Hepatocellular carcinoma (HCC), a common consequence of chronic liver disease, ranks among the most prevalent cancers globally and contributes significantly to cancer-related mortality. Liver fibrosis is intimately associated with hepatic function and the likelihood of future HCC occurrence. Despite the fact that liver biopsy continues to be the gold standard for diagnosing fibrosis, its utility is hindered by cost and invasiveness, along with patient unease, procedural rejection, and potential adverse effects. Liver elastography has become a leading noninvasive means of assessing tissue stiffness with considerable diagnostic precision. Malignant tumors generally exhibit higher cellularity in comparison to benign ones, resulting in increased stiffness. Elastography techniques capitalize on alterations in tissue elasticity stemming from specific pathological or physiological processes. Technological innovations, such as advanced ultrasound imaging and artificial intelligence (AI)-integrated systems, are paving the way for enhanced diagnostic accuracy and risk prediction. Recent research underscores the potential of elastography in managing HCC patients, presenting novel clinical applications, including prediction of HCC development, differentiation between malignant and benign liver lesions, evaluating treatment response, and forecasting recurrence post-treatment, though certain findings remain contentious. Therefore, this review aims to sum up the latest advancements in liver elastography for HCC patients, outlining its applications while addressing existing limitations and avenues for future progress.

Appendiceal endometriosis is a rare entity and, when accompanied by intestinal metaplasia, represents a challenging differential diagnosis with low-grade appendiceal mucinous neoplasm (LAMN). We present the case of a 47 years-old woman, with multiple surgical interventions for endometriosis, with persistent symptoms despite chronic hormonal treatment, with imaging showing stage IV endometriosis. Hence, en bloc low rectum resection with total hysterectomy and bilateral adnexectomy was performed, followed by appendectomy. Unexpectedly, despite the gross normal macroscopic appearance of the appendix, microscopy showed multiple endometriosis foci, consisting of endometrial glands embedded in varying amounts of endometrial stroma. As some of these glands were bordered by mucinous-type epithelium containing intestinal cells, Goblet cells, Paneth cells in addition to the presence of mucus-filled microcysts, immunohistochemistry (IHC) was performed in order to differentiate between intestinal-metaplasia and LAMN. IHC showed positivity of the endometrial epithelium for KRT7, estrogen receptor (ER) and progesterone receptor (PR). Both the appendiceal mucosa and the intestinal-type metaplastic epithelium of the glandular structures were positive for KRT20. Additionally, the endometrial stroma enclosing endometrial glands, as well as the stroma surrounding mucinous-type metaplastic epithelium, were positive for CD10, ER and PR. This patient's case draws attention to the rare occurrence of appendiceal endometriosis and the uncommon intestinal metaplasia, which can easily mimic LAMN, emphasizing the paramount importance of the differential diagnosis with this type of neoplasia.

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Given that delta hepatitis is associated with a 2–6 times higher risk for hepatocellular carcinoma (HCC) compared to HBV monoinfection, we aimed to identify the negative prognostic factors for complications associated with HDV infection (particularly HCC) and to validate BEA score as a screening tool for HCC in HDV. Our retrospective single centre study included all consecutive admissions of adult patients with chronic HDV infection in the period 01.01.2021–31.12.2022. The negative prognostic factors identified were higher MELD ( p < 0.0001) and higher BEA score on admission ( p < 0.0001), older age on HBV diagnosis ( p < 0.0001) and advanced fibrosis when PegINF was administered ( p = 0.01). Good prognostic factors were: Class A—BEA score ( p = 0.001), normal platelet count ( p = 0.00001), normal albumin level ( p = 0.001) and prior treatment with PegInf ( p = 0.01). ROC curve showed 78.5% sensitivity for BEA score > 2, validating it as a potential screening tool for HCC. Hence, for patients with BEA score > 2 imaging screening should be intensified in order to early diagnose HCC and prompt access to curative treatment. Additionally, the negative prognostic factors identified (MELD > 15, advanced fibrosis when treated with PegINF or diagnosis with HBV infection at an older age) should encourage more frequent monitoring for HCC compared to local guidelines recommendations.