Fine needle aspiration cytology in the diagnosis of non-Hodgkin's lymphomas of the muscle: a report of 2 cases

BACKGROUND: Primary skeletal muscle lymphoma has been reported in very few cases. Although such imaging techniques as computed tomography and magnetic resonance imaging can supply diagnostic indications, the most reliable data are obtained by means of muscle biopsy investigations. Fine needle aspiration cytology (FNAC) has not been considered before for the diagnosis of muscle lymphoma. CASES: In case 1, 60-year-old man presented with 2 masses in the pectoral muscle and neck. FNAC of the neck mass was performed. The diagnosis was non-Hodgkin's diffuse B-cell lymphoma of the muscle; the diagnosis was confirmed by surgical biopsy of the pectoral muscle. In case 2, a 70-year-old man presented with a mass in the quadriceps muscle. The results of FNAC aroused suspicion of lymphoma, and a muscle biopsy confirmed the presence of a non-Hodgkin's B-cell lymphoma. Immunohistochemistry identified it as non-Hodgkin's marginal zone B-cell lymphoma of MALT type. CONCLUSION: FNAC can be a valuable starting point in muscle involvement by lymphoma because of the possibility of obtaining material by means of multiple aspirations without causing patients any discomfort.     

Quantification of hepatic iron concentration in chronic viral hepatitis: usefulness of T2-weighted single-shot spin-echo echo-planar MR imaging

Objective

To investigate the usefulness of single-shot spin-echo echo-planar imaging (SSEPI) sequence for quantifying mild degree of hepatic iron stores in patients with viral hepatitis.

Methods

This retrospective study included 34 patients with chronic viral hepatitis/cirrhosis who had undergone histological investigation and magnetic resonance imaging with T2-weighted gradient-recalled echo sequence (T2-GRE) and diffusion-weighted SSEPI sequence with b-factors of 0 s/mm² (T2-EPI), 500 s/mm² (DW-EPI-500), and 1000 s/mm² (DW-EPI-1000).The correlation between the liver-to-muscle signal intensity ratio, which was generated by regions of interest placed in the liver and paraspinous muscles of each sequence image, and the hepatic iron concentration (µmol/g dry liver), which was assessed by spectrophotometry, was analyzed by linear regression using a spline model. Akaike information criterion (AIC) was used to select the optimal model.

Results

Mean ± standard deviation of the hepatic iron concentration quantified by spectrophotometry was 24.6±16.4 (range, 5.5 to 83.2) µmol/g dry liver. DW-EPI correlated more closely with hepatic iron concentration than T2-GRE (R square values: 0.75 for T2-EPI, 0.69 for DW-EPI-500, 0.62 for DW-EPI-1000, and 0.61 for T2-GRE, respectively, all P<0.0001). Using the AIC, the regression model for T2-EPI generated by spline model was optimal because of lowest cross validation error.

Conclusion

T2-EPI was sensitive to hepatic iron, and might be a more useful sequence for quantifying mild degree of hepatic iron stores in patients with chronic viral hepatitis.     

Diagnostic Performance of a Rapid Magnetic Resonance Imaging Method of Measuring Hepatic Steatosis

Objectives

Hepatic steatosis is associated with an increased risk of developing serious liver disease and other clinical sequelae of the metabolic syndrome. However, visual estimates of steatosis from histological sections of biopsy samples are subjective and reliant on an invasive procedure with associated risks. The aim of this study was to test the ability of a rapid, routinely available, magnetic resonance imaging (MRI) method to diagnose clinically relevant grades of hepatic steatosis in a cohort of patients with diverse liver diseases.

Materials and Methods

Fifty-nine patients with a range of liver diseases underwent liver biopsy and MRI. Hepatic steatosis was quantified firstly using an opposed-phase, in-phase gradient echo, single breath-hold MRI methodology and secondly, using liver biopsy with visual estimation by a histopathologist and by computer-assisted morphometric image analysis. The area under the receiver operating characteristic (ROC) curve was used to assess the diagnostic performance of the MRI method against the biopsy observations.

Results

The MRI approach had high sensitivity and specificity at all hepatic steatosis thresholds. Areas under ROC curves were 0.962, 0.993, and 0.972 at thresholds of 5%, 33%, and 66% liver fat, respectively. MRI measurements were strongly associated with visual (r² = 0.83) and computer-assisted morphometric (r² = 0.84) estimates of hepatic steatosis from histological specimens.

