Hepatic lymphorrhea (HL) is an uncommon but potentially life-threatening type of postoperative lymphatic leakage, especially following pancreaticoduodenectomy. We herein report a case series of four patients with HL following pancreaticoduodenectomy that presented to the department with a severe clinical picture with the discovery in imaging and intraperitoneal fluid's tests. All our patients presented with a condition of Hepatic lymphorrhea secondary to pancreaticoduodenectomy, which were treated successfully with percutaneous hepatic lymphangiography (HLG). Hepatic lymphorrhea is an uncommon but potentially life-threatening complication following pancreaticoduodenectomy. Periportal lymphatic vessels, which was often isolated and dissected especially with extended lymphadenectomy, is potentially damaged and caused resistant chylous leakage. Newly techniques are updated and applied in diagnosis and treatment for this difficult-to-treat complication, one of them is percutaneous Hepatic Lymphangiography (HLG). HLG with percutaneous access could be effective to identify and terminate the chylous fistula from periportal lymphatic vessels after pancreaticoduodenectomy.

Introduction: Angiosarcoma of pancreas is an extremely rare disease with a poor prognosis. The clinical signs and symptoms of pancreatic angiosarcoma are nonspecific, and it is occasionally diagnosed at an advanced stage. Pancreatic angiosarcoma and Pancreatic ductal adenocarcinoma in one patient was never ever known in English literature. Case presentation: A 56-year-old female was admitted with clinical and laboratory signs of gastrointestinal (GI) bleeding. Upper gastrointestinal endoscopy revealed bleeding from the ampulla of Vater. Besides, abdominal computed tomographic (CT) revealed a solid mass in the region of the pancreatic tail, which was considered the origin of bleeding. Distal pancreatectomy and splenectomy were performed because of persistent GI bleeding, and the final histological diagnosis of tumor in pancreatic tail was pancreatic ductal adenocarcinoma. After 30 days, she developed recurrent bleeding in ampulla and the abdominal CT-scan revealed a huge hematoma in omentum harem. We conducted transcatheter arterial embolization, but anemia continued to worsen. Therefore, pancreaticoduodenectomy was recommended to remove this mass, and based on postoperative histological findings, pancreatic angiosarcoma was diagnosed. After few days, laparotomy was indicated again because of persistent intra-abdominal bleeding. Despite all critical care and surgical therapeutic attempts, the patient died within two weeks after operation. Discussion: A pancreatic angiosarcomas primary origin is especially rare, with the present case being the tenth accounted in the English literature. Angiosarcomas is creating a disorganized mass of cells with extravasated blood that led to characteristics, extensive amounts of hemorrhage. The clinical manifestations of pancreatic angiosarcoma are variable, and immunohistochemistry staining is mandatory, with positive staining for vascular markers, which include CD31, CD34, von Willebrand factor (vWF), factor-VIII, Ulex europaeus agglutinin 1 (UEA-1), Friend leukemia integration 1 (Fli-1) and vascular endothelial growth factor receptor (VEGFER). Conclusion: We here present a report of an extremely rare case with had pancreatic angiosarcoma and synchronous pancreatic ductal adenocarcinoma with clinical picture of GI bleeding secondary to hemosuccus pancreaticus (HP).

Objectives: The histologic grade is an important prognostic factor in hepatocellular carcinoma (HCC). A Gd-EOB-DTPA-enhanced MRI may provide noninvasive imaging markers related to tumour differentiation. This study aimed to evaluate the association of Gd-EOB-DTPA-enhanced MRI features, together with the albumin–bilirubin (ALBI) score and alpha-fetoprotein (AFP), with the HCC histologic grade and to assess the performance of combined predictive models. Methods: In this prospective cross-sectional study, 75 patients (mean age, 56.4 years; 66 men) with 88 histopathologically confirmed HCC lesions were enrolled. Patients were classified into well-differentiated (grades I–II, n = 24) and poorly differentiated (grades III–IV, n = 51) groups according to the Edmondson–Steiner system. The MRIs were performed on a 1.5-T scanner and included T1-weighted in-phase/opposed-phase imaging; T2-weighted imaging; diffusion-weighted imaging; and dynamic Gd-EOB-DTPA-enhanced sequences, including arterial, portal venous, transitional, and 20 min hepatobiliary phases. Two radiologists, blinded to the pathology, assessed predefined imaging features, and the lesion-to-liver ratio (LLR) was measured. Group comparisons were performed using Student’s t-test, a Mann–Whitney U test, and a chi-square or Fisher’s exact test, followed by a multivariable logistic regression and ROC analysis with bootstrap resampling. Results: Compared with well-differentiated HCC, poorly differentiated HCC showed a higher frequency of peritumoral hepatobiliary phase (HBP) hypointensity (62.7% vs. 4.2%, p < 0.001) and peritumoral arterial hyperintensity (39.2% vs. 0%, p < 0.001). In the multivariable analysis, peritumoral HBP hypointensity remained independently associated with poorly differentiated HCC (OR = 30.89, p = 0.002). The two-parameter MRI model, including peritumoral HBP hypointensity and HBP tumour signal, yielded an AUC of 0.84. The combined MRI + ALBI + AFP model yielded an AUC of 0.87 and an accuracy of 78.7%, representing only a small exploratory improvement over the two-parameter MRI model (AUC = 0.84) in this cohort. Conclusions: Gd-EOB-DTPA-enhanced MRI features, particularly peritumoral HBP hypointensity, were associated with a high histologic grade in HCC. In this surgically treated, predominantly HBV-related cohort with mostly preserved liver function, these findings provide a preliminary basis for preoperative histologic risk stratification; however, they remain exploratory and require external validation in larger, more diverse cohorts before broader clinical application.

