Isolated intracavitary metastatic hepatocellular carcinoma of the right atrium without inferior vena cava involvement; report of a case

A 63-year-old female had been treated for liver cirrhosis and hepatocellular carcinoma (HCC) since 3 years before. She developed symptoms of dyspnea and echocardiography revealed a large tumor in the right atrium. The stalk of tumor was attached to the intraatrial septum just above the tricuspid valve and the tumor was floating between the right atrium and the right ventricle according to cardiac rhythm. The size of tumor was 30 x 15 mm in diameter. She was admitted to our hospital for emergency operation. She was operated for cardiac tumor under cardiopulmonary bypass successfully and the postoperative course was uneventful. But the pathology reported direct intracavitary metastasis of HCC without intravascular involvement. She was discharged on the 7th postoperative day for the treatment of HCC.     

Treatment of colorectal liver metastasis with biliary and portal vein tumor thrombi by hepatopancreatoduodenectomy

We present a case of a large colorectal liver metastasis with portal vein and biliary tumor thrombi and duodenal and jejunal direct invasion that required hepatopancreatoduodenectomy. A 38-year-old woman presented to her local hospital with right back pain and jaundice. She had undergone transverse colectomy and limited liver resection for transverse colon cancer with a synchronous liver metastasis in September 1991, and low anterior resection for rectal carcinoma in January 1996. She was diagnosed as having colorectal liver metastasis and was referred to our hospital for possible surgery. Radiologic and endoscopic examinations revealed a large liver tumor occupying the right lobe, biliary dilation in the left lateral section, and a portal vein tumor thrombus. Invasion of the inferior vena cava and the right renal vein were also suspected. Intraoperative findings revealed a large liver tumor that occupied the right lobe and invaded the duodenum and jejunum. The tumor was resected successfully by right trisectionectomy, caudate lobectomy, pancreatoduodenectomy, partial resection of the jejunum, and combined portal vein resection and reconstruction. The inferior vena cava, right kidney, and renal vein could be detached from the tumor. The patient has enjoyed an active life without recurrence for 2 years since the operation.     

Case report: a case with small cell carcinoma of the bladder transformed from urothelial carcinoma

A 69 year-old woman visited our hospital with a chief complaint of macrohematuria in April 2004. She was diagnosed with bladder tumor. She underwent transurethral resection ofbladdar tumor three times and right partial ureterectomy for ureteral tumor following primary bladder carcinoma. All pathological findings demonstrated that the tumor was urothelial carcinoma (UC), G1-G2, pT1 including right ureteral tumor. In spite of intravesical instillation of BCG, recurrent invasive bladder tumor was found in June 2006. In July 2006, we performed total cystectomy and construction of ileal conduit. Surgical specimen revealed small cell carcinoma and immunohistochemical staining with NSE and synaptophysin was positive. On day 67 after operation, the patient died of multiple metastases to liver and bone.     

Metastatic hepatocellular carcinoma obstructing the right ventricular outflow tract.

A 49-year-old female with a past history of liver resection due to hepatocellular carcinoma was referred to our Department for treatment of a metastatic cardiac tumor obstructing the right ventricular outflow tract. She underwent operation twice with cardiopulmonary bypass, and symptoms were relieved. Metastasis from hepatocellular carcinoma to the heart is very rare, but should be taken into consideration during follow-up after treatment for a primary liver tumor.     

Successful resection of cecal hepatic metastasis extending into the right side of the heart under cardiopulmonary bypass

Resection is the best hope for the cure of colorectal metastasis to the liver. However, surgery is indicated for only a few patients, especially those who have major vascular involvement. We report a 55-year-old woman with a liver metastasis from the cecum that showed a tumor thrombus in the right side of the heart. She had undergone laparoscopic right hemicolectomy for cecal cancer 6 months before, and presented with a palpable mass in the epigastrium. Abdominal ultrasonography, computed tomography, hepatic angiogram, and echocardiography showed a huge mass on the left lobe of the liver, with a tumor thrombus which extended to the right ventricle through the left hepatic vein and inferior vena cava. Tumor thrombectomy, through a right atriotomy, was success-fully performed under cardiopulmonary bypass, followed by left hepatic lobectomy. The patient's postoperative course was uneventful. Received for publication on Oct. 5, 1998; accepted on Jan. 11, 1999     

