1/891. An extrahepatic bile duct metastasis from a gallbladder cancer mimicking Mirizzi's syndrome.We report a case of an extrahepatic bile duct metastasis from a gallbladder cancer that mimicked Mirizzi's syndrome on cholangiography. A 67-yr-old woman was admitted to our hospital with a diagnosis of acute calculous cholecystitis. As obstructive jaundice developed after the admission, percutaneous transhepatic biliary drainage was performed to ameliorate the jaundice and to evaluate the biliary system. Tube cholangiography revealed bile duct obstruction at the hepatic hilus, and extrinsic compression of the lateral aspect of the common hepatic duct, with nonvisualization of the gallbladder. No impacted cystic duct stone was visualized on CT or ultrasonography. laparotomy revealed a gallbladder tumor as well as an extrahepatic bile duct tumor. We diagnosed that the latter was a metastasis from the gallbladder cancer, based on the histopathological features. This case is unique in that the extrahepatic bile duct metastasis obstructed both the common hepatic duct and the cystic duct, giving the appearance of Mirizzi's syndrome on cholangiography. Metastatic bile duct tumors that mimic Mirizzi's syndrome have not been previously reported. The presence of this condition should be suspected in patients with the cholangiographic features of Mirizzi's syndrome, when the CT or ultrasonographic findings fail to demonstrate an impacted cystic duct stone.- - - - - - - - - - ranking = 1keywords = hepatic (Clic here for more details about this article) |
2/891. Parietal seeding of unsuspected gallbladder carcinoma after laparoscopic cholecystectomy.Laparoscopic cholecystectomy (VALC) represents the treatment of choice for the symptomatic gallstones. However the occurrence of an adenocarcinoma of the gallbladder results a controindication for this surgical technique. We present a case of a 52 years old woman who underwent a VALC; histology revealed a gallbladder adenocarcinoma. For this reason the patient underwent a second operation that is right hepatic trisegmentectomy. Six months later the patient presented with a parietal recurrence at the extraction site of the gallbladder. We discuss the possible mechanism responsible for carcinomatous dissemination during laparoscopic surgery and we raccommend the use of some procedures in order to limit the risk and eventually to treat a neoplastic parietal seeding. These complications suggest the problem about the utility and the future played by video assisted laparoscopic surgery in the diagnosis and treatment of intraabdominal malignancies.- - - - - - - - - - ranking = 0.090909090909091keywords = hepatic (Clic here for more details about this article) |
3/891. Combined hepatocellular-cholangiocarcinoma. Diagnostic challenge in hepatic fine needle aspiration biopsy.OBJECTIVE: To study the cytohistologic features of combined hepatocellular-cholangiocarcinoma (CHCC-CC) in fine needle aspiration biopsy (FNAB) material. STUDY DESIGN: Six hepatic FNAB cases with cell blocks (five) and hepatic resections (two) were analyzed cytohistologically and immunohistochemically. RESULTS: The six cases were diagnosed as CHCC-CC based on clinicopathologic correlation. Unequivocal hepatocellular carcinoma (HCC) cells corresponding to Edmondson and Steiner's grade 3 lesions were identified in the FNAB in three instances. adenocarcinoma, represented by cohesive columnar cells with ovoid, basal nuclei displaying nuclear palisading, acini and/or papillary structures with variable intracytoplasmic intraacinar or brush border mucin production, was identified in all cases. Intermediate cells with hybrid/polymorphic cytologic features straddling malignant hepatocytes and glandular cells were identified in five instances. Tissue alpha-fetoprotein was negative. There was brush border and/or diffuse cytoplasmic p-carcinoembryonic antigen immunoreactivity in the glandular elements. CONCLUSION: FNAB diagnosis of CHCC-CC is possible if the clinical, cytohistologic and immunohistochemical findings support the presence of HCC and adenocarcinoma. Intermediate cells pose a great challenge to recognize and define: they tend to lose the classic cytologic features of malignant hepatocytes and acquire glandular characteristics. At the very least, there should be a high index of suspicion. These cases underscore the necessity for clinicopathologic correlation in enhancing the precision of FNAB diagnoses.- - - - - - - - - - ranking = 0.54545454545455keywords = hepatic (Clic here for more details about this article) |
4/891. Partial hepatectomy for metastatic carcinoma.Three years after colonic resection for a rectal carcinoma, the patient evinced some weight loss and alkaline phosphatase elevation. Detailed workup revealed what appeared to be a solitary, well-defined metastatic lesion of the right hepatic lobe. Since the patient could be considered a good candidate for surgery, and given the grim prognosis of alternative approaches, hepatic lobectomy was carried out, as described here.- - - - - - - - - - ranking = 0.18181818181818keywords = hepatic (Clic here for more details about this article) |
5/891. Pancreatic cancer and fibrinogen storage disease.BACKGROUND: Ductal adenocarcinoma is the most common type of pancreatic carcinoma while squamous, carcinosarcoma, sarcoma, giant cell carcinoma, and clear cell types are all rare. Hepatocellular fibrinogen storage disease is also an uncommon disorder which may be associated with hepatocellular carcinoma. Two cases of pancreatic carcinoma were encountered in a family with fibrinogen storage disease, further raising the possibility of a predilection to malignancy in this unusual disorder. The tumour in one case was of the rare clear cell type. These two cases are the basis for this report. methods: Sections were cut from retrieved paraffin embedded tissue and stained for routine histology. immunohistochemistry using the avidin-biotin technique was applied for the expression of the markers p53 (D07), carcinoembryonic antigen (CEA), c-erbB-2, epithelial membrane antigen (EMA), and alpha-fetoprotein (AFP). RESULTS: Both cases were adenocarcinoma of pancreatic ductal origin. The tumour in one case showed features of a clear cell carcinoma. The tumour cells expressed p53, CEA, and EMA immunoreactivity and were negative for c-erbB-2 and AFP. CONCLUSIONS: Hepatocellular fibrinogen storage disease is rare and has been described in association with chronic hepatitis, cirrhosis, and rarely with hepatocellular carcinoma. This represents the first report of its association with carcinoma outside of the liver.- - - - - - - - - - ranking = 0.078094291105855keywords = liver (Clic here for more details about this article) |
