alendronate sodium 40 mg daily was started and a gluten-free diet was recommended to him but he was not adherent to the treatments and lost to follow-up.

This case further supports the idea of considering PDB as an osteoimmunologic disorder, like psoriasis and CD, because of similar biochemical features, including elevated levels of Cytokines such as interleukin-6 and tumor necrosis factor- α as well as bone resorption markers such as OPG and urinary deoxypyridinoline. So, the treatment of Paget’s disease of the bone may benefit from progresses in osteoimmunology-targeted therapies. Also a probable causal relationship between PDB and CD either by production of neutralizing antibodies in CD against OPG or by inducing PDB in genetically susceptible patients through oxidative stress, has been postulated here.

MMA (middle meningeal artery) embolization for the treatment of refractory CSDH (chronic subdural hematoma) was first described by Mandai et al. in 2000. More surgeons hadbegun to pay attention to such surgery to treat CSDH and explored the changes in the middle meningealartery in the formation of hematomas.

We present three cases of chronic subdural hematoma after head trauma and compared the diameter of middle meningeal artery in MRA images before and after chronic subduralhematoma to discuss our new understanding of CSDH.

The enlarging of MMA was found through MRA in patients with craniocerebral trauma on one side but not on the other. However, only the enlarged side had a subdural hematoma, so we speculate that the enlargement of MMA might be one of the initiating factors of CSDH.

A 65-year-old patient presented with subtle lumbalgia twenty days following his failed endovascular retrograde recanalization of the right iliac artery, followed by a surgical femoral-femoral left-to-right by-pass graft.

Computer tomography angiography (CTA) revealed a left-sided 18 mm large pseudoaneurysm (PA) at the level of L5 lumbar vertebrae adjacent to the aorta. This lumbal artery originated from the false lumen of the known chronic infrarenal aortic dissection. Within a single session, the pseudoaneurysm was treated by percutaneous nonadhesive liquid embolic agent (NALEA - Onyx 34) embolization under CT-fluoroscopy guidance. Follow-up imaging showed complete occlusion of the PA.

This case shows the first usage of Onyx as a liquid embolic agent for this complication.

Sesamoids and accessory bones are generally small-sized and oval-shaped structures whose function and pathology are not fully elucidated. Despite their small size, sesamoid bones can directly or indirectly cause diagnostic problems. Sesamoid bones are less common in the elbow region and may need to be differentiated from a lot of diagnoses such as fractures, osteochondritis dissecans, calcific tendinitis, and synovial chondromatosis.

A 55-year-old female patient presented with right elbow pain. An oval mass was seen near the medial epicondyle on the radiograph. A dynamic ultrasound examination was performed to reveal the relationship between the bone mass and the surrounding tissues, especially the ulnar nerve. Due to the well-circumscribed mass, a diagnosis of os subepicondylare mediale, a rare sesamoid bone, was made in light of current literature.

When a bone mass is seen in patients presenting with elbow pain, it will be useful to know and consider the sesamoid bones. In addition, ultrasonography should be performed in addition to radiography for a localized sesamoid bone in the medial region and adjacent to the ulnar nerve. Thus, the relationship of the sesamoid bone with existing and potential complaints can be revealed and correct diagnosis-treatment approaches can be applied.

In clinical practice, Preoperative differentiation between hepatocellular carcinoma and intrahepatic cholangiocarcinoma is challenging but critical for treatment decisions.

This study investigated the discriminatory power of the stretched-exponential model and fractional-order calculus model parameters for hepatocellular carcinoma versus intrahepatic cholangiocarcinoma in orthotopic xenograft nude mice.

Prototype orthotopic xenograft models of hepatocellular carcinoma and intrahepatic cholangiocarcinoma were developed using 20 nude mice divided into two groups and separately transplanted with MHCC97H and HUCCT1 cells. Readout-segmented diffusion-weighted imaging with multiple b-values (0-2000 s/mm²) was obtained using a 3.0-T magnetic resonance imaging scanner. The apparent diffusion coefficient was calculated using the mono-exponential model. The distributed diffusion coefficient and intravoxel water molecular diffusion heterogeneity (α) were calculated using the stretched-exponential model. The diffusion coefficient (D), fractional-order derivative in space (β), and spatial parameter (μ) were calculated using the fractional-order calculus model. The liver and tumor specimens of nude mice were immunostained after euthanasia to clarify the liver cancer type. Differences in diffusion-related parameters between the groups were evaluated using Mann-Whitney U-test and univariate logistic analysis. Receiver operating characteristic curves were used to assess the diagnostic efficacy of each parameter. P<0.05 was deemed significant.

α, D, and β were significant discriminators between the groups. The area under the curve for these three variables was 0.890, 0.830, and 0.870, respectively, with cutoff values of 0.491, 0.435, and 0.782, respectively.

The stretched-exponential model parameters α and the fractional-order calculus model parameters D and β showed high diagnostic efficacy in discriminating intrahepatic cholangiocarcinoma from hepatocellular carcinoma in orthotopic xenograft nude mouse models.