Case of primitive neuroectodermal tumor of the kidney

A 28-year-old woman presented with right flank pain. A large, firm, fixed mass was palpable in the right side of the abdomen. Computed tomography revealed a solid mass of the right kidney with extension into the renal vein and inferior vena cava. The patient underwent right radical nephrectomy with en bloc resection of the inferior vena cava containing tumor thrombus and right adrenalectomy. Histologically the tumor consisted of small tumor cells with rosette formation. Immunohistochemical staining was positive for CD99 and NSE. Analysis with polymerase chain reaction (PCR) demonstrated the EWS/FLI1 fusion products resulting from a chromosomal translocation. These findings were consistent with primary renal primitive neuroectodermal tumor (PNET). Two months after surgery, multiple lung, liver and lymph node metastases were found. The patient received 2 cycles of chemotherapy with cisplatin, ifosfamide, etoposide, resulting in a partial remission. She subsequently received 1 cycle chemotherapy with paclitaxel and carboplatin, resulting in no response. The metastatic lung and liver diseases progressed and she died 5 months after diagnosis.     

Metastatic renal cancer arising from adenoid cystic carcinoma of the parotid gland: a case report.

A 40-year-old woman underwent excision of the right parotid gland tumor in 1988. The pathological examination showed adenoid cystic carcinoma. In 1993 she underwent excision of a recurrent tumor on the right face and was referred to our department because of an incidental finding of left renal tumors. She underwent nephrectomy and was diagnosed with left renal metastasis on pathological examination. In 1997 computerized tomography demonstrated multiple metastases in the right kidney, liver, lungs and brain. She died of cancer in 1998. Secondary carcinoma of the kidney is usually identified at autopsy and represents a late and poor manifestation of primary disease when diagnosed during life. The present case is unique in its primary site, pathology and clinical course.     

Giant cavernous hemangioma of the liver and multiple primary malignant tumors in a patient with suspected familial inhibition of natural killer cell activity--a case report

A woman was operated on for a nonepithelial malignant tumor of the left leg and subsequently, for an epithelial carcinoma of the right breast and a borderline malignant tumor of the right ovary. She also developed a giant cavernous hemangioma that caused disseminated intravascular coagulation syndrome, which necessitated a left trisegmentectomy of the liver. Her family history suggested a hereditary predisposition to diverse malignant neoplasms, and also to giant cavernous hemangioma of the liver. Immunological evaluation disclosed selective inhibition of natural killer cell activity. Hormonal and hereditary factors are discussed in relation to the development of multiple primary tumors and giant cavernous hemangioma of the liver.     

Giant cavernous hemangioma of the liver and multiple primary malignant tumors in a patient with suspected familial inhibition of natural killer cell activity —A case report—

A woman was operated on for a nonepithelial malignant tumor of the left leg and subsequently, for an epithelial carcinoma of the right breast and a borderline malignant tumor of the right ovary. She also developed a giant cavernous hemangioma that caused disseminated intravascular coagulation syndrome, which necessitated a left trisegmentectomy of the liver. Her family history suggested a hereditary predisposition to diverse malignant neoplasms, and also to giant cavernous hemangioma of the liver. Immunological evaluation disclosed selective inhibition of natural killer cell activity. Hormonal and hereditary factors are discussed in relation to the development of multiple primary tumors and giant cavernous hemangioma of the liver.     

A case of intrathoracic giant malignant peripheral nerve sheath tumor in neurofibromatosis type I (von Recklinghausen's disease).

The patient was a 32-year-old woman with neurofibromatosis I (von Recklinghausen's disease), with chief complaints of shortness of breath and back pain. CT and MRI revealed a giant mass occupying the right thoracic cavity almost completely. The mass compressed the mediastinal structure to the left and the liver downwards. She underwent surgery to alleviate respiratory and circulatory disorders caused by compression of the right lung and inferior vena cava due to the giant tumor. Intraoperatively, the tumor was found to have originated from the 5th intercostal nerve. The resected tumor was 20x17x15 cm in size and 2,300 g in weight. It was histologically diagnosed as a malignant peripheral nerve sheath tumor. Her postoperative course was uneventful. All indicators of respiratory function improved, and edema of the lower half of the body disappeared, accompanied by disappearance of shortness of breath. She was discharged 21 days after surgery. Seven months after surgery, however, a recurrent tumor was found in the right thoracic cavity. She died of rapid growth of recurrent tumor 3 months thereafter. This tumor often complicates neurofibromatosis I and has a high frequency of local recurrence and distant metastasis, resulting in poor prognosis. Neither an optimal extent of resection needed for complete resection of this tumor nor an optimal regimen of chemotherapy, radiotherapy, or other therapy for the tumor has yet been established. It is desirable to establish them in the near future.     

