原发性肝癌术后复发的射频和无水酒精治疗

目的 比较原发性肝癌术后复发患者的射频（RF）治疗和无水酒精注射（PEI）治疗，探讨RF治疗的疗效。方法 回顾性分析我院诊断为原发性肝癌并行根治性手术治疗后肝内复发但没有肝外转移的患者137例，共161个病灶，除外肝功能为ChildC级的患者。分别行RF治疗74例，共86个病灶；行PEI治疗63例，共75个病灶。RF组中有9个病灶直径大于3cm（最大的肿瘤直径为4cm），平均为2．05cm；而PEI组所有病灶直径均小于3cm，平均为2．03cm。监测2组病例治疗前后血常规、肝功能、AFP、彩色多谱勒超声等变化，并统计患者的1、2及3年生存率。结果 RF组和PEI组均未出现严重并发症，RF组和PEI组的肿瘤完全坏死率分别为93．0％（80／86）及81．3％（61／75），前者明显高于后者（P〈0．05）；在RF组中，直径〈3cm和3～4cm的病灶的完全坏死率分别为96．1％（74／77）和66．7％（6／9），前者明显高于后者（P〈0．05）；RF组和PEI组的1、2和3年生存率分别为74．3％（55／74）、62．2％（46／74）及54．8％（17／31）和68．3％（43／63）、57．1％（36／63）及45．0％（9／20），差异均无统计学意义（P〉0．05）；RF组的病灶完全坏死平均治疗次数为1．3次，明显低于PEI组的2．5次（P=0．000）。结论 RF是原发性肝癌术后复发的有效治疗方法之一。     

Can Small Hepatocellular Carcinoma be Cured by Percutaneous Acetic Acid Injection Therapy?

To assess the efficacy of ultrasound (US)-guided percutaneous acetic acid (in concentrations of 15%, 20%, 30%, 40%, and 50%) injection for small hepatocellular carcinomas (HCCs) for long-term prognosis, percutaneous acetic acid injection using 15% to 50% acetic acid was performed in 91 patients with one to four HCCs smaller than 3 cm during the past 6.5 years. During the series of treatment sessions for each patient, the same concentration of acetic acid was used. All tumors could be treated successfully with percutaneous acetic acid injection despite the differences in acetic acid concentration used. The number of treatment sessions to treat similar size of tumor was less when the higher concentration of acetic acid was used. No serious complications occurred as a direct sequela to percutaneous acetic acid injection. None of the tumor treated regrew. The 1-, 2-, 3-, 4-, and 5-year survival rates for 91 patients were 95%, 87%, 80%, 63%, and 49%, respectively. The 1-, 2-, 3-, 4-, and 5-year cancer-free survival rates of these patients were 83%, 54%, 50%, 37%, and 29%, respectively. Both liver function and size of tumor affected both survival rate and cancer-free survival rate significantly, but the number of tumors did not. The concentration of acetic acid did not affect the survival rate. Percutaneous acetic acid using 15% to 50% acetic acid will be effective therapy for small HCCs for long-term prognosis.     

Treatment of Pyogenic Granuloma with a Sclerosing Agent

BACKGROUND: Pyogenic granulomas have been treated by cryosurgery, curettage, electrodesiccation, chemical cauterization, and laser surgery. The therapeutic effects of these conservative treatments are limited, however. OBJECTIVE: In this study, the efficacy of a sclerosing agent (monoethanolamine oleate) was evaluated for the treatment of pyogenic granuloma. METHODS: Pyogenic granuloma was treated by local injection of the monoethanolamine oleate solution in nine patients who were from 1 to 57 years of age (median 18 years). The treatment effect was determined by physical examination. RESULTS: All lesions were removed completely with no recurrence, and scars were inconspicuous in all cases. Complications occurred in only one patient who complained of pain due to an avoidable injection of excess solution. CONCLUSION: Sclerotherapy with monoethanolamine oleate is effective in the treatment of pyogenic granuloma and offers an alternative to conventional methods in cases for which conservative treatment is preferable.     

Inflammatory Pseudotumor of the Liver Masquerading as Hepatocellular Carcinoma After a Hepatitis B Virus Infection: Report of a Case

We report a rare case of hepatic inflammatory pseudotumor (IPT) after a hepatitis B virus (HBV) infection. Early contrast enhancement on computed tomography (CT) with a washout phenomenon at the delayed phase, and depleted Kupffer cell function on superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) suggested hepatocellular carcinoma (HCC). However, the lack of a tumor capsule, absence of liver cirrhosis, and normal serum levels of α-fetoprotein and PIVKA-II (protein induced by vitamin K absence; descarboxyprothrombin) contradicted this diagnosis. We excised the tumor to exclude malignancy, and the histopathological diagnosis was IPT. Recent evidence suggests that this entity has changed from an extremely rare pathology to an established disease. Thus, IPT should be considered in the differential diagnosis of a liver mass with an infectious–inflammatory antecedent. Although surgery is not mandatory, surgical removal is recommended if there is a possibility of malignancy. Further investigations are warranted to elucidate the mechanisms of IPT developing after an HBV infection.     

Successful Removal of a Giant Skull Base Metastasis from Hepatocellular Carcinoma after Direct Ethanol Injection: Case Report

Skull metastases from hepatocellular carcinoma (HCC) are extremely rich in vascularity, which sometimes makes surgery dangerous. For minimally invasive surgery, it is very important to diminish the intratumoral vascular flow preoperatively. We report the case of a 69-year-old man with a giant skull base metastasis from HCC that was successfully removed after two sessions of direct ethanol injection into the tumor as a preoperative treatment to diminish the intratumoral vascular flow. Direct ethanol injection is a modification of percutaneous ethanol injection therapy, which is widely used in the treatment of primary HCC. In this article, we describe in detail the practical procedures and the usefulness of this treatment for a giant skull base metastasis from HCC.     

Carcinoma Metastatic to Both Cerebellopontine Angles Masquerading as Acoustic Neuromas

Metastases to the cerebellopontine angles (CPAs) are rare. Typically, the clinical course is one of rapid onset and progression of crarial nerve deficits. The clinical presentation and course of carcinoma metastatic to the CPAs are reviewed. We report a case of bilateral CPA metastases with a radiographic appearance similar to neurofibromatosis type 2 presenting with rapidly progressive bilateral hearing loss followed by unilateral facial nerve palsy.     

甲状旁腺切除及无水酒精注射治疗继发性甲状旁腺功能亢进

目的：探讨甲状旁腺切除及腺体内无水酒精注射两种方式治疗继发性甲状旁腺功能亢进（SHPT）的疗效及安全性。方法：17例SHPT患者分为甲状旁腺切除组7例及甲状旁腺无水酒精注射组10例,术后腺体送检病理,观察药物注射前后腺体超声信号变化及术后并发症,记录血清学指标并随访1年。结果：腺体长径大于1.0cm病理改变呈结节样增生,无水酒精注射后腺体血流信号减少。两组术后钙、磷、碱性磷酸酶及甲状旁腺激素水平变化差异存在统计学意义（P〈0.01）,两组术后患者症状均有改善,并发症少,但手术组疗效优于注射组。结论：甲状旁腺切除治疗严重继发性甲状旁腺功能亢进效果确切,临床作为首选,甲状旁腺无水酒精注射治疗可作为单一腺体增生或甲状旁腺切除后的补充治疗。     

Spontaneous Cutaneous Rupture of a Pyogenic Liver Abscess

Spontaneous rupture of a pyogenic liver abscess is a rare entity reported. Spontaneous cutaneous rupture of a pyogenic liver abscess is even a rarer clinical entity not well documented in the literature. A patient having spontaneous cutaneous rupture of a pyogenic liver abscess is reported. The condition is rare and serious because of the possible delay in diagnosis. Recently, with the advent of ultrasound (USG) and computed tomography (CT) scan, there has been improvement in the rate of early diagnosis of liver abscess as well as in prognosis. The clinical presentation is variable; in some cases there are delays, misdiagnoses, or incidental recovery. Per cutaneous catheter drainage under USG or CT guidance has become the standard of care.     

