Small hepatocellular carcinoma with ring calcification:A case report and literature review

Ring calcification in untreated hepatocellular carcinoma(HCC) is extremely rare,with only 3 previously reported cases in the English-language literature.A case of HCC with ring calcification was reported in this paper.Additionally,3 previously reported cases of HCC with ring calcification were reviewed.In 3 of these 4 cases(including our case),surgery was performed.Although the size of the ring-calcified lesion ranged from 3.0-3.7 cm in previously reported cases,the size was only 1 cm in ours.The differentiation of the tumor was moderate in the 2 previously reported cases in the histological findings and poor in ours.In spite of their poor differentiation for their sizes,these tumors showed no early enhancement in dynamic computed tomography.All calcified tumors showed a thick fibrous capsule and extensive necrosis histologically.Ring calcification was considered to result from a circulatory disturbance caused by the imbalance between the less abundant arterial blood flow and high inner pressure induced by either the thick fibrous capsule or vigorous proliferation due to the poor differentiation.Ring calcification in untreated HCC may suggest a lower differentiation of the tumor.Even if its size is small,hepatic resection should be performed for any tumor with ring calcification because poor differentiation is considered to be one of the risk factors for recurrence after local ablation therapy,including radio frequency ablation.     

Heterotopic gastric mucosa together with intestinal metaplasia and moderate dysplasia in the gall bladder: report of two clinically unusual cases with literature review

We report the clinicopathological findings of two patients with ectopic gastric mucosa within the gall ladder. The first patient, a 78 year old man, was asymptomatic. He was admitted to hospital for a colon adenocarcinoma. Intraoperatively, a firm nodule was palpable in the gall bladder. Histological examination of the resected specimen revealed a body type gastric mucosa in the submucosa, adjacent to which were extensive pyloric gland and intestinal metaplasia with mild to moderate dysplasia. The remaining gall bladder mucosa demonstrated changes of chronic cholecystitis. The second patient was a 62 year old woman with symptoms of chronic cholecystitis. The preoperative diagnosis was consistent with this diagnosis with a "polyp" at the junction of the neck and cystic duct. Cholecystectomy was performed and the histological examination of the resected specimen showed that the "polyp" consisted of heterotopic gastric mucosa with glands of body and fundus type. In the remaining mucosa, chronic cholecystitis was evident. To the best of our knowledge, this is the first report of a clinicopathological presentation of heterotopic gastric mucosa, pyloric gland type, and intestinal metaplasia with dysplastic changes in the gall bladder. As heterotopic tissue may promote carcinogenesis of the gall bladder, close attention should be paid to any occurrence of such lesions in this anatomical region.     

弥漫性肺动静脉瘘2例报道及文献复习

目的 探讨弥漫性肺动静脉瘘（PAVFs）的临床表现、诊断和治疗方法.方法 回顾性分析2例弥漫性PAVFs的病例资料,并结合国内外相关报道进行文献复习.结果 2例弥漫性PAVFs患者临床均表现为劳累性呼吸困难、紫绀和杵状指/趾等三联征.例1为女性,基础疾病为遗传性毛细血管扩张症,临床表现为反复鼻衄及面部毛细血管扩张等.例2为男性,基础疾病为肝硬化,临床表现为肝肺综合征.2例患者超声心动图均未见明显异常,超声心动图声学造影左心房显影.胸部CT显示双肺血管影增粗,胸膜下多发小结节影和磨玻璃影.肺动脉造影显示肺循环时间缩短,例2患者左下叶背段动脉分支与肺静脉直接连通,经导管行栓塞术,术后氧合无明显改善.随访5年,例1病情平稳,例2死于肝硬化,二者均无脑部并发症.结论 弥漫性PAVFs临床罕见,常表现为劳累性呼吸困难、紫绀和杵状指/趾等三联征.肺动脉造影和超声心动图声学造影有助于早期诊断.     