Background/Objectives: Type 1 autoimmune pancreatitis (AIP) can resemble pancreatobiliary malignancy. We described pancreatic and extrapancreatic CT/MRI findings and explored retrospective interpretive patterns, including unrecognized diffuse disease. Methods: This retrospective single-center study included 40 selected patients with archived definite/probable JPS 2018 classifications. CT was available for 31 patients and MRI/MRCP for 36. Two radiologists reviewed features independently and reached consensus; access to diagnostic information during these assessments could not be reconstructed. Six operated patients formed an illustrative case series reviewed post hoc with final diagnoses known. Results: Diffuse disease occurred in 28/40 (70.0%), a capsule-like rim in 33/40 (82.5%), homogeneous portal venous and/or delayed enhancement in 40/40, and qualitative diffusion restriction in 36/36 MRI examinations. Extrapancreatic abnormalities compatible with IgG4-related involvement were recorded in 32/40 patients (80.0%): biliary abnormalities in 30/40 and renal abnormalities in 11/40. Two extrapancreatic presentations initiated evaluation. Three of six operated patients had diffuse disease. The narratives illustrate biliary-dominant findings, temporal change, and discordant multimodality evidence. These are selected-cohort frequencies, not population prevalence or sensitivity estimates. Imaging also contributed to diagnostic adjudication, creating incorporation bias; malignant controls were absent. Conclusions: The findings describe an imaging spectrum and generate educational hypotheses. The diagnostic-role framework has not been validated as a diagnostic algorithm or shown to reduce misdiagnosis or unnecessary surgery. Independent comparative validation is required.

Objectives: Histologic grade is an important prognostic factor in hepatocellular carcinoma (HCC). Gd-EOB-DTPA-enhanced MRI may provide noninvasive im-aging markers related to tumour differentiation. This study aimed to evaluate the association of Gd-EOB-DTPA-enhanced MRI features, together with the albu-min-bilirubin (ALBI) score and alpha-fetoprotein (AFP), with HCC histologic grade and to assess the performance of combined predictive models. Methods: Methods: In this prospective cross-sectional study, 75 patients (mean age, 56.4 years; 66 men) with 88 histopathologically confirmed HCC lesions were en-rolled. Patients were classified into well-differentiated (grade I–II, n = 24) and poorly differentiated (grade III–IV, n = 51) groups according to the Edmondson–Steiner system. MRI was performed on a 1.5-T scanner and included T1-weighted in-phase/opposed-phase imaging, T2-weighted imaging, diffu-sion-weighted imaging, and dynamic Gd-EOB-DTPA-enhanced sequences, in-cluding arterial, portal venous, transitional, and 20-min hepatobiliary phases. Two radiologists, blinded to pathology, assessed predefined imaging features, and the lesion-to-liver ratio (LLR) was measured. Group comparisons were per-formed using Student’s t-test, the Mann–Whitney U test, and the chi-square or Fisher’s exact test, followed by multivariable logistic regression and ROC analy-sis with 500 bootstrap resamples. Results: Compared with well-differentiated HCC, poorly differentiated HCC showed a higher frequency of peritumoral hepatobiliary phase (HBP) hypointensity (62.7% vs. 4.2%, p < 0.001) and peritu-moral arterial hyperintensity (39.2% vs. 0%, p < 0.001). In multivariable analysis, peritumoral HBP hypointensity remained independently associated with poorly differentiated HCC (OR = 30.89, p = 0.002). The 2-parameter MRI model, includ-ing peritumoral HBP hypointensity and HBP tumour signal, yielded an AUC of 0.84. The combined MRI + ALBI + AFP model showed the highest discriminative performance, with an AUC of 0.87 and an accuracy of 78.7%. Conclusions: Con-clusions: Gd-EOB-DTPA-enhanced MRI features, particularly peritumoral HBP hypointensity, were associated with high histologic grade in HCC. In this cohort, combining MRI features with ALBI grade and AFP yielded higher discriminative performance than the MRI-only model. These findings may support preoperative histologic risk stratification, although external validation is required.