title: Transient elastography-derived liver stiffness measurements were found to be useful for predicting liver infiltration in a case of mature T-cell neoplasm involving liver dysfunction.
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.
authors.affiliation: Department of Hematology, Juntendo University Urayasu Hospital Chiba, Japan ; Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine Tokyo, Japan.
authors.forename: Kunimoto
authors.initials: K
authors.lastname: Ichikawa
authors.affiliation: Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital Shizuoka, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Narita
authors.affiliation: Department of Pathology, Institute of Medical Science, The University of Tokyo Tokyo, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Ota
authors.affiliation: Division of Hematology, Department of Internal Medicine, Juntendo University School of Medicine Tokyo, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Komatsu
authors.affiliation: Department of Hematology, Juntendo University Shizuoka Hospital Shizuoka, Japan.
authors.forename: Michiaki
authors.initials: M
authors.lastname: Koike
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000378:metabolism; D001706:Biopsy; D001856:Bone Marrow Examination; D049109:Cell Proliferation; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D006801:Humans; D007150:Immunohistochemistry; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D008099:Liver / Q000187:drug effects / Q000378:metabolism / Q000473:pathology*; D008111:Liver Function Tests; D008297:Male; D009361:Neoplasm Invasiveness; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000627:therapeutic use; D012074:Remission Induction; D013601:T-Lymphocytes / Q000187:drug effects / Q000378:metabolism / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014408:Biomarkers, Tumor; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone
keywords: Transient elastography; and mature T-cell neoplasm; liver infiltration; liver stiffness