Conclusions

This MRI approach, using a conventional, rapid, gradient echo method, has high sensitivity and specificity for diagnosing liver fat at all grades of steatosis in a cohort with a range of liver diseases.     

In vivo assessment of microcystin-LR-induced hepatotoxicity in the rat using proton nuclear magnetic resonance (1H-NMR) imaging.

Microcystin-LR (MCLR)-induced hepatotoxicity was assessed in vivo in male Sprague-Dawley rats (150-350 g) using magnetic resonance imaging (MRI). Following the intraperitoneal administration of MCLR (LD(50)), a region of damage, characterised by increased signal intensity on T(2)-weighted images, was seen proximal to the hepatic portal vein in the liver. Similarly, increased signal intensity was seen in the chemical-shift selective images (CSSI) of water frequency, proximal to the hepatic portal vein in the liver. This indicates that the increased signal intensity observed in the T(2)-weighted images was due to an increased amount of magnetic resonance (MR) visible protons in the tissue which represents an oedematous response. Image analysis of regions of apparent damage around the hepatic portal vein indicated a statistically significant increase in signal intensity in this region. Mitochondrial swelling and lipid inclusions were observed by transmission electron microscopy (TEM) in samples obtained from the oedematous regions of the liver using spatial coordinates from the magnetic resonance (MR) images. Massive haemorrhagic necrosis and nuclear swelling were observed by light microscopy in the centrilobular regions of the lobules.     

Is MR Spectroscopy Really the Best MR-Based Method for the Evaluation of Fatty Liver in Diabetic Patients in Clinical Practice?

Objective

To investigate if magnetic resonance spectroscopy (MRS) is the best Magnetic Resonance (MR)-based method when compared to gradient-echo magnetic resonance imaging (MRI) for the detection and quantification of liver steatosis in diabetic patients in the clinical practice using liver biopsy as the reference standard, and to assess the influence of steatohepatitis and fibrosis on liver fat quantification.

Methods

Institutional approval and patient consent were obtained for this prospective study. Seventy-three patients with type 2 diabetes (60 women and 13 men; mean age, 54±9 years) underwent MRI and MRS at 3.0 T. The liver fat fraction was calculated from triple- and multi-echo gradient-echo sequences, and MRS data. Liver specimens were obtained in all patients. The accuracy for liver fat detection was estimated by receiver operator characteristic (ROC) analysis, and the correlation between fat quantification by imaging and histolopathology was analyzed by Spearman''s correlation coefficients.

Results

The prevalence of hepatic steatosis was 92%. All gradient-echo MRI and MRS findings strongly correlated with biopsy findings (triple-echo, rho = 0.819; multi-echo, rho = 0.773; MRS, rho = 0.767). Areas under the ROC curves to detect mild, moderate, and severe steatosis were: triple-echo sequences, 0.961, 0.975, and 0.962; multi-echo sequences, 0.878, 0.979, and 0.961; and MRS, 0.981, 0.980, and 0.954. The thresholds for mild, moderate, and severe steatosis were: triple-echo sequences, 4.09, 9.34, and 12.34, multi-echo sequences, 7.53, 11.75, and 15.08, and MRS, 1.71, 11.69, and 14.91. Quantification was not significantly influenced by steatohepatitis or fibrosis.

Conclusions

Liver fat quantification by MR methods strongly correlates with histopathology. Due to the wide availability and easier post-processing, gradient-echo sequences may represent the best imaging method for the detection and quantification of liver fat fraction in diabetic patients in the clinical practice.     

Phospholipid synthesis in the lymphomatous mouse liver studied by 31P nuclear magnetic resistance spectroscopy in vitro and by administration of 14C-radiolabelled compounds in vivo

High phosphomonoester to ATP ratios have been found in ³¹P magnetic resonance spectra from livers of patients with hepatic lymphoma (Dixon et al. (1990) Br. J. Cancer 63, 953–958). The present study of a murine lymphoma showed that the phosphomonoester in the lymphomatous liver was largely phosphoethanolamine, which is an intermediate of phospholipid metabolism. A significant positive correlation was found between the concentration of phosphoethanolamine, measured by high resolution ³¹P nuclear magnetic resonance spectroscopy of extracts, and the degree of infiltration, assessed by quantitative histology. The phosphoethanolamine concentration reached about 10 times its normal level, but the phosphocholine concentration remained the same as in the normal liver. Radiolabelling studies showed that while the rate of phosphoethanolamine synthesis from exogenous [¹⁴]ethanolamine was higher in the lymphomatous mouse liver than in control livers, the rate of phosphatidylethanolamine synthesis was lower in the lymphomatous liver. The rate of phosphatidylcholine synthesis in lymphoma-bearing livers was not significantly different from that in control mouse livers.     

