Liver pathology associated with the use of anabolic-androgenic steroids

Abstract: This review examines the liver-damaging side effects of anabolic-androgenic steroids (AAS). It seems that AAS can cause development of peliosis hepatis, subcellular changes of hepatocytes, hepatocellular hyperplasia and hepatocellular adenomas. On the other hand, it has not been convincingly proved that AAS can cause development of hepatocellular carcinomas when used in the usual therapeutic doses. Tumours reported as hepatocellular carcinomas caused by AAS seem to be hyperplastic lesions of a benign nature able to regress with withdrawal of the putative agent. The effects of untraditional combinations and high-dose AAS are not yet known, leaving the possibility of a carcinogenic effect in those cases.     

Combined laparoscopic and endoscopic treatment of perforated gastroduodenal ulcer using the ligamentum teres hepatis (LTH)

We propose a novel technique for laparoscopic treatment of perforated gastroduodenal ulcers. The principle of this procedure involves the closure of the perforated ulcer using the ligamentum teres hepatis (LTH). The LTH is cut near its umbilical end and then dissected up to the site of its hepatic insertion. The umbilical extremity of LTH is grasped with a Dormia noose passed through the ulcerated perforation via a gastroscope. Using the noose, the LTH is pulled through the ulcerated perforation until its volume fits and completely closes the perforation. This laparoscopic technique was performed in 15 patients (12 M, 3 F) with anterior perforated duodenal ulcer revealed within the previous 6 h. The procedure could not be performed in three cases: diameter of the perforation exceeding 1.5 cm (n=1), general purulent peritonitis (n=2). In the other 12 cases, closure of the ulcerated perforation with the LTH was realized without technical difficulty. The postoperative course was uncomplicated. The posttreatment comfort was excellent; the mean period of hospitalization was 10 days (range, 8–14 days). An endoscopic examination carried out following 5 weeks of anti-H2 treatment showed that cicatrization of the ulcer was good and that no pyloric stenosis remained. These initial results suggest that laparoscopic treatment of perforated gastroduodenal ulcer using the LTH is a simple procedure which can be performed with general assurance of success in patients whose perforated ulcers have occurred quite recently. As the laparoscopic procedure is less aggressive than a laparotomy, it enhances the postoperative comfort of patients and prevents the risk of parietal complications. Compared to laparoscopic endosuture this procedure is simple, effective, easier, and particularly adapted to large ulcerated perforation or when an ulcer's edges are tough or friable, tending to tear when knots are tied.Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES), Nashville, TN, USA, 18–19 April 1994.     

Ramification of the portal vein at the porta hepatis in humans

The ramification of the portal vein at the porta hepatis was studied by anatomic dissection performed in 32 formalin fixed human livers. In all the specimens there were branches which ran towards the caudate lobe, arising from the portal vein and either from the left or the right portal branches. Tri-and quadrifurcation of the portal vein was observed. In 5 cases (16%) there were branches arising from left portal branch or portal vein and directed anteriorly to the quadrate lobe or to the region of the gall-bladder sulcus. These branches ranged from 1.0 to 6.0 mm in diameter. The portal caudate branches were divided into 3 groups.Group 1: Branches to the papillary process; 1 or 2 branches in 26 cases (82%), 3 or 5 branches in 3 cases (9%) and no branches in 3 cases (9%);     

Malignant obstructive jaundice: treatment with external-beam and intracavitary radiotherapy

Eleven patients with obstructive jaundice from unresectable cholangiocarcinoma, metastatic porta hepatis adenopathy, or direct compression from a pancreatic malignancy were treated at the Stanford University Medical Center from 1978-1983 with an external drainage procedure followed by high-dose external-beam radiotherapy and by an intracavitary boost to the site of obstruction with Iridium192 (Ir192). A median dose of 5000 cGy was delivered with 4-6 Mv photons to the tumor bed and regional lymphatics in 9 patients, 1 patient received 2100 cGy to the liver in accelerated fractions because of extensive intrahepatic disease, and 1 patient received 7000 "equivalent" cGy to his pancreatic tumor bed and regional lymphatics with neon heavy particles. An Ir192 wire source later delivered a 3100-10,647 cGy boost to the site of biliary obstruction in each patient, for a mean combined dose of 10,202 cGy to a point 5 mm from the line source. Few acute complications were noted, but 3/11 patients (27%) subsequently developed upper gastrointestinal bleeding from duodenitis or frank duodenal ulceration 4 weeks, 4 months, and 7.5 months following treatment. Eight patients died--5 with local recurrence +/- distant metastasis, 2 with sepsis, and 1 with widespread systemic metastasis. Autopsies revealed no evidence of biliary tree obstruction in 3/3 patients. Mean survival time from initial laparotomy and bypass was 16.1 months, and from radiotherapy completion was 8.3 months. Evolution of radiation treatment techniques for biliary obstruction in the literature is reviewed. High-dose external-beam therapy followed by high-dose Ir192 intracavitary boost is well tolerated and provides significant palliation. Survival of these aggressively managed patients approaches that of patients with primarily resectable tumors.     

