Abstract Background Liver involvement in adults with acute myeloid leukemia is uncommon. Most of the case reports describe acute liver failure or obstructive jaundice, while acute hepatitis is rarely mentioned. We report a patient with acute myeloid leukemia who presented with clinical, biochemical, and radiological signs of acute hepatitis that totally regressed after chemotherapy. Case presentation A 38-year-old Caucasian man presented with fever, cough, and mild fatigue. Laboratory workup showed anemia, thrombocytopenia, severe leukocytosis, transaminitis, and hyperbilirubinemia. Imaging of the abdomen (ultrasound and magnetic resonance) showed hepatomegaly, splenomegaly, upper limits portal veins diameters, increased thickness of the gallbladder wall, and significant abdominal lymph nodes. Peripheral blood smear and bone marrow evaluation were consistent with acute myeloid leukemia, and liver biopsy showed massive sinusoidal and portal infiltration by leukemic cells. After remission-inducing chemotherapy, there was complete normalization of liver function tests, and liver, spleen, and portal vein size. Conclusions This case highlights the importance of taking acute myeloid leukemia into account as a possible cause of liver damage to make a rapid diagnosis and start appropriate treatment that may lead to hematological remission and hepatic dysfunction resolution.
Aims Radiomics uses radiological imaging to generate multi-dimensional data, defined as features. The novelty of radiomics is the possible correlation with clinical endpoints, mostly in oncological diseases. We present results of a retrospective study investigating correlations between pretreatment imaging radiomics and clinical outcomes in Patients (Pts.) with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE).
Current practice for upper gastrointestinal endoscopy: a multicentre study in Lazio, ItalyTo the Editor, Esophagogastroduodenoscopy (EGD) is largely used in clinical practice.Different international guidelines advised some actions to improve this endoscopic examination, including an adequate sampling of gastric mucosa for both Helicobacter pylori (H.pylori) diagnosis and detection of precancerous lesions to evaluate gastric cancer risk [1].Therefore, assessing current EGDs practice, including pre-, during, and post-procedure measures, is relevant to identify potential aspects to be implemented.With this aim, we designed this multicentre study on EGD practice in 8 endoscopic centres in Lazio, an Italian region with 5,709,263 inhabitants in 2022.Clinical, endoscopic, and histological data of consecutive patients referred for UGIE in the participating centres between March 1 and March 31, 2022, were anonymously reviewed.An adequate gastric mucosa sampling was considered to be accomplished when at least two antral and two gastric LETTERS TO THE EDITOR body biopsies were collected in two different vials beyond endoscopic lesions, as suggested [2, 3].A total of 912 patients (male 399; mean age: 58.7 ± 15.4 years) underwent EGD for any reason in the 8 participating centers.There were 52 endoscopists involved in the centers (median: 6; range: 2-12), and the median number of endoscopic examinations performed per center was 111 (range: 51-168).Regarding the pre-procedure questions, information on first-degree upper gastrointestinal cancers was lacking in 619 (67.9%) cases, and smoking habits were uninvestigated in 634 (69.6%) cases.Data on previous H. pylori eradication, ongoing proton pump inhibitor (PPI) therapy, and ongoing anti-thrombotic therapy were not collected in 605 (66.4%), 437 (48%), and 195 (21.3%) patients, respectively.No sedation was administered to 277 (30.4%) patients.Before endoscopy, no gastric cleaning preparation was given in any of the centers.Concerning the intra-procedure phase, an image-enhanced endoscopy technique was applied in only 14 (1.5%) cases.Overall, adequate gastric biopsy sampling was achieved in 426 (46.7%) cases, at least one biopsy in further 241 (26.4%), while no biopsy was performed in 245 (26.9%)EGDs.In detail, the rate of standard gastric mucosa sampling ranged from 20% to 82.3% (p<0.001) in different centres, with 25% in one, 26% to
Spleen and liver stiffness (LS) measured by acoustic radiation force impulse (ARFI) imaging has been shown to be useful in identifying patients with portal hypertension. The study aims to establish if the modification of portal pressure induced by a transjugular intrahepatic portosystemic shunt (TIPS) parallels the modification of spleen or LS measured by ARFI in order to understand if ARFI may be used to monitor the modification of portal pressure in patients with cirrhosis.Thirty-eight patients with severe portal hypertension underwent LS and spleen stiffness (SS) before TIPS and 1 week after TIPS. Portal atrial gradient (PAG) was measured before and after the shunt opening.Portal atrial gradient decreased significantly from 19.5 to 6 mmHg (P < 0.001). SS decreased significantly after TIPS (pre-TIPS 3.7 m/s vs post-TIPS 3. 1 m/s; P < 0.001), and LS was also significantly modified by TIPS (pre-TIPS 2.8 m/s vs post-TIPS 2.4 m/s; P = 0.003). PAG and SS values measured before and after TIPS were significantly correlated (r = 0.56; P < 0.001); on the other hand, PAG and LS were not (r = 0.19; P = 0.27). Two patients developed a persistent hepatic encephalopathy refractory to medical treatment and were submitted to the reduction of the stent diameter. The modification of SS was parallel to the modification of PAG.Spleen stiffness is superior to LS in detecting the modification of portal pressure induced by TIPS. This makes SS a potential non-invasive method to monitor the modification of portal hypertension. Further investigations are needed to establish applicability and clinical utility of this promising tool in the treatment of portal hypertension.