Magnetic resonance imaging findings in primary lymphoma of the liver: a case report

ABSTRACT: INTRODUCTION: Primary lymphoma of the liver is an extremely rare finding, with the few such cases reported in the literature to date describing indeterminate imaging findings, being focused more on computed tomography. To the best of our knowledge, there is no prior report describing magnetic resonance imaging scan findings with such a lesion. In the case reported here, magnetic resonance imaging gave us the opportunity to ascertain the correct diagnosis, confirmed by histopathology, thus avoiding unnecessary surgery or other treatments. Although this condition is rare, knowledge of magnetic resonance imaging findings will be invaluable for radiologists and other medical subspecialties that may face such cases in the future in helping to provide adequate management for affected patients. CASE PRESENTATION: A focal lesion was incidentally detected by ultrasound in a 75-year-old asymptomatic Albanian man being treated for benign hypertrophy of prostate. Chest and abdomen computed tomography scans did not reveal any abnormal findings besides a solid focal lesion on the right lobe of the liver and a mild homogenous enlargement of the prostate gland. Subsequently, magnetic resonance imaging of the upper abdomen was performed for better characterization of this lesion. Our patient was free of symptoms and his laboratory test results were normal. CONCLUSIONS: The magnetic resonance imaging scan results showed some distinctive features that helped us to make the correct diagnosis, and were thus very important in helping us provide the correct treatment for our patient.     

^1HMRS在定性诊断乙肝后早期肝硬化中的初步研究

目的：研究慢性乙型肝炎后早期肝硬化患者的氢质子磁共振波谱图像特点,旨在探讨^1HMRS成像技术诊断慢乙肝后早期肝硬化的可行性,为早期肝硬化的定性诊断提供新的方法。方法：首先,筛选出15例健康志愿者及15例慢乙肝后早期肝硬化患者。并将15例患者依据肝穿结果分为S2期、S3期和S4期三组;然后,对15例健康志愿者及15例慢乙肝后肝硬化组患者进行常规MRI扫描,包括三平面定位,横断面T1加权像（T1WI）、T2加权像（T2WI）,于T2WI上选取感兴趣区进行单体素氢质子波谱扫描。分别采集各化合物峰,通过GE公司波谱分析软件校正,测量各波峰峰值和峰下面积,分析正常组和病例组各波峰和峰下面积变化特征。结果：正常组均得到谷氨酸和谷氨酰氨复合物（glumatic acid and glutamylamnnia complex,GIX）峰与胆碱／磷酸肌酸（choline／phosphoric creatine acid,Cho／Pcr）峰,病例纽除上述两峰外,还得到乳酸（Lactate,Lac）峰和脂质（Lipid,Lip）峰。经统计学分析正常组与病例组Glx、Cho／Pcr峰值及峰下面积无明显差异（P〉0．05）,而Lac、Lip峰值及峰下面积有差异统计学意义（P〈0.05）。病例组内的S2、S3及S4期三组各自的Glx、Cho／Pcr、Lac、Lip峰值及峰下面积差异无统计学意义（P〉0．05）。结论：1H磁共振波谱成像技术是一种非创伤性定性检测慢乙肝后早期肝硬化的方法。     

Giant hydatid cyst of the liver with a retroperitoneal growth: a case report

ABSTRACT: INTRODUCTION: Hydatid disease is a helminthic anthropozoonosis with worldwide distribution due to the close associations among sheep, dogs, and humans. It can occur almost anywhere in the body with a variety of imaging features, which may change according to the growth stage, associated complications, and affected tissues. A definitive diagnosis requires a combination of imaging, serologic and immunologic studies. Ultrasonography, computed tomography and magnetic resonance imaging are highly accurate in detecting a hepatic hydatid cyst. However, hepatic hydatid cysts in an unusual location and/or of an unusual dimension, with atypical imaging findings, may complicate the differential diagnosis. Surgical treatment remains the best treatment. CASE PRESENTATION: We describe an unusual case of a giant hydatid cyst, with exophytic growth from the right lobe of the liver of a 55-year-old Egyptian man. The cyst was strongly adhered to his ipsilateral kidney, which was displaced in a downwards and anterior direction, close to his abdominal wall, simulating a retroperitoneal origin. This atypical growth raised doubts about the most appropriate surgical approach. Magnetic resonance imaging easily clarified the origin of the cyst as our patient's liver, allowing accurate surgical planning. CONCLUSION: Rarely, hydatid cysts can reach an extremely large size without any additional symptoms. Giant cysts need radical therapy because they might lead to perforation and anaphylaxis in some patients. Magnetic resonance imaging is very useful in the study of hydatid disease because of its capacity to allow a large field of view, multiplanar acquisition, and high contrast resolution. In some unusual hepatic presentations, magnetic resonance imaging can be used to determine the correct anatomical relationships.     

