Xanthogranulomatous gastritis: association with xanthogranulomatous cholecystitis.

A case of xanthogranulomatous inflammation of the gastric wall is reported. The lesion was associated with adherent xanthogranulomatous cholecystitis and simulated, clinically, a malignant neoplasm. Histologically, foamy histiocytes, multi-nucleated giant cells, other inflammatory cells, fibrous reaction with spindle cells and cholesterol clefts were found.     

A case of multiple gastric carcinoids that could not be preoperatively diagnosed.

Here, we report the case of patient with multiple gastric carcinoids showing histopathological behavior similar to that of type I carcinoid tumors of the stomach. The patient was a 61-year-old man diagnosed as having a gastric tumor, which was revealed by follow-up computed tomography. Upper gastrointestinal endoscopy revealed a protruded tumor in the greater curvature and a small polyp in the anterior wall of the upper stomach. A biopsy revealed gastric carcinoid. Because he refused to be operated for gastric carcinoid, upper gastrointestinal endoscopy was performed 5 months later. A malignant transformation of the gastric carcinoid was strongly suspected. Therefore, the patient was admitted for operation. Laboratory findings were normal. With the diagnosis of type III gastric carcinoid, total gastrectomy was performed. Microscopic examination revealed that the carcinoid tumor was confined to the submucosa and that the small polyp mentioned earlier was also a carcinoid. Microcarcinoids and numerous enterochromaffin-like cell hyperplasias were observed along the muscularis propria of the fundus. The tumor differed from typical type I gastric carcinoids in several ways. Immunohistochemical staining for chromogranin A, synaptophysin, and cytokeratin was positive. However, p53 was absent, and the MIB-1 index was low. Two years after surgery, the patient is alive without recurrence.     

Simultaneous xanthogranulomatous cholecystitis and primary adenocarcinoma of gallbladder

We describe the clinicopathological features of xanthogranulomatous cholecystitis and adenocarcinoma arising in the same gallbladder, a circumstance only briefly alluded to in the existing literature.     

A rare case of xanthogranulomatous pyelonepheritis with hepatic angiomyolipoma

Xantogranulomatous pyelonephritis (XGP) is a rare and chronic variant of pyelonephritis typically associated with obstruction and infection. Xantogranulomatous pyelonephritis can infiltrate liver and connect with hepatic dysfunction. Here we report on a 52-year-old female with a liver mass and a left renal mass detected by uitrasonography and magnetic resonance imaging. Right lobectomy and partial nephrectomy were successively performed. Subsequent pathologic examination indicated hepatic angiomyolipoma and xanthogranulomatous pyelonepheritis, respectively. To the best of our knowledge, this is the first case of such rare combination.     

Infectious etiology of xanthogranulomatous cholecystitis: immunohistochemical identification of bacterial antigens in the xanthogranulomatous lesions

The clinicopathologic features of 31 surgical patients with xanthogranulomatous cholecystitis were analysed in relation to the immunohistochemical demonstration of bacterial antigens using a polyclonal anti-E. coli antibody. The time period after the initial clinical manifestation was critical for identifying the bacterial antigens in the cytoplasm of foamy macrophages. Of 12 lesions removed within 4 weeks of the onset (subacute group), 7 lesions showed positive staining. No positivity was seen in 19 gall-bladder specimens with a clinical course of more than 4 weeks (chronic group). Abscess formation was seen in 7 cases in the subacute group, 5 of which were positive for the bacterial antigens. Gram-negative bacteria were cultured from the bile in four in the subacute group and three in the chronic group. All the four culture-positive subacute lesions were immunoreactive for the bacterial antigens. Accumulation of ceroid pigment in the cytoplasm of foamy macrophages was characteristically seen in 16 of 20 chronic lesions. Three subacute lesions with ceroid pigmentation was negative for the bacterial antigens. In conclusion, xanthogranulomatous cholecystitis can be divided into two forms: subacute and chronic, and the subacute form is closely related to bacterial infection.     

Hepatic splenosis preoperatively diagnosed as hepatocellular carcinoma in a patient with chronic hepatitis B: a case report

We report on a case of hepatic splenosis. A 32-yr-old man underwent a splenectomy due to trauma at the age of 6. He had been diagnosed as being a chronic hepatitis B-virus carrier 16 yr prior to the surgery. The dynamic computer tomography (CT) performed due to elevated serum alpha-fetoprotein (128 ng/mL) demonstrated two hepatic nodules, which were located near the liver capsule. A nodule in Segment IVa had a slight enhancement during both the arterial and portal phases, and another nodule in Segment VI showed a slight enhancement only in the portal phases. Dynamic magnetic resonance imaging (MRI) of the mass in Segment VI showed enhanced development in the arterial phases and slight hyperintensivity to the liver parenchyma in the portal phases. These imaging findings suggested a hypervascular tumor in the liver, which could be either focal nodular hyperplasia, adenoma, or hepatocellular carcinoma (HCC). Even though these lesions were diagnosed as HCC, some of the findings were not compatible with typical HCC. On dynamic CT and MRI, all lesions showed a slight arterial enhancement and did not show early venous washout. All lesions were located near the liver capsule. These findings, along with a history of splenectomy, suggested a diagnosis of hepatic splenosis.     

