technetium-tc-99m-sulfur-colloid and Hyperplasia

Topics: Humans; Hyperplasia; Liver; Liver Neoplasms; Pylorus; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

The management of focal nodular hyperplasia (FNH) of the liver requires a systematic approach. After a histologic diagnosis of FNH is obtained, asymptomatic lesions can be observed safely with regular follow-up and treated if they become symptomatic or enlargement occurs. In the case presented here, we have elected follow-up with serial CT scans because our patient is asymptomatic and the lesion has not significantly enlarged. Patients who have symptomatic lesions while taking an oral contraceptive can have conservative follow-up when they stop taking the oral contraceptive, because regression of FNH has been reported to occur after cessation of oral contraceptive use. If the patient remains symptomatic or if the lesion enlarges after discontinuance of oral contraceptive use, surgical resection is warranted. Other symptomatic patients, including those with a previous history of taking oral contraceptives, should be treated by surgical resection or, when resection is not possible, by embolization or ligation of the hepatic artery, because symptomatic patients are at risk for having malignant lesions misdiagnosed as FNH.

Topics: Female; Humans; Hyperplasia; Liver; Liver Diseases; Liver Function Tests; Magnetic Resonance Imaging; Middle Aged; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

Two cases, of focal nodular hyperplasia (FNH) are presented which were detected by chance and in which the gammagraphic study was the only parameter which indicated the changes that occurred in the hyperplasia revealing a hypervascular mass, colloid capture and 99mTc-DISIDA retention in the later image. These liver masses are now seen more frequently given the wide use of echography and the gammagraphic studies could be useful in the orientation of their nature in a non aggressive manner.

Topics: Adult; Female; Humans; Hyperplasia; Imino Acids; Liver; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid

Hepatoblastoma is a primary liver neoplasm in which prompt diagnosis and resection are critical to long-term survival. Liver scintigraphy using Tc-99m sulfur colloid and Tc-99m iminodiacetic acid (IDA) derivatives has been used in the evaluation of hepatic masses. Most space-occupying lesions of the liver appear as photopenic regions following either Tc-99m SC or IDA agents. Two exceptions have been reported. Focal nodular hyperplasia (FNH) has been shown to have variable colloid uptake, which is dependent upon the number of Kupffer cells per given volume. Many patients with FNH will demonstrate activity within the FNH to be greater or equal to the normal liver. In addition, two cases of hepatoblastoma have been reported to show colloid activity within the tumor, and in one patient slight uptake of Tc-99m IDA was noted in the tumor 15 minutes postinjection. The current case demonstrates a hepatoblastoma in which the scintigraphic findings with Tc-99m SC and Tc-99m IDA were similar to those reported, with retention of IDA far greater than the previously reported case.

Topics: Carcinoma, Hepatocellular; Diagnosis, Differential; Humans; Hyperplasia; Imino Acids; Infant; Liver; Liver Neoplasms; Male; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A case of focal nodular hyperplasia of the liver is reported and its scintigraphic picture is presented. In the authors' experience and in accordance with available literary sources, Tc-99m-sulfur colloid scintigraphy is to be considered the crucial noninvasive examination approach revealing the pathologico-anatomical substrate of this asymptomatic hepatic lesion which may mimic severe focal disease of the liver.

Topics: Humans; Hyperplasia; Liver; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Focal nodular liver hyperplasia (FNLH) is a benign liver tumor developing mostly in young women but occurring sometimes in men. It is often confused with other liver diseases, particularly with hepatic cell adenoma. Differential diagnosis of these diseases is very important because their prognosis and therapy are quite different. The presence of functioning Kupffer cell determined by scintigraphy with 99mTc-colloid is a decisive factor in FNLH diagnosis. However colloid accumulation was not recorded in 30-50% of patients (according to literature data), and there were cold zones on scans. 99mTc-colloid uptake can be determined by single-photon emission computed tomography.

Topics: Adult; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Humans; Hyperplasia; Imino Acids; Liver; Liver Diseases; Liver Neoplasms; Male; Organometallic Compounds; Organotechnetium Compounds; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

It is currently believed that hepatocellular adenoma is photon deficient on technetium-99m sulfur colloid scintigraphy because these tumors lack Kupffer cells. In a retrospective review of 13 pathologically proven cases of hepatocellular adenoma with technetium-99m sulfur colloid scintigrams, Kupffer cells were present in all 13 cases. We observed uptake of the radiocolloid by the hepatocellular adenoma in three cases (23%), and there were no histologic differences between the tumors with uptake and the ones without it. We conclude that the currently accepted reason for the lack of technetium-99m sulfur colloid uptake within hepatocellular adenoma is incorrect, and an explanation other than a lack of Kupffer cells is responsible for the photon-deficient appearance in the majority of cases of hepatocellular adenoma. Further, because hepatocellular adenoma may have technetium-99m sulfur colloid uptake in a significant percentage of cases, it should be added to focal nodular hyperplasia in the differential diagnosis of a hepatic mass with uptake by technetium-99m sulfur colloid.