肝细胞脂肪变性程度对慢性病毒性肝炎弥散度成像的影响

目的：探讨肝细胞脂肪变性对肝脏弥散度成像技术（Realtime Tissue Elastography,RTE）无创评估病毒性肝炎肝纤维化及炎 症程度的影响。方法：91 例确诊慢性乙型或丙型病毒性肝炎患者均于肝脏活检穿刺前行肝脏弥散度成像检查,分析不同肝细胞脂 肪变性程度与肝纤维化程度及肝脏炎症程度之间的弥散度成像LF指数差异。结果：中度脂肪变性组LF 指数最高（P=0.0254）;轻 度纤维化（S1-S2）时,不同的脂肪变性程度组间LF 值的差异无统计学意义（P=0.1105）;中- 重度纤维化时,不同的脂肪变性程度 组间LF值的差异无统计学意义（P=0.0994）。轻度炎症时,不同的脂肪变性程度组间LF值的差异具有统计学意义,中度脂肪变性 组的LF值最高（P=0.0010）;中- 重度炎症时,不同的脂肪变性程度组间LF值的差异具有统计学意义（P<0.05）。结论：应用肝脏弥 散度成像的LF指数判断肝脏纤维化程度不受肝细胞脂肪变性的影响,但对于肝脏炎症程度的判断受肝细胞脂肪变性的影响,尤 其应重视中度肝细胞脂肪变性对于测值的影响。     

Effect of magnetic resonance imaging on human respiratory burst of neutrophils

It is known that low intensity magnetic fields increase superoxide anion production during the respiratory burst of rat peritoneal neutrophils in vitro. We investigated whether the high intensity magnetic fields (1.5 T) during magnetic resonance imaging can influence the human neutrophil function under in vivo conditions. Blood samples were obtained from 12 patients immediately before and after magnetic resonance imaging (mean time 27.6(+/-11.4 min)). The induced respiratory burst was investigated by the intracellular oxidative transformation of dihydrorhodamine 123 to the fluorescent dye rhodamine 123 via flow cytometry. The respiratory burst was induced either with phorbol 12-myristate 13-acetate, Escherichia coli, N-formyl-methionyl-leucylphenylalanine or priming with tumor necrosis factor followed by FMLP stimulation. There was no significant difference between the respiratory burst before and after magnetic resonance imaging, irrespective of the stimulating agent. Short time exposure to a high intensity magnetic field during magnetic resonance imaging seems not to influence the production of radical species in living neutrophils.     

Proton magnetic relaxation studies in normal and cancerous breast tissues

Proton magnetic resonance (PMR) relaxation times were measured for dissected malignant and normal tissue derived from breast cancer patients. Relaxation time measurements (T1, T2) were carried out at a RF frequency of 20 MHz and at a temperature of 27 degrees C with a Brucker PC 120 NMR Process analyser. The tissue types were confirmed by histopathological examination. In general T1 values were found to be longer for malignant tissues as compared to normal tissues which is in agreement with the earlier observations. The measured T2 values do not exhibit the malignant tissues above. The percentage of water content was also measured in both normal and malignant tissue and was found to be considerably larger in tumour tissue as compared to normal tissue. These results are discussed on the basis of two fraction fast exchange models of water molecules and confirm that PMR relaxation time measurement plays an important role in the differentiation of cancerous tissues from that of normal.     

Oesophageal carcinoma demonstrated by whole-body nuclear magnetic resonance imaging.

The quality of the images produced by nuclear magnetic resonance (NMR) imaging has steadily improved over the past five years. Images of the head, thorax, and abdomen have clearly shown the normal anatomy. A clinical trial of NMR imaging has therefore been started in Aberdeen to assess its diagnostic accuracy and compare it with conventional radiography and other imaging technique. The first patient examined by whole-body NMR imaging had carcinoma of the oesophagus diagnosed on barium meal examination. A technetium-99m-sulphur colloid liver scan also showed hepatic metastases. NMR imaging showed a large tumour in the lower third of the oesophagus, and areas of increased proton spin-lattice relaxation time (T1) on a section through the liver corresponded with the metastases shown on the radionuclide scan. Increased areas of T1 were present in some vertebrae, and a technetium-99m bone scan confirmed the presence of bone metastases. The NMR images in this patient compared well with the images from other techniques. The continuing clinical trial may show that NMR is an accurate diagnostic aid which will complement existing techniques for diagnosing intrathoracic and intra-abdominal conditions.     

Use of magnetic resonance imaging in surgical hepatology

Three hundred and ninety eight patients with different diseases of the liver and biliary tract were examined on the basis of the complex use of latest technologies of magnetic resonance imaging (dynamic contrast MRI, MR-arterio- and venoportography, MR-cholangiopancreatography), which yield all necessary information during one study to design surgical treatment. The study was conducted by using a Magnetom Vision 1.5T apparatus (Siemens). The advantages of the technique over invasive X-ray studies are shown. Different MRI procedures have been ascertained to be highly diagnostically effective in evaluating hepatic and biliary diseases.     

Partial hepatectomy of marmoset: clinical and pathological effects and utility in microsomal enzyme analysis.

Liver biopsy based on a partial hepatectomy technique (shearing) was performed in 10 common marmosets (Callithrix jacchus). This is a preliminary study to evaluate the effects of drugs on hepatic microsomal enzymes: cytochrome P-450 and T4 uridine diphosphate glucuronyl transferase (T4-UDPGT), by comparing post-treatment values with pre-treatment values individually with a limited number of animals. The effects of the biopsy on clinical findings and liver pathology were evaluated during the first 5 post-surgical weeks. Although the plasma aspartate aminotransferase (AST) activities tended to decrease from 1 to 4 weeks post-surgery, no abnormality was noted in clinical sign, body weight, the hematocrit value or other blood chemical values. At necropsy, adhesion of the sheared site of the liver to the parietal peritoneum or the small intestine was evident in 2 of the 4 marmosets. Microscopic examination revealed focal fibrosis in the liver, but it was localized around the sheared site. Based on the above results, it was concluded that liver biopsy must be performed more than one month before administration of the drug to be tested. The biopsy samples and the whole liver samples obtained at autopsy were subjected to analysis of microsomal protein content, cytochrome P-450 content and T4-UDPGT activity. In comparison with the values from the whole liver samples, those from the biopsy samples showed no significant difference. Furthermore, there was a significant correlation rather than difference between matched values. This suggested that partial hepatectomy is a useful method for obtaining pretreatment values in liver biochemistry to evaluate the effects of drug-treatment in individual animals.     

肝移植术后肝脏淋巴回流淤滞发生的影响因素初步临床分析

目的:分析肝移植术后肝脏淋巴回流淤滞(Intrahepatic lymphatic stasis,IHLS)的影响因素。方法:收集我院自2004~2012年期间行肝移植手术并经增强计算机断层扫描(Computed tomography,CT)和/或磁共振(Magnetic resonance imaging,MRI)确诊的IHLS病人,分析正常肝移植组IHLS阳性率与肝移植术后静脉并发症、胆道并发症、乙肝复发、肝癌复发、动脉并发症、移植排斥、药物性肝损害、转移瘤组IHLS阳性率的差异。结果:正常移植肝组术后IHLS的阳性率分别与术后胆道并发症、静脉并发症、乙肝复发组肝移植术后IHLS的阳性率差异有统计学意义(P0.05),与其他并发症组IHLS的阳性率差异无统计学意义(P0.05)。结论:肝移植术后静脉并发症、胆道并发症及乙肝复发可影响肝移植术后IHLS发生。     

Tumefactive multiple sclerosis requiring emergent biopsy and histological investigation to confirm the diagnosis: a case report

Introduction

Tumefactive multiple sclerosis is a demyelinating disease that demonstrates tumor-like features on magnetic resonance imaging. Although diagnostic challenges without biopsy have been tried by employing radiological studies and cerebrospinal fluid examinations, histological investigation is still necessary for certain diagnosis in some complicated cases.