A resected case of recurrent carcinoma of the right colon ten years after the initial operation

A 59 year-old female complained of right lower abdominal mass. She underwent radical operation 10 years ago for the right colonic cancer staged Dukes C. She had passed 10 years without any sign or symptom of recurrence. She noticed a egg-sized tumor in the right lower abdomen unexpectedly one month ago when she got a bruise on that region, and then the tumor grew rapidly. Preoperative examinations, including barium enema, abdominal computerized tomography and so on, suggested a extraluminal tumor with infiltration to the colon. Laparotomy revealed that the tumor originated from the right paracolic gutter. The tumor sized 18 X 11 X 8 cm was resected and histological diagnosis was adenocarcinoma with the similar structural pattern to the initial specimen. On the basis of both operations and histological findings, we concluded that free tumor cells might be implanted in the large raw surface of the right dorsolateral abdominal wall, which was created by surgical incision at the initial operation, and subsequently appeared as a local recurrence after 10 years interval.     

How far should we treat metastatic liver cancer? Report of three long-term survivors

The major issue in treating metastatic liver cancer is: how far should we perform resection? We believe that only reports of long-term survival afford an answer to this problem. We report three such patients. The first patient underwent pancreatoduodenectomy for cancer of the papilla of the duodenum and resection of metastatic liver cancer. She is alive without recurrence 15 years and 1 month after the initial surgery. The second patient received low anterior resection for rectal cancer, extended right lobectomy for liver metastasis, and pancreatoduodenectomy for metastasis at the common bile duct. She survived 6 years and 9 months after the initial surgery. The third patient underwent right nephrectomy for Wilms' tumor (adult type), extended right lobectomy for liver metastasis, and repeat resection of recurrences at the mediastinum and in the thoracic and abdominal walls. She is alive 21 years and 2 months after the initial surgery. These experiences have prompted us to carry out resection when surgery is deemed feasible.     

Primary osteogenic sarcoma of the breast. Report of a case

Primary osteogenic sarcoma (POS) of the breast is very rare. Only eleven cases have been previously reported in Japan. In this paper, we report an additional case of POS. A 30 year old female was admitted to our hospital with chief complaint of rapidly growing mass of the right breast. She was diagnosed carcinoma of the right breast and underwent a radical mastectomy (Br + Ax + Mj + Mn). Histological findings of the resected tissues revealed POS of the breast. After three months from the operation, local recurrence was demonstrated by an incisional biopsy. One more months later, chest X-P revealed bilateral lung metastases. Irradiation with 60Co for recurrence and chemotherapy using vincristine, methotrexate for distant metastases were not effective. However, cisplatin caused the necrosis of local recurrent tumor. She died nine months after operation. At autopsy, extended metastasis of tumor cells diffusely to the pleura, lungs, liver, adrenal glands, pancreas, peritoneum, fifth lumbar vertebra, skull, dura mater and left pulmonary hilar lymph nodes was observed.     

Giant mesenchymal hamartoma of the liver in an adult

We report a case of hepatic mesenchymal hamartoma in an adult; this condition is extremely rare, with only 15 cases having been reported in the English-language literature worldwide. The patient was a 36-year-old woman who was seen at her local hospital for upper abdominal distension. A giant multilocular cystic tumor, which had almost entirely replaced the normal parenchyma of the right lobe of the liver, was diagnosed. She was referred to our hospital, where, with a diagnosis of biliary cystadenoma, the tumor was successfully removed by right hemihepatectomy. After an uneventful postoperative course, the patient was discharged from our hospital. On histological examination, the tumor consisted of numerous cystic lesions without epithelial lining cells; hepatocytes, bile duct, and vascular components, without either lobular structure or atypia, were observed in the pseudocyst wall, leading to a diagnosis of hepatic mesenchymal hamartoma. There have been a few previously reported cases of multifocal hepatic mesenchymal hamartoma reappearing in the remaining liver after hepatectomy, although these cases are considered to be extremely rare. Therefore, periodic follow-up will be necessary for the patient.     

Liver hemorrhage due to idiopathic peliosis hepatis successfully treated with hepatic artery embolization

Peliosis hepatis is an extremely rare condition that may cause fatal hepatic hemorrhage and liver failure. We report a case of liver hemorrhage due to idiopathic peliosis hepatis. A 60-year-old woman was admitted to our hospital with slight right hypochondriac pain. She went into hemorrhagic shock, and computed tomography (CT) showed multiple low-density areas in the right liver with massive subcapsular blood collection. Selective transfemoral arteriography of the celiac artery revealed no signs of vascular malformation or tumor stain, but showed signs of pooling in the right posterior segmental artery. The artery was embolized with particles of gelatin sponge, and hemostatic control was successful. Although peliosis hepatis is extremely rare, the diagnosis is significant because of its urgent clinical status, and transarterial embolization is a useful and minimally invasive procedure for liver hemorrhage due to peliosis hepatis.     

