Thorotrast-associated cholangiocarcinoma: an epidemiologic and clinicopathologic study

Six cases of Thorotrast-associated cholangiocarcinoma (TACC) are studied and compared with eight previously reported cases as well as with cases of non-TACC. TACC shares some epidemiologic features both with non-TACC as well as Thorotrast-associated angiosarcoma (TAAS) but appears to occur in younger patients than non-TACC. There is an apparent increased prevalence of both benign and malignant thyroid disease in the current group of patients with TACC; previous epidemiologic studies have not identified this phenomenon. Thorotrast-associated hepatic fibrosis was present in all 14 TACC cases; otherwise, both non-TACC and TACC are clinically and morphologically similar. Bile duct dysplasia and/or transition to adenocarcinoma, which occurred in all the AFIP cases, are seldom described in case reports of either TACC or non-TACC; in the current study they served to validate the intrahepatic origin of the tumors.     

Epidemiology of hepatocellular adenoma. The role of oral contraceptive use.

A case-control study of hepatocellular adenoma (HCA), a serious though nonmalignant liver tumor, was conducted by the Center for Disease Control and the Armed Forces Institute of Pathology (AFIP). Interviews with 79 women with HCA and with 220 age- and neighborhood-matched controls were completed. Limited information was obtained on nine additional patients who had died. Women with HCA and hemorrhage have a greater risk of morbidity and death than those with other symptoms. Increasing duration of OC use increases the risk of HCA. Use of OCs with high hormonal potency and age over 30 years may further increase a woman's risk of HCA. Long-term users of OCs have an estimated annual incidence of HCA of 3 to 4 per 100,000.     

Hepatic abscess complicating ulceroglandular tularemia

In a patient with the clinical features of classic ulceroglandular tularemia a solitary hepatic abscess was found during an ultrasound examination. Hepatic tularemia has rarely been reported since the advent of specific therapy, which prevents the disease from reaching the disseminated state. This case, however, shows that the liver can be involved early in the course of tularemia. Increased serum levels of hepatic enzymes may be the only sign of such a complication.     

Bile duct adenoma. A study of 152 cases

In order to determine the morphologic spectrum of bile duct adenoma (BDA), we reviewed the clinical, gross, and histopathological features of 152 cases. All BDA were asymptomatic nodules discovered incidentally during intra-abdominal surgery (103 cases) or at autopsy (49 cases). They were usually subcapsular, ranged in size from 1 to 20 mm (mean, 5.8 mm), and were well circumscribed but nonencapsulated. Histologically, BDA was composed of benign, noncystic ductules and variable degrees of inflammation and fibrosis. The immunophenotype of these ductules was similar to that of interlobular bile ducts. Follow-up of 38 of the surgically treated patients confirmed the benign behavior of this lesion. BDA should be distinguished from an adenocarcinoma by the absence, in the former, of nuclear hyperchromasia, mitotic activity, and vascular invasion. The absence of bile and cystic changes and lack of association with polycystic disease of the liver and kidneys are the main features distinguishing BDA from von Meyenburg complex. We believe that BDA is a reactive process to a focal injury rather than a true neoplasm or a developmental anomaly.     

Hepatic lesions caused by anabolic and contraceptive steroids

Many hepatic lesions, ranging from subcellular alterations to malignant tumors, have been attributed to the use of anabolic steroids (AS) and contraceptive steroids (CS). These lesions that have been attributed to AS and CS are discussed with focus on the following: biochemical changes; subcellular alterations; intrahepatic cholestasis; vascular complications (sinusoidal dilatation, peliosis hepatitis, Budd-Chiari syndrome); hyperplasia and neoplasia (diffuse hyperplasia, nodular transformation, focal nodular hyperplasia, hepatocellular adenoma, hepatocellular carcinoma, and miscellaneous malignant tumors); and miscellaneous effects (effects of preexisting liver disease, cholelithiasis, and pancreatitis). OCs have a number of physiologic effects on the liver. These include decreased bile flow, diminished secretion of organic anions, and decreased synthesis and secretion of bile acids. Retention of bromosulfophthalein has been noted with AS during late pregnancy and in the puerperium. It is well established that the CS can lead to elevations of serum ceruloplasmin and copper levels. Subcellular alterations have been reported in both humans and rats on AS or women on CS and involve multiple organelles of the several systems of the liver. Both AS and CS have been implicated in intrahepatic cholestasis. Jaundice usually develops after 2-5 months of therapy with AS or after 3 months of OC use. The lesions attributed to CS and AS can involve any of the systems of the liver. At times more than 1 system is affected simultaneously. Most of the steroid related lesions resemble similar ones caused by other etiologies. Some, such as peliosis hepatitis, are rarely related to other etiologies, but others can be termed steroid specific. A number of diseases associated with the CS or AS also occur in pregnancy. Acute fatty metamorphosis of pregnancy and the periportal hemorrhagic necrosis characteristic of eclampsia have not been reported in patients on CS. Spontaneous rupture of the liver during pregnancy has not been attributed to the CS.     

Fixation of greater tuberosity fractures: a biomechanical comparison of three techniques

The fixation of displaced greater tuberosity fractures with 5-0 Fiberwire, Fiberwire tape, and 5-0 Ethibond sutures was compared in 12 pairs of cadaveric humeri. A simulated fracture was created and fixed with suture in a figure-of-eight pattern. The tuberosity was cyclically loaded and its displacement measured. There was no statistical difference in fixation stability between the three suture types.     

Magnetic resonance imaging evaluation of the ulnar collateral ligament in young baseball pitchers less than 18 years of age

INTRODUCTION: It has been shown that the asymptomatic, dominant elbow of professional baseball pitchers can demonstrate magnetic resonance (MR) imaging signal abnormalities of the ulnar collateral ligament (UCL) consistent with a strain. The purpose of this study was to determine if younger, asymptomatic, adolescent baseball pitchers exhibit similar signal abnormalities in the UCL. METHODS: Magnetic resonance images of both elbows of 14 asymptomatic, young male baseball pitchers (ranging in age from 12 to 20 years) were performed on an outpatient basis using a 1.5-T Sigma MRI unit with a dedicated extremity coil to obtain T1 and T2 coronal and axial images which were subsequently evaluated by a musculoskeletal radiologist. Chronic tears of the UCL were suspected if the signal was attenuated or absent. Magnetic resonance images of the UCL were also evaluated for high-intensity signal or thinning. Morphologic changes such as complete tears, avulsions or thickening were identified. The images were classified into 4 grades from 0 to 3 depending on the degree of signal abnormality. RESULTS: No discrete tears were found in any of the subjects. For the dominant pitching arm, 4 of 14 subjects had increased thickness of the ulnar collateral ligament, 3 of 14 demonstrated Grade 1 changes, and 11 of 14 demonstrated no abnormal signal within the ligament. No focal tears were present in any of the subjects. Contralateral elbows in 13 of 14 patients demonstrated Grade 0 signals with 1 patient demonstrating morphological thickening of the ligament without increased signal. DISCUSSION: Signal abnormalities in the throwing elbow of asymptomatic, adolescent pitchers were uncommon. These pitchers may not have experienced sufficient pitching time to develop changes in the UCL.