Case presentation

A 37-year-old Asian man complaining of mild left leg motor weakness visited our clinic. Magnetic resonance imaging demonstrated high-signal lesions in bilateral occipital forceps majors, the left caudate head, and the left semicentral ovale on fluid-attenuated inversion recovery and T2-weighted imaging, and these lesions were enhanced by gadolinium-dimeglumin. Tumefactive multiple sclerosis was suspected because the enhancement indistinctly extended along the corpus callosum on magnetic resonance imaging and scintigraphy showed a low malignancy of the lesions. But oligoclonal bands were not detected in cerebrospinal fluid. In a few days, his symptoms fulminantly deteriorated with mental confusion and left hemiparesis, and steroid pulse therapy was performed. In spite of the treatment, follow-up magnetic resonance imaging showed enlargement of the lesions. Therefore, emergent biopsy was performed and finally led to the diagnosis of demyelinating disease. The enhanced lesion on magnetic resonance imaging disappeared after one month of prednisolone treatment, but mild disorientation and left hemiparesis remained as sequelae.

Conclusions

Fulminant aggravation of the disease can cause irreversible neurological deficits. Thus, an early decision to perform a biopsy is necessary for exact diagnosis and appropriate treatment if radiological studies and cerebrospinal fluid examinations cannot rule out the possibility of brain tumors.     

Simultaneous staining of cytoplasmic iron and collagen matrix in human liver biopsy specimens

One of the major liver fibrogenic activators is the cellular iron overload that can severely damage parenchymal and non-parenchymal cells. The aim of this study was to investigate a histochemical staining technique that allows the simultaneous detection of the irregular deposition of matrix collagen and both the amount and distribution of iron in liver cells on the same histological section. The method was evaluated using 3-microm histological sections obtained from ten standard liver biopsy specimens taken from patients with hepatitis C virus-related diseases and simultaneous liver cell iron overload. The results indicate that the double-staining technique is simple, sensitive and rapid, and can be routinely applied to liver biopsy specimens for diagnostic purposes. Furthermore, it may also facilitate the study of the complex relationship between hepatic fibrosis and iron overload during common genetic or secondary liver metabolic disorders.     

Influence of strong static magnetic fields on primary cortical neurons

Intense uniform magnetic fields, such as those used in magnetic resonance imaging (MRI), are thought to exert little influence at the cellular level. Here we report modifications of the signaling cascades in rat cortical neurons cultured for 1 h in magnetic fields of up to 5 Tesla. The activation of c-Jun N-terminal kinase (JNK) increases monotonically with field strength, with a maximal activation of approximately 10% at 5 T, whereas the activation of extra cellular-regulated kinase (ERK) shows a maximum at 0.75 T ( approximately 10%). Since ERK is involved in cellular differentiation, these results indicate a magnetic induction of the signaling events associated with differentiation. However, the cells respond to further increases in field strength by evoking a stress response, since JNK is a stress-activated protein kinase. Three possible mechanisms are discussed and of these, the most plausible is magnetic field induced change in the membrane rest potential, a microscale magnetohydrodynamic effect. This mechanism most likely involves the activation of voltage dependent Ca(2+) channel opening; since intracellular Ca(2+) concentration was also found to be modified by the static magnetic field.     

Diagnosis of Primary Cancer of the Liver

The diagnosis of primary cancer of the liver was reviewed in 75 patients. A definitive diagnosis was made during life in 63% and in a further 20% this condition was suspected though histological confirmation was obtained only at necropsy. The most common presenting complaints were abdominal pain and weight loss and the most frequent findings hepatomegaly and ascites. Less than one-half of the patients were jaundiced and when present it was usually mild. An arterial bruit was heard over the liver in 25% of the patients. A sudden and unexplained deterioration in a patient known to have cirrhosis or haemochromatosis should raise the possibility of a primary hepatic tumour; this occurred in 24% of our patients.Alpha-fetoprotein was found in the serum of 11 out of 18 cases. The presence of a mass in the liver was frequently confirmed by liver scan, portal venography, or hepatic arteriography, but these showed no features diagnostic of a primary tumour. Liver scan also proved useful in localizing the lesion for biopsy purposes. Definitive diagnosis is dependent on the histological demonstration of the features of the tumour. This can frequently be achieved by percutaneous needle biopsy, which was positive in 38 out of 57 patients. Wedge biopsies were positive in a further nine patients.