Malignant transformation of clival chordoma after gamma knife surgery - case report -

A 54-year-old woman presented a midline clival tumor manifesting as right abducens palsy in May 1997. Magnetic resonance (MR) imaging revealed a midline clival tumor. She underwent surgery twice with the transsphenoidal approach and gamma knife surgery for residual tumor. The histological diagnosis was chordoma. MR imaging revealed that the tumor had extended to the right cerebellopontine angle, with spinal seeding in February 2002. She underwent partial removal of the right cerebellopontine angle tumor. The histological diagnosis was chordoma with slight nuclear atypism. She died 5 years and 5 months after the first gamma knife surgery. Autopsy revealed multiple areas of spinal seeding. Histological examination confirmed malignant transformation with unique epithelial characteristics, possibly caused by gamma knife surgery.     

Treatment of renal cell carcinoma extending into the right atrium with extra-corporeal circulation using high-grade hypothermia: a case report

A 68-year-old woman underwent surgical treatment for renal cell carcinoma associated with tumor thrombus extending into the right atrium. Although the tumor thrombus reached the level of the right atrium, there were no other apparent metastases. Combination therapy with interferon alfa plus tegafur/uracil (UFT) was attempted with the expectation of reducing the tumor thrombus, but there was no change. Successful management was achieved with right radical nephrectomy, right auriculotomy, and partial cavectomy using cardiopulmonary bypass under high-grade hypothermia. After removal of the tumor and thrombus, blood loss was 13,900 ml during the patient's recovery. She had mild heart failure for about two weeks after the operation, but recovered. She was discharged on the 40th day after the operation. Proper preparation for blood transfusion is the key point of this operation.     

Metastatic Osteosarcoma in the Jejunum with Intussusception: Report of a Case

We report a case of metastatic osteosarcoma in the jejunum causing intestinal intussusception. A 58-year-old woman underwent right femoral region amputation, lower lobectomy of the left lung and complete left pneumonectomy after four courses of chemotherapy for osteosarcoma of the right femur with left lung metastases. She was referred to our department 13 months later with progressive abdominal pain and vomiting. Abdominal radiography showed a small-bowel obstruction. She underwent emergency laparotomy, which revealed jejunal intussusception. The lead point was found to be an intraluminal tumor. We resected the jejunum containing the tumor and histological examination confirmed that the tumor was osteosarcoma metastasis.     

Metastatic fibrosarcoma of the brain: transformation from conventional to epithelioid form--case report

A 45-year-old woman presented with an extremely rare metastatic fibrosarcoma of the brain manifesting as persistent headache. She had undergone surgery for a fibrosarcoma of the soft tissue of the thigh 2 months earlier. She had a history of previous surgery and radiotherapy for this tumor. She was somnolent with papilledema and left hemiparesis. Magnetic resonance imaging of the brain revealed a right frontal lesion with mass effect and heterogeneous enhancement. Computed tomography and scintigraphy showed multiple metastatic lesions of the lung. Right frontal craniotomy was performed for gross total removal of the yellowish-white tumor. Histological examination showed signs of epithelioid transformation based on positive staining for epithelial membrane antigen compared to the primary tumor. Postoperatively the patient was alert and the left hemiparesis improved. She refused radiotherapy or chemotherapy. Follow-up computed tomography showed multiple intracranial metastases. She died 5 months after the surgery.     

Neurinoma of the oculomotor nerve: case report

A case of solitary neurinoma of oculomotor nerve is reported. A 40-year-old female had a sudden headache with nausea and vomiting in January, 1978. She complained of diplopia and right ptosis two months later and visited a neurosurgical clinic, but radiological examination was told to be normal. Headache and right ptosis diminished, but diplopia continued. She was admitted to our clinic on Aug. 30, 1984, complaining of diplopia and right ptosis which were noticed only when she was tired. On admission, she had no neurological deficits except for right oculomotor nerve palsy. There was no cutaneous manifestation of von Recklinghausen's disease. Plain skull radiogram and angiogram showed normal study. CT scan showed a solitaly enhancing mass in the right prepontine region. On Sept. 22, 1984, a right frontotemporal craniotomy was performed, and the tumor was totally removed by pterional approach. The tumor was located beside the right internal carotid artery and the oculomotor nerve was incorporated in the tumor. The histological diagnosis was Antoni B type neurinoma. The clinical features of fourteen reported cases of neurinoma of the oculomotor nerve in the literature were reviewed.