Topics: Adolescent; Adult; Carcinoma, Hepatocellular; Diagnosis, Differential; Female; Humans; Hyperplasia; Kupffer Cells; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

This report describes 21 cases of nodular regenerative hyperplasia (NRH) and its clinical and radiologic features. NRH of the liver is an established pathologic entity that should not be confused with focal nodular hyperplasia, hepatocellular adenoma, or the regenerative nodules associated with cirrhosis. Correct diagnosis will prevent an unnecessary hepatic lobectomy should NRH be mistaken for hepatocellular adenoma. Unlike focal nodular hyperplasia, NRH may bleed, may be associated with portal hypertension in one-half of cases, and is often associated with a systemic disease such as a myelo- or lymphoproliferative disorder. Correct diagnosis is important because the prognosis in patients with NRH and portal hypertension is better than that in patients with portal hypertension due to cirrhosis. Radiologically, multiple nodules, large masses, or an apparently normal liver (containing nodules less than 0.5 cm in diameter) were visible. The nodules may take up technetium sulfur colloid and have variable echogenicity on sonography. They are often hypodense on CT without significant enhancement. The nodules may fill from the periphery on angiography, are vascular, and sometimes contain small hypovascular areas due to hemorrhage. A large nodule may rupture and cause hemoperitoneum. These findings may resemble some features of focal nodular hyperplasia, hepatocellular adenoma, or metastases. NRH is probably underdiagnosed owing to a lack of recognition of the entity and limited sampling of liver tissue by needle biopsy. Scintigraphy, sonography, and CT of the liver should be performed in cases of idiopathic portal hypertension to detect NRH. In cases with compatible findings, multiple needle biopsies or a laparoscopically guided needle biopsy or wedge liver biopsy should be recommended for definitive diagnosis.

Topics: Adenoma; Adolescent; Adult; Aged; Angiography; Biopsy; Child; Diagnosis, Differential; Female; Humans; Hyperplasia; Liver; Liver Neoplasms; Liver Regeneration; Male; Middle Aged; Prognosis; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

Topics: Adult; Female; Humans; Hyperplasia; Liver; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Topics: Adult; Biliary Tract; Diagnosis, Differential; Female; Humans; Hyperplasia; Liver; Liver Diseases; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Based on strict predefined histologic criteria, we identified 23 patients with hepatic adenoma and 41 patients with focal nodular hyperplasia seen at this institution between 1961 and 1980. Patients with hepatic adenoma were young and 91% were female. When a reliable history was available, 89% had used oral contraceptives; 53% presented acutely or with pain. Eleven of 11 radionuclide scans were abnormal; 15 of 15 angiograms showed a hypervascular mass with 7 of 15 showing areas of hypovascularity. Eighteen resections were performed with one operative death. Two tumors contained areas of unequivocal hepatocellular carcinoma. Fifteen of 18 patients followed for 82 +/- 11 mo were living and well and had discontinued oral contraceptives. Focal nodular hyperplasia patients were older, 88% were female, and 58% had used oral contraceptives. Their lesions were discovered accidentally. Seven of 12 radionuclide scans demonstrated voids, while 13 of 13 angiograms showed hypervascular lesions with no areas of hypovascularity. Seventeen tumors were resected. Twenty-three of 24 patients followed for 45 +/- 7 mo were living and well. One died of nonhepatic causes. Based on the findings of this review, we believe that if the clinical suspicion of hepatic adenoma or focal nodular hyperplasia is strong, elective laparotomy for diagnosis is usually the best approach. Hepatic adenoma should be resected if technically feasible. Intraoperative wedge biopsy is appropriate for focal nodular hyperplasia.

Topics: Abdomen; Adult; Biopsy; Carcinoma, Hepatocellular; Contraceptives, Oral; Diagnostic Techniques, Surgical; Female; Humans; Hyperplasia; Liver; Liver Neoplasms; Male; Middle Aged; Pain; Palpation; Prognosis; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Carcinoma, Hepatocellular; Child; Child, Preschool; Female; Humans; Hyperplasia; Liver; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Three cases of focal nodular hyperplasia of the liver are reported, presumably associated with the long-term use of oral contraceptives. Special reference is made to hepatobiliary scintigraphy with 99mTc diethyl-IDA, and the cause of the observed findings is discussed.

Topics: Adult; Contraceptives, Oral; Female; Humans; Hyperplasia; Liver; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid