We reviewed the efficacy and complications of transcatheter arterial chemoembolization using degradable starch microspheres (DSM) for primary neuroendocrine tumors of the liver or liver metastases from gastrointestinal neuroendocrine tumors in ten patients. The rate of complete and partial response was 70.0%. The one year and two year survival rate was 77.8% respectively, with a median survival time of 852 days (28.4 months). All symptoms and laboratory data related to treatment were acceptable. It is thought that DSM-TACE is an effective treatment for inoperable liver neuroendocrine tumors or liver metastases from gastrointestinal neuroendocrine tumors.
A clinicopathological study was made on 9 cases of mucocele (8 cases of adenoma and 1 case of adenocarcinoma) of the appendix treated at the hospital in the recent 12 years. With abdominal CT, correct preoperative diagnosis was successfully made in 7 out of 9 cases of mucocele of the appendix. Two cases of mucocele of the appendix were diagnosed as peritoneal pseudomyxoma before surgery. The most common operative procedure was ileocecal resection in 4 cases including 2 cases undergone irrigation of the abdominal cavity, and partial cecectomy in 5 cases including 2 cases undergone irrigation in the abdominal cavity. For a patient with adenocarcinoma, we repeated intraperitoneal chemotherapy with cisplatin after surgery. Eight patients with adenoma are doing well, but one patient with adenocarcinoma died 48 months after surgery. Therapeutic approaches based on homogeneous pathologic entities can now be considered rationally.
An 84-year-old male was admitted to our hospital due to diarrhea. Fourteen yeas ago, he underwent a graft replacement for an abdominal aortic aneurysm. Three years ago, he waa pointed out left internal iliac artery aneurysm about 8cm in diameter. During the hospital stay, he experienced sudden massive hematochezia. Colonoscopic examination revealed a fistula at the rectum. Abdominal CT showed left internal iliac artery aneurysm with aorto-enteric fistula (AEF). An emergent aneurysmectomy and Hartmann's procedure was performed and the patient recovered. This case might show the usefulness of colonoscopy and CT for early diagnosis of secondary AEF. Early diagnosis and surgical treatment are necessary to recover from secondary AEF.
We report a case of endocrine carcinoma of the sigmoid colon. A 71-year-old man was admitted to our hospital because of constipation and bloody stool. Colonoscopy showed a mass lesion with irregular ulceration in the sigmoid colon. He was given a diagnosis of the poorly differentiated adenocarcinoma of the colon, and underwent sigmoidectomy with dissection of the lymph nodes. Histological and immunohistochemical examinations of the resected specimen revealed endocrine carcinoma. Endocrine carcinoma of the colon is rare, and the prognosis is very poor. We discuss this case with references.
We report a 52-year-old patient with a small hepatic mass which was ultrasonographically anechoic with scattered high echoic spots, and appearing slightly hyperattenuating relative to the surrounding parenchyma on unenhanced CT scans. Laparotomy revealed that the lesion was a unilocular cyst containing a mucinous fluid. The histologic diagnosis was ciliated hepatic foregut cyst (CHFC). The CHFC is a rare congenital cystic tumor which derives from the embryologic foregut. Up to 2006, only 24 cases, including our case, had been reported in Japan. The patients were 13 men and 11 women, aged between 41 years and 79 years. All of the lesions were solitary and unilocular. In 22 cases, the CHFC was located in the medial segment of the left lobe, mostly just beneath the hepatic surface. In all 24 Japanese cases, the cystic wall was benign histologically. However, reports of 3 malignant cases overseas indicates we should treat this disease cautiously.
A 47-year man was hospitalized to our hospital because of consciousness disturbance. He had been abnormally fond of soy bean products since childhood. His plasma levels of ammonia and citrulline were elevated, and we suspected of adult-onset type II citrullinemia (CTLN2). Gene examination demonstrated abnormality in the SLC25A13 gene, confirming CTLN2. Serum levels of hepatobiliary enzymes were increased and his liver biopsy revealed nonalcoholic steatohepatitis. Although we considered that living donor liver transplantation was suitable for the treatment, unfortunately, there was no appropriate donor candidate in his family. He has received conservative treatments, showing a symptom-free course.
We report a case of focal spared area of segment VIII in fatty liver. The patient was a 73-year-old man. Abdominal ultrasonography showed focal hypo-echogenicity with an irregular margin in segment VIII. Abdominal computed tomography and enhanced computed tomography showed a high-density mass in segment VIII of the right lobe. MRI examination revealed that the mass in S8 was high-intense on the T1 out of phase image and iso-intense on the T1 in phase image. The lesion was not observed on T2 weight images. He had a sigmoid colon cancer and was performed a sigmoidectomy and partial resection of the liver. A microscopic examination of the liver specimen revealed normal hepatic parenchymal cells, while the surrounding liver had a fat deposition.
A 74-year-old woman underwent abdominal echography at a local clinic and a splenic mass was found. She was hospitalized for detailed examinations and treatment. Splenectomy was performed to make a definite diagnosis and for treatment because a definitive diagnosis could not be made, despite various examinations. Histopathological examination revealed that the lesion was infiltrated by polyclonal lymphoid cells and contained proliferating spindle-shaped fibroblasts without any atypical cells, so the splenic mass was diagnosed as an inflammatory pseudotumor. Because some cases of inflammatory pseudotumor can be diagnosed from the clinical course and imaging findings, this possibility should also be considered in the differential diagnosis of a splenic mass.