We investigated the usefulness of contrast-enhanced ultrasonography for differential diagnosis of polypoid gallbladder lesions in 60 patients, consisting of gallbladder carcinoma in 20, adenoma in 2, benign polyp in 29, and adenomyomatosis in 9, comparing contrast enhancement patterns with pathologic findings. We monitored vascular flow for 120 sec, constructing a time intensity curve (TIC) by flash-echo imaging. We compared the number of vessels and vessel diameter determined by contrast enhancement patterns and by pathologic examination. Contrast enhancement patterns were classified as linear, scattered, diffuse, or branched. When diffuse type and branched type were considered as indicative of cancer, accuracy was 84.5%, sensitivity 100%, and specificity 76.9%. In gallbladder carcinoma, the TIC rose from no contrast to early-phase contrast sooner than in other diseases. In adenocarcinoma, high-intensity values persisted at 120sec. With an intensity of 90 or greater at 120 sec taken as indicating cancer, accuracy was 89.7%, sensitivity 89.5%, and specificity 89.7%; Vessels were significantly more numerous in diffuse type cases than in those with other patterns. Vessel diameter was greatest in the diffuse type and the branched type patterns, both differing significantly from the linear type. Ultrasonographic contrast enhancement patterns show characteristic associations with pathologic findings and serve as valuable adjuncts in the diagnosis of gallbladder diseases.
We encountered two cases of C1 inhibitor deficiency (26-year-old man and 29-year-old woman) . They had been suffering from paroxysmal abdominal pain for many years. Imaging studies showed wall thickening of the intestine and ascites and diagnosis was difficult. Decreased serum levels of C4 and C1INH activity indicated a diagnosis of C1INH deficiency. Although C1INH deficiency is rare, it should be considered as a differential diagnosis in young patients with paroxysmal abdominal pain.
A 53-year-old man was admitted hospital because of frequent vomiting and poor digestion. Abdominal computed tomography showed a tumor, about 5 cm in diameter at the duodeno-jejunal junction. A barium contrast duodeno-small bowel series revealed stenosis in the therd portion, where push enteroscopy could not pass with normal mucosa. The preoperative diagnosis was submucosal or mesenteric tumor. Open surgery was performed. The tumor derived from the mesenterium and involved the anal side of the small intestine. The tumor was removed with partial excision of the upper jejunum. The diagnosis of mesenteric desmoid tumor was confirmed, histologically.
The patient was a 61-year-old man with chronic hepatitis C who achieved a sustained virological response to interferon therapy in 1993. As a result, the status of his liver improved pathologically from F2A2 to F1A1. Eleven years later, however, a tumor measuring 15 mm in diameter in segment 6 of the liver was indicated by CT. A well-differentiated hepatocellular carcinoma was detected by a fine needle biopsy. The lesion was treated by transcatheter arterial chemoembolization combined with radiofrequency ablation. Even if patients with chronic hepatitis C have achieved a sustained virological response to interferon therapy, patients with risk factors for the development of hepatocellular carcinoma, such as being a male of advanced age and with progressive fibrosis of the liver, should receive careful long-term follow-up.
A 42-year-old woman with chronic hepatitis C has visited our hospital since October 2003. Liver biopsy revealed chronic hepatitis (A1/F1) . Therapy was initiated with interferon (IFN) α-2b and ribavirin in February 2004. Two months later, the patient developed left facial weakness. Laboraroty findings showed cryoglobulinemia and abnormal thyroid function without any evidence of other viral infections. Idiopathic peripheral facial nerve palsy was diagnosed. IFN was discontinued at week 9 of therapy, but she obtained sustained virological response and her symptoms resolved at 6 month after the withdrawal.
A 25-year-old man was admitted to our hospital because of abdominal pain, nausea and low-grade fever. An abdominal CT showed remarkable thickening of the wall of the small intestine and extensive thrombosis of the mesenteric, portal and splenic veins. Because neither intestinal infarction nor peritonitis was seen, anticoagulation therapy was chosen. Heparin was administered intravenously and was used alternatively with warfarin later. The patient's symptoms and clinical data improved gradually. Concerning the etiological factors of the thrombosis, only protein S activity definitely decreased. Genetic analysis indicated a variant of protein S, protein S Tokushima.
A 30-year-old woman was referred to us because of hypoglycemic attack. The tumor on the pancreatic body of 22 mm size was revealed by close inspection, and was diagnosed as insulinoma. Surgical resection was performed, but curative resection was impossible because the component of adenocarcinoma infiltrating into surrounding tissue coexisted with insulinoma. Postoperatively, we make a diagnosis of combined tumor of the pancreas, i.e. mixed duct-islet cell carcinoma. In this paper, we discuss this rare disorder and summarizie 33 cases reported in the Japanese literature.