Clinical,biochemical and histological analysis of seven patients with cholesteryl ester storage disease

Lysosomal acid lipase (LAL) deficiency leads to two phenotypically different diseases: cholesteryl ester storage disease (CESD) and Wolman's disease. Lysosomal acid lipase hydrolyzes cholesteryl esters and triglycerides. Deficiency of LAL results in intralysosomal storage of cholesteryl esters and triglycerides. CESD has a chronic and benign course and is characterized by hepatomegaly and mild hypercholesterolemia. It leads to fibrosis (cirrhosis) and early atherosclerosis. This report presents the clinical, biochemical and microscopic data of seven patients with CESD followed up over 10 years. The physical development of all the study children remained within the normal range; 7 patients had hepatomegaly and 6 also had splenomegaly. Three patients had normal cholesterol, triglycerides and transaminases values; the other four had slightly elevated levels for these parameters. The activity of LAL in all patients was reduced to below 30% of the lower normal value. Histologically, cholesteryl crystals and lipid storage vacuoles in Kupffer cells were present in all examined patients except one. Accumulation of cholesteryl esters was visible on thin-layer chromatography of lipid extracts obtained from liver biopsies.     

肝门胆管癌的CT诊断价值探讨

目的探讨肝门胆管癌的CT诊断价值及病理基础。方法本文收集21例均经手术及病理证实的肝门管癌,行CT平扫及增强双期扫描,21例均加做CT延迟扫描。结果①胆管扩张14例;②21例肝门胆管癌动态扫描,呈低密度13例,等密度6例,高密度2例;③延迟扫描,呈相对高密度18例,等密度3例,无低密度,肿瘤边界更明确。结论CT是诊断原发性肝门胆管癌有效、准确的检查方法。     

Peliosis Hepatis Shows Isometabolism on 18F-FDG PET/CT: Two Case Reports

Peliosis hepatis (PH) is a rare benign disease that is characterized by multiple blood-filled cystic spaces in the hepatic parenchyma. It is also characterized by a range of radiologic findings that might mimic various diseases, including metastatic liver disease and hepatocellular carcinoma. The findings of PH on ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) are not well reported. We here report two cases of biopsy-proven PH. Both patients had been treated for cancer (advanced gastric carcinoma and rectal adenocarcinoma), and follow-up CT of both cases revealed hepatic lesions with the possibility of metastasis. Examination of ¹⁸F-FDG PET/CT images suggested that the lesions were isometabolic, having metabolism similar to that of adjacent hepatic parenchyma. The outcomes of hepatic core-needle biopsies were consistent with peliosis hepatis.     

肝门胆管狭窄的病因分析与影像学诊断的临床评价

目的:总结分析肝门胆管狭窄的病因并探讨各影像学诊断方法在肝门胆管狭窄疾病中的诊断符合率.方法:回顾分析我院及山西医科大学第二医院于1982-200482例资料完整的肝门胆管狭窄患者的主要病因以及超声(US)、磁共振胰胆管造影(MRCP)、逆行胰胆管造影(ERCP)、经皮肝穿胆道造影(PTC)等影像诊断结果,分析各项影像技术在肝门胆管狭窄诊断中的适应症和诊断符合率.结果:恶性病变占肝门胆管狭窄病的87.80%,其中大部分由肝门胆管癌引起,占总例数的76.83%,其次胆囊癌占7.32%,结肠癌肝门转移1.22%,肝细胞癌并发癌栓2.44%等.良性病变占12.2%,主要为损伤性胆管、胆管囊肿、硬化性胆管炎以及胆管结石等.US,ERCP,PTC,MRCP对肝门胆管狭窄的诊断准确率分别为84.15%,92.86%,100%,100%.结论:恶性病变是肝门部胆管狭窄病的主要原因,良性病变相对比例较小.在肝门胆管狭窄的诊断中,影像学诊断技术扮演着关键辅助作用的角色,能协助临床迅速获得准确结论.     

Frequency of and factors associated with vascular complications after pediatric liver transplantation

Objectiveto evaluate the frequency and factors associated with vascular complications after pediatric liver transplantation.Methodrisk factors were evaluated in 99 patients under 18 years of age with chronic liver disease who underwent deceased donor liver transplantation (DDLT) between March of 1995 and November of 2009 at the Hospital de Clínicas de Porto Alegre, Brazil. The variables analyzed included donor and recipient age, gender, and weight; indication for transplant; PELD/MELD scores; technical aspects; postoperative vascular complications; and survival.Resultsvascular complications occurred in 19 patients (19%). Arterial events were most common, occurred earlier in the postoperative period, and were associated with high graft loss and mortality rates. In the multivariate analysis, the following factors were identified: portal vein diameter ≤ 3 mm, donor‐to‐recipient body weight ratio (DRWR), prolonged ischemic time, and use of arterial grafts.Conclusionthe choice of treatment depends on the timing of diagnosis; however, in this study, surgical revision or correction produced worse outcomes than percutaneous angioplasty. The reduction of risk factors and early detection of vascular complications are key elements to a successful transplantation.     

Peliosis hepatis complicated by portal hypertension following renal transplantation

Peliosis hepatis is a rare benign disease, but in last years the number of identified cases has increased. This disease is known to be sometimes accompanied by hepatocellular carcinoma. In the recent article, Yu et al describe a case of liver peliosis, characterized by an increased proliferative index. Therefore, additional diagnosis of patients should include analyzing other tumor markers expression in order to assess the risk of malignant cell transformation in peliosis hepatis.