Fulminant hepatitis due to the massive hepatic necrosis is the most serious syndrome in hepatic inflammations, exhibiting various complications such as cerebral edema, renal dysfunction and impaired blood coagulation system. It is usually difficult to examine the liver histologically during hepatic coma. In this paper, the histological changes in the liver both during and after recovery from fulminant hepatitis were described in a 59 years old woman. On the liver specimen obtained at the initial phase of coma, normal hepatic structure was diffusely destroyed, showing hepatic cell necrosis, degeneration, bleeding and inflammatory cell infiltration. Chronic hepatitis i.e. destruction of the limiting plates, and inflammatory cell infiltration was revealed on two liver biopsy specimens obtained after two and six months, respectively.
The report was made on a case of 33 year-old man with multi-hormone producing insulinoma. One of his sisters had a case of WDHA syndrome which could suggested his insulinoma to be a hereditary type. The tumor found in the pancreatic tail using abdominal ultrasound, ERCP and angiography was diagnosed as an insulinoma according to Whipple's Triad as well as with giucagon test. Mesurement of many hormones such as insulin, glucagon, VIP, ACTH, andβ-MSH in the tumor verified it as multi-hormone producing APUDoma. Additional concepts concerning the central nervous disturbance induced by hypoglycemia were discussed in ad hoc literatures.