正常兔胆道系统常规超声及超声造影表现

背景：应用实验动物模型可深入探讨超声及超声造影在缺血型胆道病变诊治方面的作用。但尚未见适用于各种肝胆疾病兔模型的超声造影研究的时相划分标准。 目的：探讨正常兔胆道系统常规超声、超声造影表现及兔肝脏超声造影时相划分标准。 方法：对10只正常新西兰兔行肝胆系统常规超声检查,并对常规超声可显示的胆管壁行超声造影检查,总结其特点。 结果与结论：①门脉管径/胆管管径为3.59±0.54。②常规超声及超声造影上胆总管及中叶胆管的显示率显著高于外叶胆管,胆总管-中叶胆管是兔首选的超声观察目标。③正常兔肝脏超声造影时相兔肝脏增强时相划分与人类不同,可划分为动脉期(10-20 s)、门脉期(21-30 s)及延迟期(31-180 s)。正常胆管壁动脉期呈高增强,门脉期及延迟期呈等增强。上述正常参数的建立,为进一步研究超声造影在兔胆道缺血诊治方面的作用奠定基础,亦可推广应用至兔的其他肝胆疾病模型。     

Chronic cholecystitis with bone metaplasia. A case report

Bone metaplasia is a rare phenomenon in the gastrointestinal tract. We present a case of a 58-year-old man who underwent laparoscopic cholecystectomy for symptoms of chronic cholecystitis. Histologic examination of the removed gallbladder revealed intramural bone metaplasia in association with chronic cholecystitis. To the best of our knowledge, such a case has not yet been reported. The clinical significance of this finding remains to be elucidated.     

Comparison of contrast-enhanced ultrasonography with grey-scale ultrasonography and contrast-enhanced computed tomography in diagnosing focal fatty liver infiltrations and focal fatty sparing

PurposeFatty liver infiltrations and fatty sparing impair diagnostic performance of grey-scale ultrasonography in differentiating malignant and benign focal liver lesions.In the study, we present our experience in diagnosing focal fatty liver infiltrations and focal fatty sparing with contrast-enhanced ultrasonography (CEUS) in comparison to grey-scale ultrasonography and contrast-enhanced computed tomography (CECT).Material and MethodThe retrospective study group (n=82 patients), included 44 (53.7%) men, 38 (46.3%) women (aged 29–81 years, mean 55.8 years) with 48 focal fatty liver infiltrations and 34 focal fatty sparing. All patients underwent grey-scale ultrasonography (US), CEUS using SonoVue^® and CECT executed within the 7 days.ResultsWith US, CEUS and CECT focal fatty liver infiltrations were diagnosed in 22, 46 and 44 cases, respectively. The following values were obtained: sensitivity ? 45.8%, 95.8% and 91.7%, specificity ? 100% for all, accuracy ? 95.2%, 99.6% and 99.3%, respectively. Focal fatty sparing was diagnosed in 16, 31 and 30 cases, respectively. The following values were obtained: sensitivity ? 47.1%, 91.2% and 88.2%, specificity ? 99.8%, 100% and 100%, accuracy ? 95.6%, 99.4% and 99.3%, respectively. No statistically significant differences were found in sensitivity of diagnosing focal fatty liver infiltrations and focal fatty liver sparing between CEUS and CECT. Sensitivity of grey-scale ultrasonography was significantly lower when compared to those of CEUS and CECT (p<0.001).ConclusionCEUS is as sensitive as CECT in focal fatty infiltrations and focal fatty sparing diagnosing. However, CEUS provides more information than CECT about the vasculature and enhancement pattern of focal fatty liver infiltrations.     

