Izuru Tada

An Electron Microscopic Study of Hepatic Angiomyolipoma

Three cases of hepatic angiomyolipoma, each composed of an intimate mixture of numerous abnormal blood vessels and various‐sized fat, spindle and/or epithelioid cells, are presented along with the findings of an electron microscopic study. The spindle cells were confirmed to be smooth muscle by immunohistochemical staining for des‐min and by their ultrastructural characteristics. The mature fat cells, smooth muscle cells, immature short spindle cells apparently intermediate or transitional between the former two cell types, and the epithelioid cells were observed adjacent to the endothelial cells. Ultra‐structurally, the epithelioid cells were characterized by unusual cytoplasmic organelles such as myofilaments having focal densities and dense attachments, numerous large electron‐dense bodies, and a large number of glycogen particles and lipid droplets. Therefore, it is considered that the immature short spindle and epithelioid cells in hepatic angiomyolipoma might be primitive mesenchymal cells having an ability to differentiate toward both smooth muscle and fat cells. Acta Pathol Jpn 39 : 743‐749, 1989.

Double cancer of the liver and stomach with situs inversus totalis —A case report

A case of a 66 year old woman with situs inversus totalis who developed hepatocellular carcinoma (HCC) as well as stomach cancer, is reported herein. The patient was successfully treated with a left hepatic lobectomy for the HCC and a B-I gastrectomy for the stomach cancer. Careful anatomical mapping made it possible to perform a combined resection of the liver and stomach in the presence of this congenital anomaly.

Giant hepatic angiomyolipoma simulating focal nodular hyperplasia

A case of hepatic angiomyolipoma occurring in a 41-year-old woman, the eighteenth case in literature, is reported herein. The radiographic imagings of the tumor simulated those of focal nodular hyperplasia; namely, the tumor was hyperechoic on ultrasound, hypodense on computed tomography, hypervascular on angiography, and exhibited an uptake of technetium (Tc)-99m phytate. The diagnosis was established after successful removal of the huge tumor from the right hepatic lobe. Histologically, the tumor was angiomyolipoma which was made up of three components, blood vessels, smooth muscle and fatty tissue. Furthermore, extramedullary hematopoiesis, which is usually seen in this tumor was confirmed. The differentiation of hepatic angiomyolipoma from FNH is also discussed.

Fibrolamellar hepatocellular carcinoma coexistent with a hepatocellular carcinoma of common type: report of a case.

A case of small fibrolamellar hepatocellular carcinoma (HCC) coexistent with a HCC of common type is herein reported. A 56-year-old man was diagnosed as having multi-nodular type HCC with liver cirrhosis. The serum alpha-fetoprotein (AFP) level was slightly increased. The patient underwent a partial caudate lobectomy and lateral segmentectomy. Histologically, both resected tumors were small HCCs measuring less than 2 cm in diameter. One was a fibrolamellar type located in the caudate lobe, while the other was the common type in the lateral segment of the liver. Positive immunohistochemical staining for AFP was observed in the tumor cells of the HCC of common type but was not observed in the fibrolamellar HCC. We also reviewed previously reported cases of fibrolamellar HCC in Japan, and discussed the clinicopathologic implications of this disease.

PRE-AND POST-OPERATIVE ELEMENTAL DIET FOR CANCER OF THE ESOPHAGUS OR THE CARDIA

食道噴門癌25症例に術前後の栄養管理として成分栄養法 (ED) を試みた. 術前は数経鼻的に胃・十二指腸にチューブを留置し, 術後は胃管に作成した胃瘻あるいは空腸瘻から術後の腸蠕動の回復をまつことなく, 術後第1日目から持続点滴法により24時間連続投与した. 術前ED施行例では入院時から手術までに平均3%の体重増加がみられた. 術後ED施行例の血清アルブミン値は術後普通経管栄養食投与群に比して術前値に対する減少率は軽度であった. またED施行群では術後6日目に窒素平衡が正に転じた. 術後縫合不全, 術後乳糜胸の症例にも有効であった.