An epithelial cyst in an intrapancreatic accessory spleen (ECIAS) is rare. We herein report a case of a patient with ECIAS who underwent laparoscopic surgery. A 57-year-old woman was referred to our ...hospital because of a pancreatic tail tumor. She was asymptomatic, and a physical examination revealed no remarkable abnormalities. The levels of the tumor marker carbohydrate antigen 19-9 (CA19-9) and s-pancreas-1 antigen (SPan-1) were elevated. Ultrasonography showed a well-defined homogeneous cystic tumor. Computed tomography showed a well-demarcated cystic tumor in the pancreatic tail. Magnetic resonance imaging showed that the cystic tumor exhibited low intensity on T1-weighted images and high intensity on T2-weighted images. The cystic tumor was diagnosed as mucinous cystic neoplasm preoperatively. The patient underwent laparoscopic spleen-preserving distal pancreatectomy. A histopathological examination revealed the cyst wall to be lined by stratified squamous epithelium within splenic parenchyma, and the ultimate diagnosis was ECIAS. The postoperative course was uneventful, and the patient was discharged on postoperative day 12. ECIAS is very difficult to diagnose preoperatively. Laparoscopic surgery is a safe and minimally invasive procedure for patients with difficult-to-diagnose pancreatic tail tumor suspected of having low-grade malignancy.
Recently, bisphosphonate and denosumab have been widely used for the treatment of bone metastasis of breast cancer. However, medication-related osteonecrosis of the jaw(MRONJ)has often been reported ...as a side effect of these drugs. We experienced a rare case of intracranial epidural abscess secondary to MRONJ. The patient died of the condition, although chemotherapy was effective. The mechanism of and therapy for MRONJ have not been clarified; therefore, its prevention should be emphasized.
Background: A hepatic artery–portal vein reciprocal response and hepatic hemodynamics have well been investigated under normal condition, but not under pathologic condition with decreased vascular ...bed. This study was designed to determine the hemodynamic changes in the hepatic blood flow, tissue perfusion and interrelationship between portal venous flow (PVF) and hepatic arterial flow (HAF) after inflow interruption in the various size of hepatic vascular bed.
Methods: Anesthetized dogs were used to measure PVF and HAF using a transit time flow meter and hepatic tissue flow (HTF) using a laser Doppler flow meter before and after portal venous (PVO) or hepatic arterial occlusion (HAO) under various range of portal triad occlusion (PTO).
Results: The ratio of HAF/TLF (total liver flow) was 38±14% under the basal condition. This ratio did not change under the 30% PTO where there was a similar decrease in PVF and HAF, but reduced to 25±12% under the 70% PTO where there was more selective reduction in HAF than PVF. Although a reciprocal HAF increase was observed under any conditions after PVO, the TLF and HTF decreases after PVO were largest under the 70% PTO with the highest PVF/TLF ratio. On the other hand, there was no reciprocal PVF increase in any conditions after HAO, and the TLF and HTF decreases after HAO were minimal under the 70% PTO with the lowest HAF/TLF ratio.
Conclusions: With decreasing hepatic vascular bed, dependency of the remnant hepatic hemodynamics and tissue perfusion on the portal blood flow increased. These findings suggest that an integrity of portal venous flow becomes crucial in the remnant hepatic tissue perfusion after extensive hepatic resection.
Multiple tumors within the liver are a characteristic feature of hepatocellular carcinoma (HCC). This study investigated alterations in the histologic type and DNA content of multiple nodules of HCC. ...Both a pathologic examination and flow cytometric DNA analysis were performed on 49 resected specimens of multinodular HCC. The results showed that 35 cases had multiple metastatic satellite nodules around the main tumor (group 1), while 14 had two solitary nodules in different segments without satellite nodules (group 2). In group 1, 28 out of 35 (80.0%) showed a single DNA index while 7 (20.0%) revealed two different DNA contents in the main tumor. The histological type, cytological grade, and DNA index were equivalent between the main and satellite tumors in 100%, 88.6%, and 97.1% of the cases, respectively. In group 2, all tumors showed a single histological type, cytological grade, and DNA index in each nodule. The histological type was identical in 85.7% of the pairs of nodules, but the cytological grade and DNA index were different in 42.9% and 85.7%, respectively. The patients in group 2 showed a significantly higher 5-year survival rate than that in group I (64.8% vs 27.2%, P < 0.05). This study thus indicates that the cytological grade and DNA content are useful in distinguishing multicentric occurrence from intrahepatic metastasis in HCC.
In a retrospective analysis of 174 formalin fixed, paraffin-embedded, hepatocellular carcinoma tissue samples, the correlation between the coefficient of variation (CV) as determined by flow ...cytometry and the duration of formalin fixation (DFF) was investigated. In addition a potential adverse effect of prolonged formalin fixation on CV and fluorescence intensity in paraffin-embedded liver tissue was also investigated prospectively in samples from four patients in which the DFF varied from three days to four weeks. In the retrospective study, there was a significant linear correlation between the CV and DFF (p<0.001), with the CV increasing as the DFF became prolonged. The proportion of samples in which the CV was less than 10.0 was significantly greater (p<0.01) in samples in which the DFF was less than two weeks. In the prospective study, a decrease in fluorescence intensity was observed as the DFF increased. Following two weeks of formalin fixation the fluorescence intensity decreased to 38.1% of the intensity observed in fresh samples. The mean CV was greater than 10.0 in the samples in which the DFF exceeded two weeks. It is concluded that prolonged formalin fixation has an adverse effect on CV. The DFF for flow cytometric analysis of paraffin-embedded tissue should be no greater than two weeks.
