Spontaneous Regression of a Metastatic Liver Tumor: Report of a Case

A 60-year-old man, who suffered from advanced rectal cancer accompanied with liver metastasis, underwent an abdominoperineal resection and a partial hepatectomy. He remained well until 4 months after surgery when he developed a biopsy-proven recurrent intrapelvic mass and multiple liver tumors. At 6 months after surgery, the metastatic liver tumors grew larger and almost completely occupied both lobes of the liver. However, 9 months after surgery, the liver tumors regressed remarkably and his clinical condition improved without any specific treatment for cancer. Although he died of cancerous peritonitis 18 months after surgery, the autopsy findings did not indicate any apparent regrowth of the liver tumors. To date, only one case report of a spontaneous regression of a metastatic liver tumor from colorectal cancer has been published in the English literature. We herein describe this rare case and discuss some of the reasons potentially responsible for the regression. Received: July 16, 2001 / Accepted: March 5, 2002     

Adult Capillary Hemangioma of the Liver: Report of a Case

We report a rare case of capillary hemangioma of the liver in an adult. The patient was a 55-year-old man, admitted for investigation of a hepatic tumor. The tumor was seen as a hypoechoic mass with a peripheral hypoechoic ring on ultrasonography. Computed tomography (CT) showed an enhancement pattern different from that of hepatocellular carcinoma (HCC) or cavernous hemangioma. Ultrasonography-guided biopsy was technically very difficult because the tumor was located just below the diaphragm. We could not establish whether the tumor was HCC or cavernous hemangioma by the imaging findings, so we performed a hepatic resection. Histopathological examination confirmed a diagnosis of capillary hemangioma. Ultrasonography, CT, and magnetic resonance imaging showed an intermediate pattern between cavernous hemangioma and HCC. Thus, we must be aware of the possibility of capillary hemangioma when finding an atypical liver tumor inconsistent with HCC or cavernous hemangioma.     

Metastatic Breast Tumor Arising from Synovial Sarcoma: Report of a Case

We report a case of metastatic breast tumor arising from a synovial sarcoma of the lower limb. A 27-year-old Japanese woman was diagnosed to have synovial sarcoma 14 months prior to finding a mass in her left breast. An excisional biopsy was performed and a metastatic synovial sarcoma to the breast was confirmed. Eight months after the resection of the breast lesion, the patient developed local recurrences in both her knee and breast. A tumor resection of the limb lesion and a simple mastectomy for the huge lesion, which was diagnosed to be a metastatic breast tumor without lymph node metastasis, were performed. After the operation, the patient received adjuvant systemic chemotherapy. To the best of our knowledge, this is only the second reported case of a solitary metastatic breast tumor arising from synovial sarcoma.     

Giant Adrenal Hemangioma: a Case Report

Although adrenal masses are relatively common, hemangiomas occurring in adrenal glands are rare. This entity creates problems in the differential diagnosis. We report a patient with a giant cavernous hemangioma with a diameter of 13 cm, which was pre-operatively diagnosed as an adenoma or a malignant tumour. Clues to the correct diagnosis and therapeutic alternatives are discussed in the context of the available literature.     

腹腔镜肝切除术在治疗肝血管瘤中的价值

目的探讨腹腔镜肝血管瘤手术的可行性和疗效。方法回顾性分析2006年6月～2012年1月66例腹腔镜肝切除术治疗肝血管瘤的临床资料。断肝方式为超声刀+LigaSure联合分离法,结合腔镜下切割缝合器。结果行左半肝切除7例,左外叶切除28例(包括1例单孔左外叶切除),肝段切除8例,右半肝切除9例,局部切除14例。术后病理证实海绵状血管瘤55例,硬化性血管瘤4例,血管内皮细胞瘤3例,毛细血管瘤4例。手术时间43～380 min,平均165 min。术中出血量50～1100 ml,平均210 ml。术后腹腔引流量15～650 ml,平均180.4 ml。2例术后胆漏,经充分引流7天和20天治愈。术后住院时间3～13 d,平均5.8 d。结论在病例选择适当时,腹腔镜下肝血管瘤手术是一种安全、有效、微创的手术,可安全用于局部、肝段及半肝切除术。     

Hepatic Inflammatory Pseudotumor Mimicking Intrahepatic Cholangiocarcinoma: Report of a Case

Hepatic inflammatory pseudotumor (IPT) is a relatively rare lesion comprised of proliferating fibrovascular tissue infiltrated by inflammatory cells. IPT has a potential for recurrence and persistent local growth. We present a case of hepatic IPT mimicking a periductal-infiltrating type of intrahepatic cholangiocarcinoma (ICC) in a patient whose serum carbohydrate antigen 19-9 was slightly elevated. We performed a left hepatic lobectomy with resection of the extrahepatic bile duct and regional lymph node dissection under a preoperative diagnosis of ICC. However, histlogical examination of the resected tumor revealed granuloma tissue with lymphocyte infiltration, mainly by plasma cells, and proliferation into the surrounding connective tissue, and the lesion was ultimately diagnosed as hepatic IPT. This case points out the difficulties in differentiating between hepatic IPT extending along Glisson's sheath and ICC, based on imaging findings alone.     

Hemoperitoneum from a Spontaneous Rupture of a Giant Hemangioma of the Liver: Report of a Case

Hemangioma is the most common benign tumor of the liver and it is often asymptomatic. Spontaneous or traumatic rupture, intratumoral bleeding, consumption coagulopathy, and rapid growth are mandatory surgical indications. We report a case of giant hemangioma of hepatic segments II and III, which presented as hemoperitoneum, and were treated successfully with preoperative transcatheter arterial embolization (TAE) and hepatic bisegmentectomy. A PubMed Medline search has identified up to now 32 cases of spontaneous rupture of hepatic hemangioma in adults (age >14 years) without a history of trauma, including the present case. Twenty-seven out of these were reviewed. Sixteen (84.2%) of 19 tumors of known size were giant hemangiomas (mean diameter 14.8 cm; range 6–25). Twenty-two (95.7%) patients underwent surgery. Thirteen patients (59.1%) had a resection, 5 (22.8%) were sutured, and 4 (18.1%) underwent tamponade. Three (23%) out of the 13 resected patients died. Four patients (30.8%) underwent TAE prior to elective hepatic resection without any operative mortality. Among the 5 sutured patients, 2 (40%) died as well as 3 (75%) out of 4 patients who underwent tamponade. The mortality rate of all surgery patients was 36.4% (8/22). Received: April 8, 2002 / Accepted: September 3, 2002 RID="*" ID="*" Reprint requests to: V. Ziparo     

Basaloid Cell Carcinoma of the Esophagus with a Metastatic Neck Tumor of Unknown Origin: Report of a Case

A 51-year-old man was admitted to our hospital with a tumor in the right anterior region of his neck. Aspiration biopsy revealed squamous cell carcinoma (SCC). Further investigations, including upper gastro-intestinal series and endoscopy, showed two flush lesions in the middle and lower thoracic esophagus. An endoscopic biopsy was done and the pathological findings indicated poorly differentiated SCC. He underwent esophagectomy with three-field lymph node dissection, including the neck tumor. Histological findings revealed that the tumor in the middle thoracic esophagus was moderately differentiated SCC, and that the other tumor below it was basaloid cell carcinoma (BCC). The depths of invasion were to the lamina propria mucosae for the former and to the submucosal layer for the latter. There was no lymphatic invasion, venous invasion, or lymph node metastasis. A diagnosis of poorly differentiated SCC of unknown origin was made for the neck tumor. Postoperative recombinant chemotherapy with cisplatin and 5-fluorouracil was given for the unknown primary site, which we still have not identified. No recurrence of the esophageal cancer has been detected. Received: January 30, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: M. Kawamoto     

Capillary Hemangioma of the Liver with Kasabach-Merritt Syndrome in a Neonate: Report of a Case

(Received for publication on Sept. 28, 1998; accepted on July 13, 1999)     

肝海绵状血管瘤108例临床分析

目的探讨肝海绵状血管瘤临床特点及手术治疗的方法与疗效。方法回顾性分析108例肝海绵状血管瘤患者的临床资料,其中34例远离肝门,74例邻近肝门,行肝血管瘤包膜外剥除术34例;行肝切除术74例。74例邻近肝门者中邻近第一肝门30例,第二肝门22例,第三肝门15例,邻近3个肝门者7例。结果远离肝门组术中平均出血量(251.2±112.7)ml,平均阻断时间(20.3±11.8)min,术后发生出血1例(2.9%),胸水2例(5.9%),其临床效果明显优于邻近肝门组(P<0.05或P<0.01),后者的术中出血量为(631.3±233.5)min,平均阻断时间(45.5±25.3)ml,术后出血6例(8.1%),胸水11例(14.9%),胆漏3例(4.1%)。7例邻近第一、二、三肝门的患者,其瘤体直径达(13.5±5.4)cm,术中平均阻断肝门时间(85.4±28.5)min,术中出血量达(1 507.8±228.1)ml,与其他邻近第一肝门、第二肝门及第三肝门三组分别比较,差异显著(P<0.05)。结论手术治疗肝海绵状血管瘤是安全可行的。手术方式首选肝血管瘤包膜外剥离术,对瘤体位于肝实质并累及肝门者可行肝叶或半肝切除术。     

Left Extended Hepatectomy for a Metastatic Gastrointestinal Stromal Tumor After a Disease-Free Interval of 17 Years: Report of a Case

Gastrointestinal stromal tumors (GISTs), although rare, are frequently diagnosed with liver metastasis. These metastatic GISTs are poorly responsive to conventional chemotherapy; however, recent studies report improved survival after complete surgical resection of liver metastases. On the other hand, few reports describe the treatment of delayed liver metastasis after resection of a primary GIST. We report the case of a 55-year-old woman found to have liver metastasis from a GIST after a 17-year disease-free interval. The patient underwent a left extended hepatectomy for a complete resection of the metastatic GIST and is alive and well 30 months later. To our knowledge, this is the longest disease-free interval reported in the literature, and emphasizes the importance of considering late metastasis when evaluating patients with a history of GIST. Thus, surgical resection of delayed liver metastasis from a GIST should be considered as primary therapy.     

Malignant Sarcomatoid Tumor of the Liver: Report of a Case

A 65-year-old man was referred to our hospital for treatment of a liver tumor. Abdominal ultrasonography (US) demonstrated a low echoic mass in the S2–S4 region of the liver, which was confirmed by abdominal computed tomography (CT). In the delayed phase of angio-CT, the inside of the mass was not enhanced. Abdominal angiography showed a hypovascular area in the liver. An extended left lobectomy was performed. Macroscopically, the tumor was 9.5 × 9.5 cm in size, and on cross section, it was white and clearly demarcated from the surrounding tissue. Microscopic observation of hematoxylin–eosin-stained specimens did not show any glandular or trabecular formation. Histologically, there was diffuse proliferation of atypical spindle cells that had hyperchromatic, short, spindle-shaped nuclei, and pale cytoplasm with poor intercellular adhesion. The nontumorous tissue was almost normal with no sign of cirrhosis. Immunohistochemical examination showed that the spindle cells were positive for vimentin and cytokeratins (AE1/AE3, CAM 5.2), but negative for all other markers. The final diagnosis was a sarcomatoid carcinoma, the origin of which was not able to be confirmed immunohistochemically. This case of a primary hepatic tumor composed of malignant cells with sarcomatous features is described, and the immunohistochemical findings are discussed. Received: February 21, 2000 / Accepted: July 25, 2000     

Spontaneous Rupture of a Giant Hepatic Hemangioma-Report of a Case

Hemangioma is the commonest benign hepatic neoplasm. Most cases are asymptomatic. Spontaneous rupture is rare (1–4%). Only 34 cases have been reported in adults. None had history of trauma. We report a case, the first from India of spontaneous rupture of a giant hepatic hemangioma, in a 25 year old male presenting with acute abdomen. He underwent right hepatectomy. Histopathology suggested cavernous hemangioma.     

Intrahepatic Segmental Primary Sclerosing Cholangitis: Report of a Case

A 67-year-old woman was referred to our hospital for investigation of epigastric discomfort. Computed tomography (CT) showed dilatation of the intrahepatic bile duct in the left lobe of the liver, endoscopic cholangiography showed complete stenosis of the left main branch of intrahepatic bile duct, and CT during angiography showed decreased portal blood flow to segment 3 of the liver. Based on these findings, we suspected intrahepatic cholangiocarcinoma and performed left lobectomy of the liver. However, pathological examination revealed fibrosis and infiltration of inflammatory lymphoid cells around the stenotic bile duct and periportal area, without any evidence of malignancy. Since these findings were compatible with sclerosing cholangitis and the patient did not have a disorder that would cause secondary sclerosing cholangitis, the final diagnosis was primary sclerosing cholangitis (PSC). It is difficult to distinguish segmental PSC from cholangiocarcinoma; thus we think surgical resection is an appropriate therapeutic and diagnostic procedure for segmental intrahepatic bile duct stenosis.     

肝血管瘤的介入治疗(37例疗效观察)

目的观察经皮肝动脉超选插管栓塞治疗肝血管瘤的临床疗效。方法对37例确诊肝血管瘤患者,超选至肝动脉后以超液化碘油和平阳霉素栓塞硬化治疗。结果31例1次栓塞,6例行2次栓塞。随访2~12个月,瘤体缩小>50%者21例,缩小20%~50%者9例,<20%以下者7例,均无严重并发症发生。结论超液化碘油和平阳霉素经皮肝动脉超选插管栓塞治疗肝血管瘤疗效确切。     

Double Intussusceptions in the Small Intestine Caused by Metastatic Renal Cell Carcinoma: Report of a Case

Renal cell carcinoma (RCC) may metastasize to almost any organ, but it is unlikely to be a direct cause of intussusception. We report a case of double enteric intussusceptions caused by metastatic RCC in a 64-year-old man. The patient presented with intermittent abdominal pain and diarrhea 11 years after undergoing a radical nephrectomy. Abdominal computed tomography (CT) showed two enhanced masses with the “target” sign, suggesting enteric intussusceptions. We performed partial enterectomy, and histological examination confirmed that the tumors had originated from RCC. To our knowledge, this is the first report of metastases from RCC manifesting as synchronous intraluminal polypoid tumors serving as the lead points of two intussusceptions in the small intestine. Thus, the possibility of multiple tumor metastases in the small intestine, with or without intussusceptions, should be considered in patients with recurrent RCC.     

Hepatic Inflammatory Pseudotumor With Elevated Serum CA19-9 Level Mimicking Liver Metastasis From Rectal Cancer: Report of a Case

Inflammatory pseudotumor (IPT) of the liver is rare, and differential diagnosis from malignant tumors is difficult. We herein report a case of IPT of the liver with marked elevation of carbohydrate antigen 19-9 (CA19-9). A 72-year-old woman, who underwent low anterior resection for rectal cancer, had low-grade fever and epigastric pain. The patient has well-controlled idiopathic thrombocytopenic purpura (ITP) with steroid maintenance treatment. Abnormal laboratory findings included serum carcinoembryonic antigen of 15.9 ng/mL and CA19-9 up to 14,632 U/mL. Computed tomography revealed a low-density lesion, and magnetic resonance imaging demonstrated a high intensity lesion on T1, T2-weighted, and diffusion-weighted images (55 × 22 mm in the Couinaud''s segment 4 of the liver). However, 1 month after the appearance of the symptom, serum level of CA19-9 suddenly decreased to 37 U/mL. The tumor decreased spontaneously to 20 × 10 mm. Seven months later, the tumor had reduced to 18 × 11 mm. With a diagnosis of IPT, the patient remains well without regrowth of the tumor at 1 year follow-up after CA19-9 decrease to normal limits.     

电视胸腔镜手术在肺硬化性血管瘤诊断和治疗中的应用

目的探讨电视胸腔镜手术在以孤立性肺结节（solitary pulmonary nodule,SPN）为表现的肺硬化性血管瘤（pulmonary sclerosing hemangioma,PSH）诊断和治疗中的价值。方法回顾性分析1999年2月-2008年10月,11例术前经胸片、胸部CT发现的周围型SPN（咳嗽2例,咳血1例,胸痛1例,无症状7例）,术后病理确诊为肺硬化性血管瘤的临床资料。全胸腔镜或胸腔镜辅助小切口肺楔形切除7例,肺段切除3例,肿瘤切除术1例。结果 11例均成功完成电视胸腔镜手术（video-assisted thoracoscopic surgery,VATS）。术中快速冰冻病理示PSH7例,2例肺良性病变,2例恶性肿瘤待排除;术后病理确诊为PSH。平均手术时间57 min（45-70 min）,平均出血量85 ml（50-120 ml）;术后无并发症和手术死亡。11例术后随访22-63个月,平均31个月,无复发。结论 PSH术前诊断困难,电视胸腔镜不仅是PSH的诊断手段,也是目前最有效的治疗方法。