Hepatic Bruits in Malignant Liver Tumors

There have been few reports concerning hepatic bruits in malignant liver tumors, especially in those other than hepatocellular carcinoma. Lately we noticed hepatic bruits in several cases of malignant liver tumors. The murmurs were confirmed by sound recordings. In cases of hepatocellular carcinoma the murmurs were continuous or continuous with late systolic accentuation. In a case of cholangiocarcinoma of the liver the murmur was continuous with late systolic accentuation and in a case of metastatic liver carcinoma it was systolic. These murmurs were considered to be caused by various mechanisms and some of them are discussed in this paper. Hepatic bruits would be a useful aid in diagnosing hepatic tumors.     

Desmoplastic Fibroma of the Pediatric Cranium: An Aggressive Skull Tumor with Local Recurrence

Cranial desmoplastic fibroma (DF) is extremely rare and only 20 cases, including only 7 pediatric cases, have been reported previously. We describe the first case of a child with cranial DF that increased in size over a short-term and recurred after resection. The aim of this case report was to discuss the clinical, radiological, and histological characteristics and optimal treatment for this rare and aggressive skull tumor.     

Colony-Stimulating Factor Producing Carcinoma of the Gallbladder

A patient with an anaplastic carcinoma of the gallbladder accompaniedby marked neutrophilia was found to have high colony-stimulatingfactor (CSF) activity in the urine and serum. The supernatantof the cultured tumor cells (6th passage) showed high and specificCSF activity. These specimens induced the formation of granulocytecolonies, macrophage colonies or granulocyte macrophage mixedcolonies by both human and C57BL mouse bone marrow cells insoft agar. These results suggest that this tumor is a human granulocyte-macrophage(GM)-CSF producing tumor.     

Clinical characteristics of acute respiratory deterioration in pulmonary fibrosis associated with lung cancer following anti-cancer therapy

Background and objective: To clarify the clinical characteristics and risk factors for acute respiratory deterioration following anti‐cancer therapy in patients with pulmonary fibrosis (PF) and lung cancer. Methods: Patients with primary lung cancer and PF were identified by review of medical records. Of the 865 consecutive patients with primary lung cancer who had been treated between June 1999 and September 2007, 53 were diagnosed as having PF. This retrospective study analysed the prevalence of and risk factors for acute respiratory deterioration after treatment of lung cancer in these patients. Results: Acute respiratory deterioration was found in 10 (24%) of the 41 patients who received anti‐cancer therapy, and six (60%) of these patients died of respiratory failure. The incidence of acute respiratory deterioration was 28% (8/29) after chemotherapy and 16% (2/12) after surgery. Mortality after acute respiratory deterioration was 50% (4/8) among patients with idiopathic PF and 100% (2/2) among the patients with PF associated with rheumatoid arthritis. Logistic regression analysis revealed that a higher smoking index (cigarettes smoked per day × years of smoking) was a significant risk factor for acute respiratory deterioration (odds ratio: 1.002, P = 0.025). Conclusions: Patients with lung cancer who have pre‐existing PF should be carefully managed because of their high risk for developing acute respiratory deterioration after anti‐cancer therapy.     

Impact of aging on penile hemodynamics in men responding normally to prostaglandin injection: A power Doppler study

AIM: Hemodynamic changes with aging in the penile arterial circulation, including the helicine arteries, were evaluated with power Doppler imaging in erectile dysfunction patients with a normal response to prostaglandin injection. METHODS: In 36 patients with erectile dysfunction and no definite vascular risk factors, 72 corpora were examined using power Doppler imaging. Patients were classified by age: younger than 40 years, from 40 to 49, or 50 and older. Hemodynamic variables in the cavernous arteries, helicine arteries and dorsal arteries were measured after intracavernous injection of prostaglandin E1 (20 microg). RESULTS: All cavernous arteries had a maximum peak systolic velocity of greater than 35 cm/s and a minimum end-diastolic velocity of less than 0 cm/s. Mean peak systolic velocity in the cavernous artery differed between groups (P = 0.016), especially between the younger than 40 age group and the 40-49 age group. Peak systolic velocity correlated negatively with age (P = 0.0048). In the helicine arteries and dorsal arteries, peak systolic velocity did not differ between groups and showed no correlation with age. End-diastolic velocity, resistance index and acceleration time did not differ between groups, or correlate with age for any artery. CONCLUSIONS: Hemodynamic change with aging occurs predominantly in the cavernous arteries, where peak systolic velocity decreases. The arterial circulation beyond the cavernous arteries, including the helicine arteries, as well as veno-occlusive mechanisms, may have an important role in maintaining erectile function in aging.     

Imaging diagnosis and interventional radiology in systemic vasculitis with particular emphasis on Takayasu arteritis: Part 1

This is a review article describing some new and interesting aspects in the diagnosis and treatment in systemic vaseulitis and demonstrating several cases that we have encountered. Particular emphasis will be put on Takayasu arteritis(also known as aortitis syndrome) most commonly observed in Japan and other oriental countries. CT and MRI better demonstrate the vessel wall abnormality of Takayasu arteritis than angiography. Importance of plain chest radiograph should also be kept in mind;it could provide a clue in the diagnosis of Takayasu arteritis in its early stage.     

Intestinal-type mucinous adenocarcinoma arising from the prostatic duct

We present a case of mucinous adenocarcinoma of intestinal type arising from the prostatic duct in a 72-year-old Japanese man. The patient presented with macroscopic hematuria. Cystourethroscopy exhibited a mucus deposit at the 5 o'clock position of the verumontanum portion. A transurethral biopsy specimen revealed mucinous adenocarcinoma. A radical retropubic prostatectomy was performed. In the prostatectomy specimen, the cancer lesion mainly showed intraductal growth in the prostatic ducts with scattered mucin lakes in the prostatic stroma. There were no abnormalities in the urethral epithelium. The cancer cells resembled the intestinal epithelium rather than either the prostatic duct or the acinar epithelium, which showed diffusely positive immunohistochemical staining for carcinoembryonic antigen, but showed negative staining for prostate-specific antigen. Therefore, these findings suggest mucinous adenocarcinoma of intestinal type arising from the prostatic duct. A number of cases with mucinous adenocarcinoma arising from the prostatic urethra resembling the present case have been reported, but this is the first known case of carcinoma arising from the prostatic duct.     

Erythropoietin-producing renal cell carcinoma in chronic hemodialysis patients: A report of two cases

Erythropoietin (EPO)-producing renal cell carcinomas in two hemodialysis patients are reported. Despite deteriorated kidney function, these patients did not manifest anemia at diagnosis and their elevated serum EPO levels rapidly returned to within the normal range after nephrectomy. Immunohistochemical staining of the resected specimens showed production of erythropoietin in the tumor cells in one case and in the lining cells of the cyst wall in the other case. Renal cell carcinoma could cause an increase of blood hematocrit level in dialysis patients.