Involvement of Escherichia coli in pathogenesis of xanthogranulomatous cholecystitis with scavenger receptor class A and CXCL16-CXCR6 interaction

Xanthogranulomatous cholecystitis (XGC) is characterized by the infiltration of numerous foamy macrophages. Bacterial infection is thought to be involved in the pathogenesis of XGC. Using XGC and cultured murine biliary epithelial cells (BEC), the participation of E. coli and the role of the scavenger receptor class A (SCARA), as well as chemokine(C-X-C motif) ligand 16 (CXCL16) and its receptor chemokine(C-X-C motif) receptor 6 (CXCR6), were examined in the pathogenesis of XGC. E. coli components and genes were detected in XGC on immunohistochemistry and polymerase chain reaction (PCR), respectively. SCARA-recognizing E. coli was found in foamy macrophages aggregated in xanthogranulomatous lesions. CXCL16, which functions as a membrane-bound molecule and soluble chemokine to induce adhesion and migration of CXCR6(+) cells, was detected on gallbladder epithelia, and CXCR6(+)/CD8(+) T cells and CXCR6(+)/CD68(+) macrophages were also accumulated. In cultured BEC, CXCL16 mRNA and secreted soluble CXCL16 were constantly detected and upregulated by treatment with E. coli and lipopolysaccharide through Toll-like receptor 4. These suggest that SCARA in macrophages is involved in the phagocytosis of E. coli followed by foamy changes and that bacterial infection causes the upregulation of CXCL16 in gallbladder epithelia, leading to the chemoattraction of macrophages via CXCL16-CXCR6 interaction and formation of the characteristic histology of XGC.     

肝移植术后肝癌复发的超声造影与CT诊断比较

目的探讨超声造影（CEUS）对肝移植术后肝癌复发的诊断价值。方法对肝癌病人肝移植术后常规彩色超声随访发现肝内占位性病变23例，先行超声造影检查，3d内行螺旋CT增强扫描，分别与病理结果比较。结果23例病人经过穿刺活检病理确诊20例，行再次肝移植术经病理确诊3例，CEUS确诊18例，疑诊4例，误诊1例；CT确诊20例，疑诊2例，误诊1例。结论CEUS与CT对原位肝移植术后肝癌复发的诊断均很敏感且价值很高，尤其对不典型病灶的诊断，CT与CEUS结合能提高诊断率。     

Fetal choledochal cyst diagnosed at 22 weeks of gestation by three-dimensional ultrasonography: a case report

Choledochal cyst is a cystic or fusiform dilatation of the extra- or intrahepatic bile duct that has rarely been reported in prenatal cases. Here we report a fetus with choledochal cyst diagnosed prenatally by three-dimensional (3-D) ultrasonography at 22 weeks of gestation. We demonstrated an image of choledochal cyst by using a new ultrasound technique, a 3-D multislice view. After close intrauterine followup, surgery was successfully performed and postoperative course was uneventful.     

超声造影在甲状腺结节诊断中的应用价值简

甲状腺结节在临床上检出率逐渐升高,超声检查作为甲状腺结节的首选影像学方法,有时并不能完全区别其良恶性,超声造影在甲状腺结节良恶性鉴别方面有一定的价值,文章就超声造影在甲状腺结节中的不同表现,即甲状腺结节增强模式、甲状腺结节在造影前后大小变化情况、时间强度曲线分析结果、甲状腺结节超声造影与微血管密度的关系、超声造影引导下甲状腺结节的细针穿刺．超声造影在甲状腺结节射频消融中的作用作一综述。     

A case of hemorrhagic gallbladder paraganglioma causing acute cholecystitis.

Gallbladder paraganglioma is a very rare tumor and so far only a few cases have been reported. Most of these were asymptomatic and were found incidentally during operation. Recently, we experienced a gallbladder paraganglioma that gave rise to hemorrhage, which in turn caused acute cholecystitis. Our case involved a 45 year-old female patient complaining of an intermittent right upper abdominal pain. After a preoperative evaluation, cholecystectomy and lymphadenectomy were performed under the impression of gallbladder cancer with acute cholecystitis. Postoperative pathologic examination revealed a hemorrhagic gallbladder paraganglioma accompanied by acute cholecystitis. Immunohistochemical staining of the chief cells for neuron specific enolase, chromogranin and synaptophysin were positive. Sustentacular cells also stained positively for S100 protein.     

A case of Crimean Congo hemorrhagic fever complicated with acalculous cholecystitis and intraabdominal abscess

Crimean Congo hemorrhagic fever is a fatal systemic viral infection which is an important health problem in Turkey. Since it leads to diffuse endothelial damage, many complications can be seen during the course of the disease. We report here an atypical presentation of CCHF with acute acalculous cholecystitis and intraabdominal abscess.     

A case of myeloid sarcoma diagnosed by FISH

Myeloid sarcoma (MS) is a tumor mass of myeloblasts or immature myeloid cells occurring in an extramedullary site or in bone. The tumor mass may precede or occur concurrently with acute or chronic myeloid leukemia or with other types of myeloproliferative disorders or myelodysplastic syndromes. MS is a rare disease, estimated to comprise between 2 to approximately 14% of acute myeloid leukemia. On the other hand, 95% of cases of CML have characteristic t (9;22) cytogenetic abnormality and BCR/ABL fusion gene at diagnosis. We here report the clinical significance of FISH in a diagnosis of MS that formed tumor in femur during the chronic phase of CML.