6/891. Well-differentiated adenocarcinoma, gastric foveolar type, of the extrahepatic bile ducts: A previously unrecognized and distinctive morphologic variant of bile duct carcinoma.Two examples of a rare but distinctive morphologic variant of extremely well-differentiated adenocarcinoma of the extrahepatic bile ducts are reported. One tumor arose in the common bile duct of a 51-year-old man; the other arose in the common hepatic duct of a 27-year-old man. Both tumors were composed predominantly (>95%) of gastric foveolar-type epithelium. Because of their bland nuclear features, low mitotic index, and focal polypoid and lobular architecture, they were initially confused with adenomas. Foci of less-differentiated adenocarcinoma and perineural invasion present in the deep portions of the tumors facilitated recognition. The neoplastic cells and extracellular mucin were periodic acid-Schiff- and alcian blue-positive. By immunohistochemistry, the tumor cells expressed cytokeratins 8 and 20 as well as cathepsin d, as reported in normal foveolar cells. Likewise, p53 overexpression was documented immunohistochemically in both adenocarcinomas, which also stained with the Ki-67 antibody. Despite the well-differentiated nature of the neoplasms and their deceptively benign microscopic appearance, one patient developed recurrence and liver metastasis 5 years after surgery. The other patient is disease-free 2 years following a segmental resection of the common hepatic duct, cystic duct, and gallbladder. The cell phenotype of these tumors can be explained by the ability of the bile duct epithelium to differentiate along gastric cell lines.- - - - - - - - - - ranking = 0.71445792746949keywords = hepatic, liver (Clic here for more details about this article) |
7/891. Rapid growth of residual colonic tumor after incomplete mucosal resection.We report an 89-year-old man with colon cancer that developed rapidly after an incomplete endoscopic mucosal resection (EMR), and discuss the adverse effect of this maneuver on the tumor biology. A sessile polyp, 15 mm in size, was detected at the hepatic flexure. EMR was performed immediately. Histological examination showed well differentiated adenocarcinoma with an adenomatous component invading the submucosal layer. There was vascular invasion (positive on elastica van Gieson staining) and the surgical margin was positive for cancer. A right hemicolectomy was performed. The surgical specimen showed the residual tumor, 22 mm in diameter. The relevant histopathological findings of the surgical specimen were: well differentiated adenocarcinoma, with partly mucinous carcinoma and a tubular adenomatous component, depth muscularis propria (mp), lymph node (LN) (0/9). Most of the submucosally invasive cancer was resected by the initial EMR, but the small residual tumor showed rapid growth within only 3 months after the EMR. It was assumed that the residual tumor cells had acquired more malignant characteristics after EMR. In regard to EMR we propose that: (1) except for patients who are at high risk for a major operation, EMR should be avoided for carcinoma with massive submucosal invasion, (2) colonic resection should be performed immediately when histology shows a positive surgical margin for carcinoma, and (3) patients operated after an incomplete EMR should be watched very carefully for the detection of recurrence.- - - - - - - - - - ranking = 0.090909090909091keywords = hepatic (Clic here for more details about this article) |
8/891. Acute neoplastic arterial embolism after pneumonectomy.Intra-arterial tumour embolism after pneumonectomy is a known but rare complication. It arises because of tumour involvement of pulmonary veins. Usual outcome of this complication is grave when embolism is to a major vessel. If embolism occurs in a peripheral circulation, timely intervention can avoid significant morbidity. We report a case where embolisation occurred in both the femoral arteries. Emergency embolectomy was done successfully avoiding major complication.- - - - - - - - - - ranking = 0.009333819136874keywords = circulation (Clic here for more details about this article) |
9/891. A case of aberrant pancreatic cancer in the jejunum.We report a case of aberrant pancreatic cancer of the jejunum in a 63 year-old man. The patient was admitted to our hospital with epigastric discomfort and vomiting due to obstruction of the jejunum. laparotomy revealed a submucosal tumor on the jejunum with multiple liver metastases. Histological examination showed the tumor to be a well differentiated tubular adenocarcinoma originating from aberrant pancreatic tissues lacking islets. Only 1 case of aberrant pancreatic cancer in the jejunum has been previously reported in the literature.- - - - - - - - - - ranking = 0.078094291105855keywords = liver (Clic here for more details about this article) |
10/891. Bone agent localization in hepatic metastases.We present the bone scintigrams of two patients, which demonstrate diffuse extraosseous uptake of a bone agent in metastatic masses in the liver, one from a primary lung tumor and one from a primary breast tumor. The bone imaging agent did not localize in the brain metastases in these patients. CTs of the abdomen in both patients showed massive metastases in the liver with multiple areas of tumor necrosis. The CT of the abdomen of the breast cancer patient showed multiple small hepatic calcifications. autopsy revealed massive tumor necrosis with calcifications in the enlarged liver. In routine bone scintigraphy, diffuse uptake of bone agents in the liver of a patient with a known malignancy should be considered suggestive of massive hepatic metastases.- - - - - - - - - - ranking = 0.85783170987796keywords = hepatic, liver (Clic here for more details about this article) |
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