The differential diagnosis between intracystic hemorrhage and cystadenocarcinoma of the liver is often difficult even with the use of various imaging modalities. A 73-year-old woman was admitted to our hospital with t...The differential diagnosis between intracystic hemorrhage and cystadenocarcinoma of the liver is often difficult even with the use of various imaging modalities. A 73-year-old woman was admitted to our hospital with the complaint of right upper quadrant pain. Ultrasonography (US) demonstrated a heterogeneous echogenic cyst measuring 11 cm × 8 cm in size in S2 of the liver, indicated intracystic hemorrhage of simple liver cyst or cystadenocarcinoma, but the differential diagnosis was considerably difficult. Levovist (Schering, Berlin, Germany) US revealed no enhancement of the intracystic structures, suggesting a clot in the case of intracystic hemorrhage. An operation was performed and the resected lesion showed a solitary benign liver cyst, measuring 5.5 cm × 4.7 cm × 8.5 cm containing a large blood clot. The patient had an uneventful recovery after the surgery. Levovist US may play an important role in discrimination between intracystic hemorrhage of simple hepatic cysts and cystadenocarcinoma of the liver.展开更多
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...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.展开更多
A 84-year-old man with a surgical history of subtotal gastrectomy for gastric cancer was transferred to our department because of a disorder of consciousness. Septic shock due to obstructive suppurative cholangitis se...A 84-year-old man with a surgical history of subtotal gastrectomy for gastric cancer was transferred to our department because of a disorder of consciousness. Septic shock due to obstructive suppurative cholangitis secondary to choledocholithiasis was diagnosed. Anemia was also present,and upper gastrointestinal tract endoscopy revealed blood emerging from the Papilla of Vater.The cause of the anemia was identified as haemobilia.Angiography showed a small aneurysm over the artery on segment 3(A3) .The cause of the haemobilia was suspected to be the bleeding into the biliary tree from this aneurysm.Because the patient's general condition was poor,minimally invasive therapy was needed.Transcatheter arterial embolization(TAE) was selected initally.Later,lateral sectionectomy was performed in order to remove the aneurysm on A3. No surgical complication occurred and,after surgery,no haemobilia was identified.In conclusion,a twostage treatment,namely,surgery following TAE,is recommended for patients in a physically poor condition who have haemobilia due to intrahepatic aneurysm.展开更多
文摘The differential diagnosis between intracystic hemorrhage and cystadenocarcinoma of the liver is often difficult even with the use of various imaging modalities. A 73-year-old woman was admitted to our hospital with the complaint of right upper quadrant pain. Ultrasonography (US) demonstrated a heterogeneous echogenic cyst measuring 11 cm × 8 cm in size in S2 of the liver, indicated intracystic hemorrhage of simple liver cyst or cystadenocarcinoma, but the differential diagnosis was considerably difficult. Levovist (Schering, Berlin, Germany) US revealed no enhancement of the intracystic structures, suggesting a clot in the case of intracystic hemorrhage. An operation was performed and the resected lesion showed a solitary benign liver cyst, measuring 5.5 cm × 4.7 cm × 8.5 cm containing a large blood clot. The patient had an uneventful recovery after the surgery. Levovist US may play an important role in discrimination between intracystic hemorrhage of simple hepatic cysts and cystadenocarcinoma of the liver.
文摘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.
文摘A 84-year-old man with a surgical history of subtotal gastrectomy for gastric cancer was transferred to our department because of a disorder of consciousness. Septic shock due to obstructive suppurative cholangitis secondary to choledocholithiasis was diagnosed. Anemia was also present,and upper gastrointestinal tract endoscopy revealed blood emerging from the Papilla of Vater.The cause of the anemia was identified as haemobilia.Angiography showed a small aneurysm over the artery on segment 3(A3) .The cause of the haemobilia was suspected to be the bleeding into the biliary tree from this aneurysm.Because the patient's general condition was poor,minimally invasive therapy was needed.Transcatheter arterial embolization(TAE) was selected initally.Later,lateral sectionectomy was performed in order to remove the aneurysm on A3. No surgical complication occurred and,after surgery,no haemobilia was identified.In conclusion,a twostage treatment,namely,surgery following TAE,is recommended for patients in a physically poor condition who have haemobilia due to intrahepatic aneurysm.