Recent years, we experienced various treatment procedures for hepatocellular carcinoma (HCC), including hepatic resection, transcatheter hepatic artery embolization and percutaneous ethanol ...injection. However, Some patients could not receive these treatments because of the liver dysfunction and the location of the tumors. In such cases, we have developed the microwave coagulation therapy (MCT) for HCC. From June 1992, 53 patients have received MCT : 8 cases received laparoscopic-MCT (L-MCT), 19 cases received open-MCT (O-MCT) and 26 cases received percutaneous-MCT (P-MCT). Liver function of L, O-MCT patients was worse than that of patients who received partial resection of the liver. The actual and disease-free 3-years survival rate were identical between the patients who received L, O-MCT and those who had partial hepatectomy. Out of 13 cases with tumor size greater than 2 cm in diameter receiving P-MCT, 7 cases should remaining enhanced area by a follow up dynamic CT, although none of 13 cases with tumor size less than 2 cm in diameter should enhancement. MCT is a possible choice of treatment for some HCCs.
We report a case of biloma which was developed by communication between the biliary tract and the retention cyst in the post hepatectomy patient, following percutaneous microwave coagulation therapy ...(MCT) for hepatocellular carcinoma (HCC). The patient developed retention cyst after posterior segmentectomy of the liver for hemangioma in 1986. About 7 years later, HCC of 2 cm in diameter was revealed adjacent to the cyst. Although surgical resection was technically possible, the patient chose to undergo MCT. He had an attack of fever approximately one year after MCT. Investigation revealed biloma that was developed from retention cyst by communication between the biliary tract and the cyst. Then we performed surgical resection of the biloma together with the recurrent HCC neighboring the cyst.
Background/Aims: Intratumor heterogeneity of DNA ploidy within a single hepatocellular carcinoma is not well understood. The present study was designed to examine the histologic distribution of ...intratumor DNA ploidy in hepatocellular carcinomas of different growth types in relation to cell differentiation.
Methods: Twenty patients (16 men and four women; mean age, 60.2 years) with hepatocellular carcinoma (mean diameter, 4.3 cm) were studied. One hundred and twenty-seven samples from different sites of each tumor were analyzed by determination of the nuclear DNA content and histological examination.
Results: The DNA ploidy was heterogeneous in nine (45%) of the 20 tumors. Five tumors had a mixture of diploid and aneuploid regions, and the remaining four consisted of aneuploid regions with different DNA indices. There was no significant difference in patient characteristics between the heterogeneous and homogeneous groups. A significant correlation was found between tumor growth type and the incidence of heterogeneity. Only 16% of single nodular carcinomas without intratumor septal formation exhibited heterogeneity, while single nodular tumors with septal formation or confluent multinodular tumors were associated with high incidences of different DNA ploidy patterns or DNA indices. There was no aneuploidy in well-differentiated foci, while aneuploidy was frequently found in moderately or poorly differentiated foci (incidences of 67% and 74%, respectively).
Conclusions: Heterogeneity of DNA ploidy may develop along with changes in growth pattern and cell dedifferentiation or by confluence of nodules originating from different tumor cell clones.
A 47-year-old woman was coincidentally diagnosed to have a liver tumor by ultrasonography. Of tumor markers, only CA19-9 was positive. Imaging studies showed the 7 cm-sized tumor located in the ...segment 6 of the liver, and the homogenious stain. And the tumor had a component of cystic and solid parts. We carried out the resection of segment 6. The tumor with the well-defined margin was 7.5cm×7.5cm in diameter and included large and small cysts. By the histopathological examination, the tumor, which was mainly consisted of fibrous connective tissue with the various sized blood vessels, lymph vessels and small bile ducts. Now she has been well and there is no reccurence at three years after surgery. There were 64 reported cases in Japan, which included 52 infants and 12 adults. Tumor growth rate in infants is rapid while it is slow adults. It is generally difficult to distinguish mesenchymal hamartoma from malignant tumor by imagings. Therefore, in both infants and adults, resection can be the first option of therapy. Although this tumor is not malignant, 3 recurred cases have been reported. We should be careful about the follow-up.
The present study reports the significance of the resection range and surgical margin for hepatocellular carcinomas (HCC) based on the experience of 217 curative resection cases from 1981 through ...December 1992. In tumors less than 5cm in size, the disease-free survival rate of lobectomy was much better than subsegmental or less extensive resection. When the prognosis was compared by surgical margin (SM), those with a SM of more than 20mm showed a disease-free survival rate much better than shorter SM cases. In selected patients with segmental or less extensive resection of tumors less than 5cm in size, the most frequent site of recurrence was the same subsegment or one adjacent subsegment to the site of the primary tumor. The incidence of recurrence at SM decreased with wider SM. These findings suggested that hepatectomy should obtain a wider surgical margin and a wider extent of resection. Twelve cases (40%) of 30 disease-free 5-year survivors had subsegmental or less extensive resection. Those patients' tumors were characterized by small size (≤5cm), single nodule and diploidy. This suggest aht if the HCC is a lower biological grade of malignancy and small, a limited operation may be indicated.
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