Surgical Intervention for Obstructive Jaundice Due to Biliary Tumor Thrombus in Hepatocellular Carcinoma

This retrospective study in eight surgically treated patients with obstructive jaundice due to biliary tumor thrombus in a patient with hepatocellular carcinoma (HCC) was performed to evaluate the role of surgical intervention. All biliary tumor thrombi were confirmed preoperatively or intraoperatively. Only two manifested intraluminal biliary obstructions due to a primary tumor that had not been found preoperatively. The operative procedures included hepatectomy with removal of the biliary tumor thrombus (n = 3), hepatectomy combined with extrahepatic bile duct resection (n = 1), thrombectomy through a choledochotomy (n = 3), and piggyback orthotopic liver transplantation (n = 1). The 1- and 3-year survival rates were 62.5% and 37.5%, respectively. Two patients survived more than 5 years. Surgical intervention was effective in patients with obstructive jaundice due to a biliary tumor thrombus in an HCC. Thus surgery for a recurrence can prolong survival, and liver transplantation is a treatment worthy of further investigation.     

Long-Term Outcome of Percutaneous Ablation in Very Early-Stage Hepatocellular Carcinoma

Purpose  

The aim of this study was to investigate the long-term outcomes of percutaneous ablation (PA) of very early-stage hepatocellulcar carcinoma (HCC) with a multimodal strategy.     

Needle Track Seeding of Primary and Secondary Liver Carcinoma After Percutaneous Liver Biopsy

Seeding of tumour in the needle track following percutaneous needle biopsy of liver neoplasms is rarely reported. We describe two such cases following the needle biopsy of an hepatocellular carcinoma and secondary colorectal carcinoma respectively. The risk of needle track recurrence of liver tumours should not be regarded as insignificant. The diagnosis of liver neoplasms may be achieved by non-invasive modalities, and their needle biopsy should be reserved for cases not amenable to surgical resection.     

Brown Tumor of Hyperparathyroidism Masquerading as Central Giant Cell Granuloma in a Renal Transplant Recipient: A Case Report

The brown tumor of hyperparathyroidism is histologically identical to the central giant cell granuloma (CGCG), but these lesions can be differentiated based on history and laboratory findings. Herein we have reported a 46-year-old renal transplant recipient in whom brown tumors of hyperparathyroidism were detected several years following renal transplantation. The lesions initially masqueraded as a CGCG with an intranasal mass and ethmoid bone involvement at 7-years posttransplantation, for which surgical resection had been performed. Six years later, she developed multiple expansile bony lesions of the chest wall with histologic features of multinucleated giant cells. A markedly elevated parathyroid hormone level led us to make a diagnosis of brown tumor of hyperparathyroidism. Hence, we propose that clinicians consider brown tumor of hyperparathyroidism to be a potential cause of giant cell lesions among renal transplant recipients. Moreover, careful follow-up examinations are required for such patients to make a timely and accurate diagnosis.     

Percutaneous Ablative Therapies of Recurrent Hepatocellular Carcinoma after Hepatectomy: Proposal of a Prognostic Model

Background

Percutaneous ablative therapies (PAT) are valuable modalities for posthepatectomy recurrent hepatocellular carcinoma (RHCC), but its impact on long-term outcome and prognosis prediction have not been well documented. The present study aimed to analyze prognostic factors and to propose a prognosis-predicting model for RHCC treated with PAT.

Methods

A total of 288 patients with posthepatectomy RHCC treated with percutaneous ethanol ablation, radiofrequency ablation, microwave ablation, or ethanol ablation combined with radiofrequency ablation were included. Survival and prognostic factors were analyzed. A prognosis-predicting model was created by quantifying and integrating all prognostic factors.

