Hyperchoice hepatic metastases on USG are seen in which of the following malignancies:
B i.e. CA colon (Mutinous adenocarcinoma) Hepatic metastasis may be hypoechoic (most common), hyperechoic and cystic or mixed echogenicity. Hypoechoic or hyporeflective lesions with no distal shadowing or enhancement is produced by highly cellular and hypovascular lesions. Hypoechoic metastases are seen in lymphoma, sarcoma and most adenocarcinoma such as breast, lung and pancreas (Sutton). Echopenic liver metastasis include lymphoma, pancreas, cervical cancer, lung (adenocarcinoma) and nasopharyngeal cancer (Wolfgang). - Hyper-reflective or hyper-choic (or echogenic) lesions with distal shadowing or enhancement is produced by vascular metastases due to many blood-tissue interfaces from the toous abnormal vessels. They are often seen in metastases from colorectal cancer and other gastrointestinal primaries and with vascular metastases from islet cell tumors, carcinoid, choriocarcinoma and renal cell carcinomaQ. Calcification which may be recognized by marked reflectivity and acoustic shadowing (i.e. hyperechogenecity), is most often seen in metastases from mucinous adenocarcinoma of colon (Sutton) /mucin secreting metastases from GI tract (Grainger)/mucinous metastases from colon & ovary (Berry). Echogenic liver metastases include colonic carcinoma (mucinous-adenocarcinoma)Q-54%, hepatoma (25%) and treated breast carcinoma (21%)-Wolfgang. - Presence of ill defined hypoechoic halo (indicating an aggressive tumor) around the hyperchoic lesion produces a bull's eye or target appearance. It is seen in metastases from bronchogenic carcinoma & gastrinomaQ (Sutton/Berry) Metastases of increased reflectivity can mimic hemangiomas and predominantly cystic metastases (eg ovary) can mimic simple cyst. (Grainger). Cystic metastases usually develop in patients who have a primary lesion with a cystic component for example ovarian cancer or cystadenocarcinoma of pancreas (Sutton). Cystic metatases are seen with adenocarcinoma of pancreas, ovary and colon (Berry). - Hypervascular liver metastases include primary neuroendocrine tumor (eg pancreatic islet cell tumor, neuroendocrine carcinoma = carcinoid, pheochromocytoma), renal cell carcinoma (hypernephroma), thyroid cancer, choriocarcinoma, melanoma, and also sarcomas, breast cancer, ovarian cystadenocarcinoma (Wolfgang). Cystadenomas (both serous and mucinous) are benign cystic tumors (eg of ovary). On USG serous cystadenoma presents with large (>10cm), thin walled, usually unilocular, anechoic (smooth black; darker than hypoechoic) masses which may be bilateral. Sonographically mucinous cystadenomas are larger (15-30cm), multilocular (thin septal), usually unilateral, showing variegated echogenicity sign in cystic mass (anechoic empty space, hypoechoic/low level echos d/ t mucoid material in the dependent poion of mass and difference in chemical composition of fluid, protein content & hemorrhage l/t different echogenocity). On MRI (T2WI) stained glass appearance is seen. Sumary: Cystadenoma is never hyperechoic, although it may be anechoic, hypoechoic or show variegated echogenicity. (Anechoic means more hypoechoic, hypoechoic lesions are seen as black and hyper echoic lesions are seen as white on USG). Colorectal carcinoma (mucinous adenocarcinoma) gives rise to hypervascular metastasis and produce hyperechoic (echogenic) lesion on USGQ. It is impoant to understand that cystic lesions are an-echoic mostly but all hypoechoic lesions are not cystic. Similary calcified lesions are hyperechoic and produce shadowing but all hyperechoic lesions are not calcified and produce shadowing.
CA ovary
CA colon (Mucinous adenocarcinoma)
Urinary bladder
Mucinous cystadenoma