Severe intestinal involvement in Wegener's granulomatosis: report of two cases and review of the literature

The clinical and pathological manifestations of severe intestinal involvement in Wegener's granulomatosis were studied by a review of the literature and reports of two patients. Altogether, six cases, two females and four males, were studied. One patient developed two episodes of bowel manifestations necessitating immediate surgical interventions. The average age at onset of intestinal symptoms was 43.3 yr (26-55 yr) and, in all cases, the first signs of such manifestations developed within the first 2 yr of disease. Prior to the onset of intestinal symptoms, immunosuppressive therapy was administered in six of seven instances. Acute abdominal pain with signs of peritonitis or distention only constituted the main clinical picture in six of the seven events. The last episode was manifested clinically with profuse diarrhoea with blood and mucus. Of the seven instances of severe intestinal manifestations, the small bowel was involved in two, the large bowel in three, and both the small and large bowel were affected in two episodes. Histological evidence of vasculitis in the bowel was demonstrated in three of the seven biopsy specimens, while in four, ischaemia, inflammation and ulceration were the pathological findings. Intestinal perforation was seen four times and surgery was performed in six of seven episodes. Severe intestinal involvement is rare in Wegener's granulomatosis. The initial bowel manifestations occur within the first 2 yr of disease, and affect both the large and small bowel. Histologically, vasculitis, ischaemia, inflammation and ulceration are the prevailing findings. Death due to intestinal catastrophy occurred in one of the six patients reported. Most likely, the manifestations are associated with the disease process rather than related to the use of immunosuppressive agents.      

Primary intestinal T lymphoma: a report of two cases and a review of the literature

Lymphomas of the gastrointestinal tract are the most common type of primary extranodal lymphomas and about 15-20% of these are primary intestinal lymphomas. They may be or B or T- cell. Intestinal T-cell lymphomas are much less common and they can be enteropathy-associated. This disease occurs in adults with abdominal pain often associated with intestinal perforation. The course is aggressive. The major problem is to distinguish this disease from a benign ulcer. Two cases with differents clinical and pathologic features are reported with a review in the literature of this uncommon entity.     

Paraquat poisoning: report of two cases and literature review

Cases of poisoning with pesticides, especially suicidal ones, continue to be an important therapeutic problem. The heribicide paraquat (1.1' dimethyl-4.4' bipyridylium dichloride) is the second cause of pesticide poisoning in our country, which is associated with a high mortality rate. We report two cases of suicidal ingestion of paraquat who developed multiorgan failure with a lethal outcome. We also present a brief review of the literature, mainly focused on the different therapeutic options.     

Bladder leiomyoma: report of two cases and literature review

Mesenchymal tumors of the urinary bladder are rare and the majority of them are malignant. We report two cases of leiomyoma of the urinary bladder presenting with symptoms of bladder outlet obstruction. The first patient was managed with staged transurethral resections, and the second with holmium laser transurethral inoculation. The outcome was excellent in both cases. A review of the literature is also outlined.     

Retrocaval ureter: report of two cases and literature review

Retrocaval ureter is a rare congenital anomaly in which the ureter passes behind, and is compressed by, the inferior vena cava. Its etiology is assumed to be abnormal embryologic development of the inferior vena cava as a result of atrophy failure of the right subcardinal vein in the lumbar portion. We report two cases of retrocaval ureter and review the relevant literature. One patient was a 7-year-old boy who presented with right flank pain. The other was a 40-year-old male who was found to have right hydronephrosis accidentally on abdominal sonography during a health examination. Both underwent retrograde pyelography which showed the typical S-shape of a retrocaval ureter. Abdominal computerized tomography and magnetic resonance imaging confirmed the diagnosis of retrocaval ureter. Ureteroureterostomies were performed. One patient showed focal squamous metaplasia of the ureter and the other had chronic inflammation and fibrosis. Follow-up studies showed improvement in hydronephrosis and renal function in both patients. We conclude that retrocaval ureter is a rare disorder and surgical correction is usually effective.     

Autoimmune pancreatitis:report of two cases and literature review

BACKGROUND:Autoimmune pancreatitis(AIP)is a unique chronic inflammation of the pancreas in which autoimmune mechanisms are involved in the pathogenesis.It is characterized by clinical,histopathological,radiographic,serologic and therapeutic features.Since it was first described in 1995,increasing numbers of AIP patients have been diagnosed.METHODS:In this study,the data from 2 patients with AIP who had elevation of serum immunoglobulin G,positive autoantibody,swelling of the pancreas and narrowing of the ma...     

甲状旁腺癌(附二例报告及文献复习)

甲状旁腺癌(Parathyroid carcinoma，PTC)发病率相对较低，占原发性甲状旁腺功能亢进症(PHPT)的0．1％～5％^[1,3]，国内文献已报道56例．本院在收治的33例PHPT中有2例PTC。现报道如下，并结合文献进行讨论。     

成人气管性支气管2例报告并文献复习

目的 提高对成人气管性支气管疾病的认识和诊断水平.方法 对2例成人气管性支气管的临床资料进行回顾性分析,分析其临床特征及电子支气管镜检查在诊断和治疗方面的作用.结果 该2例患者因肺部占位性病变行电子支气管镜检查,发现伴有气管性支气管,予电子支气管镜下活检占位组织后,气管性支气管未予处理.结论 气管性支气管是少见的气道先天发育异常,目前国内成人报告病例极少,随着介入肺脏病学及医学影像学的发展,其检出率日益增多,若无临床症状可不予特殊处理.     

Adult Kawasaki disease: report of two cases and literature review

OBJECTIVES: To describe 2 cases of adult Kawasaki Disease (KD) and to review the medical literature to better define the epidemiological, clinical, laboratory, histopathological, cardiovascular, and therapeutic aspects of adult KD compared with pediatric KD. METHODS: Report of 2 cases, and review of the literature using a Medline search from 1967 to June 2003. RESULTS: Including our 2 cases, there are 57 reports of adult KD, 74% among patients aged 18 to 30 years. Nine cases of KD associated with human immunodeficiency virus (HIV) infection were described, suggesting that an immunocompromised state may predispose to this syndrome. The incidence of specific diagnostic criteria was roughly similar in adults and in children. However, cheilitis, meningitis, and thrombocytosis were observed in a larger percentage of children, while arthralgia, adenopathy, and liver function abnormality were more common in adults. Although adult KD often was diagnosed after the acute phase, when a significant beneficial effect from gammaglobulin infusion could not be expected, this treatment did appear to shorten the course of the disease. Coronary aneurysms were less frequent in adults than in children. Prognosis was more favorable in adults, with less cardiovascular complications and no deaths. CONCLUSIONS: Adult KD is a rare condition, which may go unrecognized. Other known disease processes with similar clinical presentations such as hypersensitivity drug reaction and toxic shock syndrome must be ruled out. For adult KD, exclusion criteria such as absence of hypotension, visceral impairment, staphylococcal infection, and any drug able to induce a drug hypersensitivity reaction are suggestive of the diagnosis, in the presence of the inclusion criteria, rash, conjunctival effusion, oropharynx changes, extremity changes, or adenopathy.     

Austrian syndrome: report of two new cases and literature review

In April 2004, Rammeloo et al. reported a child-aortic-valve endocarditis following pneumococcal meningitis. Classically, the association of pneumococcal pneumonia along with meningitis and infectious endocarditis (IE) is known as Austrian syndrome. We assessed the incidence, clinical manifestations and follow-up of patients diagnosed with Austrian syndrome in Lugo (Northwest Spain) between 1987 and 2002. A computerized MEDLINE search was also performed for literature review. During the study period 165 Lugo patients met criteria for definite IE. Two of the 3 patients with definite streptococcus pneumoniae IE also met definitions for Austrian syndrome. The incidence of this syndrome in Lugo patients with definite IE was 1.2%. In the literature review 48 cases, including our two patients, were found. Complete clinical information was only available on 16 patients. Alcoholism constituted the most common predisposing factor. Aortic valve involvement and high grade of valve regurgitation leading to cardiac failure and the need of cardiac surgery during the admission were common in these patients. This review confirms that Austrian syndrome is a rare but severe disease. Early recognition of these patients is required to avoid ominous complications.     

Lymphoepithelioma-like gastric carcinoma: A case report and review of the literature

Lymphoepithelioma-like gastric carcinoma is a rare type of gastric cancer characterized by a carcinoma with intense stromal lymphocytic infiltration. Although lymphocytic infiltration is closely associated with EpsteinBarr virus(EBV) infection, concomitant occurrence with differentiated adenocarcinoma is relatively rare. The clinical manifestations of lymphoepithelioma-like gastric carcinoma(including EBV-positive and-negative forms) are similar to those of gastric cancer, and the diagnosis is based on pathologic, histologic, and immunohistochemical findings. This report describes the case of a 55-year-old female patient who presented with a 10-year history of recurrent and worsening abdominal pain and melena that had been occurring for 2 mo. An ulcerative lesion was detected in the stomach by endoscopic examination, which raised suspicion of early gastric cancer. A subsequent preoperative endoscopic biopsy showed adenocarcinoma, but the postoperative pathologic, histologic, and immunohistochemical analyses of the resected specimen revealed a final diagnosis of lymphoepithelioma-like gastric carcinoma.     

支气管肺蠊缨滴虫感染二例并文献复习

目的 提高对支气管肺蠊缨滴虫病的认识与诊断水平.方法 分析武警部队上海总队医院呼吸内科确诊的2例支气管肺蠊缨滴虫病的临床资料,结合1993-2006年文献报道的13例共15例进行文献复习.结果 (1)2例患者中,1例表现为重症哮喘,反复夜间发作咳嗽、胸闷、气喘,肺部听诊可闻及哮鸣音,支气管镜检查提示右上叶支气管狭窄、黏膜充血水肿;1例表现为支气管扩张伴感染迁延不愈,患者反复咳嗽、咳痰伴低热,胸部X线片、CT示双肺多个叶段支气管扩张伴感染,支气管镜检查提示支气管黏膜充血水肿,管腔狭窄,支气管管腔内可见白色坏死样物.2例均经支气管镜检查采集标本检验后明确诊断.(2)文献报道的13例均经病原学检查并由寄生虫病专家鉴定,诊断依据确凿.支气管肺蠊缨滴虫病最常见的症状是发热(64.3%)和咳嗽、咳痰(71.4%),半数患者外周血嗜酸性粒细胞数增多,X线胸片及胸部CT影像以肺炎样改变多见(占摄片数83.3%),慢性患者可表现为支气管哮喘、支气管扩张、肺脓肿等.痰液和经支气管镜检查采集标本,直接涂片检查是明确病原的方法.结论 支气管肺蠊缨滴虫病为新发感染性疾病,感染人体的蠊缨滴虫的宿主、传播途径、易感人群等尚不清楚,治疗亦需进一步研究.     

Cerebral thrombophlebitis revealing hyperthyroidism: two cases report and literature review

INTRODUCTION: Two cases of hyperthyroidism revealed by a cerebral venous thrombosis are reported. EXEGESIS: Clinical symptomatology consisted of intra-cranial hypertension and convulsive crisis associated to thyrotoxicosis. Evolution was favorable with etiologic and symptomatic therapy. CONCLUSION: The cerebral venous thrombosis risk on hyperthyroidism is discussed.     

Primary cardiac echinococcosis: report of two cases with review of the literature

Two case reports of Saudi patients with primary cardiac hydatid cysts are presented. In the first case, a multilocular cyst was located in the wall of the left ventricle, whereas in the second case a cyst was located in the pericardial sac and another cyst in the left ventricular wall. The diagnosis was based on a history of animal contact, full clinical examination, serological tests and the use of plain radiography, including conventional tomogram, two-dimensional echocardiography, computed tomography and thallium perfusion isotope scan. This study has indicated that non-invasive radiological methods are sufficient to diagnose cardiac echinococcosis and could provide the same information as, or even more than if invasive techniques were used. Further screening of the two patients showed no involvement of other organs by hydatid cysts.     

T-cell prolymphocytic leukemia: a report of two cases with review of literature

T-cell Prolymphocytic Leukemia (T-PLL) is a mature post-thymic T-cell malignancy with aggressive clinical course. The principal disease characteristics are organomegaly, skin lesions and raised lymphocyte counts. We report two cases of T-PLL. T-PLL is a rare T-cell malignancy with characteristic clinical and laboratory features and a poor prognosis. It needs to be differentiated from B-Cell prolymphocytic leukemia (B-PLL) and other mature T-cell lymphoproliferative disorders with predominant leukemic pattern. Differentiation can be made by a comprehensive approach taking into account the clinical features, the cell morphology and the immunophenotype of leukemic cells.     

Colonic carcinoma presenting as strangulated inguinal hernia: report of two cases and review of the literature

Inguinal hernia and colonic carcinoma are common surgical conditions, yet carcinoma of the colon occurring within an inguinal hernia sac is rare. Of 25 reported cases, only one was a perforated sigmoid colon carcinoma in an inguinal hernia. We report two cases of sigmoid colon carcinoma, one of which had locally perforated. Each presented within a strangulated inguinal hernia. Oncologically correct surgery in these patients presents a technical challenge.