Results

Three-, 5-, and 7-year postablation survival rates were 37.8, 20.7, and 14.2?%, respectively. Multivariate analysis revealed that interval between recurrence and initial hepatectomy, tumor number, largest diameter of tumor, and Barcelona Clinic Liver Cancer stage at hepatectomy were independent prognostic factors for survival. A scoring system for prognostic factors was proposed, and summation of 4 prognostic factors (prognostic score) was ranged from 4 to 10. Prognostic score was classified into three strata, designated as prognostic classes A (score 4 and 5), B (score 6 and 7), and C (??8). Three-, 5-, and 7-year postablation survival rates were 62.8, 39.4, and 26.9?% in class A, 36.9, 15.5, and 7.2?% in B, and 5.5, 0, and 0?% in class C, respectively (p?=?0.00). Three-, 5-, 7-, and 10-year survival rates after initial hepatectomy were 82.4, 66.3, 52.1, and 36.4?% in class A, 51.6, 34.8, 20.7, and 6.6?% in class B, and 11.9, 7.8, 0, and 0?% in class C, respectively (p?=?0.00).

Conclusions

The prognostic model developed in the study could clearly predict different long-term outcomes for patients with posthepatectomy RHCC and thus help decide appropriate therapeutic strategy.     

超声导向瘤内注射无水酒精治疗肝癌

目的　探讨超声导向瘤内注射无水酒精治疗肝癌的疗效。　方法　利用B超引导经皮肝穿刺瘤内注射无水酒精治疗原发性、转移性肝癌 6 0例 ,共注射 4 5 0次。　结果　癌肿直径 <3cm、3～ 5cm、>5cm病人 ,1年和 3年的生存率分别为 10 0 %、6 8.8% ,89.7%、4 8.3%和 83.3%、13.3%。 73.3%(4 4 6 0 )肿瘤缩小 ,AFP阳性患者 97.7% (4 3 4 4 )出现AFP下降或转阴 ,未发生肿瘤沿针道转移及严重并发症。　结论　该方法操作简单、适应证广、副作用少 ,疗效确切。     

肝动脉栓塞化疗联合经皮乙酸消融双介入治疗巨块型肝癌的护理

目的 探讨肝动脉栓塞化疗(TACE)联合经皮乙酸消融(PAI)双介入治疗巨块型肝癌的护理方法.方法 对38例巨块型肝癌患者首次行常规TACE治疗后l周复查,根据碘油的填充情况,对碘油稀疏和缺损区域进行PAI治疗,间隔30～45 d重复小剂量TACE治疗.结果 治疗后38例患者肿块均缩小,肝动脉造影示肿瘤血管消失20例(52.63%),甲胎蛋白恢复正常31例(81.58%).发生不良反应27例(71.05%).1、2、3年生存率分别为97.37%、84.21%、34.21%.结论 TACE联合PAI双介入治疗巨块型肝癌的疗效较好.术前细致的心理护理和周密的术前准备,术中准确配合、密切观察患者反应并及时配合医生作出相应处理.术后加强不良反应的观察和护理是保证治疗效果的主要措施.     

Hepatic Splenosis Diagnosed as Hepatocellular Carcinoma: Report of a Case

We report one case of splenosis. A 43-year-old male patient was referred to our hospital because of a hepatic mass. The hepatic lesion was incidentally found during an annual ultrasonographic follow-up since the patient was a known chronic hepatitis B carrier for the previous 10 years. Surgical records revealed a history of splenectomy in conjunction with a blunt abdominal trauma, which the patient had sustained 20 years prior to this admission. On abdominal computed tomography scanning, a 3.5-cm sized focal bulging mass was noted in segment 6 of the liver. An inferior phrenic artery angiogram showed a hepatic tumor and the patient was treated by chemoembolization for hepatocellular carcinoma. A partial resection of the liver with a portion of the diaphragm was done after the transcatheter arterial chemoembolization procedure. A pathologic examination revealed splenosis within the hepatic parenchyme. Received: February 20, 2001 / Accepted: September 11, 2001