关键词: Transient elastography and mature T-cell neoplasm liver infiltration liver stiffness

Mesh : Aged Antineoplastic Combined Chemotherapy Protocols / therapeutic use Biomarkers, Tumor / metabolism Biopsy Bone Marrow Examination Cell Proliferation Cyclophosphamide / therapeutic use Doxorubicin / therapeutic use Elasticity Elasticity Imaging Techniques Humans Immunohistochemistry Leukemia-Lymphoma, Adult T-Cell / drug therapy metabolism pathology Liver / drug effects metabolism pathology Liver Function Tests Male Neoplasm Invasiveness Positron-Emission Tomography Predictive Value of Tests Prednisolone / therapeutic use Remission Induction T-Lymphocytes / drug effects metabolism pathology Tomography, X-Ray Computed Treatment Outcome Vincristine / therapeutic use

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Abstract:
Transient elastography (TE) is a novel, non-invasive imaging technique for measuring liver stiffness (LS). It is considered to be useful for predicting the severity of fibrosis and the risk of cirrhosis or hepatocellular carcinoma. However, the association between the presence of diffuse regions of increased cell density in the liver and elevated LS values has not been assessed. We experienced a case in which a mature T-cell neoplasm had invaded the liver, but the infiltrating lesion was not detected by contrast-enhanced computed tomography (CT) or fluorodeoxyglucose positron emission tomography/CT scans. Instead, the tumor\'s presence was indicated by the change in the patient\'s TE-derived LS values after chemotherapy. At diagnosis liver dysfunction was detected in a biochemical examination, and mean LS value was as high as 25.4 kPa [interquartile range (IQR): 0.3, success rate (SR):100%]. After chemotherapy, the patient\'s mean LS value fell to 4.3 kPa (IQR: 0.8, SR:100%). A follow-up pathological investigation demonstrated that proliferating abnormal T-cells were no longer present in the patient\'s liver. This is the first report to describe the use of LS data to support a diagnosis of liver infiltration by tumor cells exhibiting a portal and sinusoidal distribution pattern rather than a focal pattern. Elevated TE-derived LS values should lead to hepatic tumor infiltration being considered during initial examinations or a suspicion of recurrence during follow-up examination of lymphoma patients who achieve complete remission, even when radiological investigations do not detect abnormalities in the liver.
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