Pao-Huei Chen

Cholangiocarcinoma in hepatolithiasis.

During the period 1979-1982, 10 cases of cholangiocarcinoma associated with hepatolithiasis were seen. We report the clinical features of 10 cases of cholangiocarcinoma in association with hepatolithiasis, along with detailed histopathology from the four resected specimens. Our observations suggest that whenever intrahepatic stones are encountered in patients over 50 years of age with a long history of recurrent cholangitis and intractable pain, further examination incuding echo-guided aspiration cytology, liver scanning, and peritoneoscopy should be performed to rule out a coexisting cholangiocarcinoma.

Acinar Cell Carcinoma of the Pancreas: Report of a Case

Acinar cell carcinoma of the pancreas is a rare neoplasm, accounting for about 1% of pancreatic exocrine tumors. In literature, males outnumbered females. Presenting symptoms, compared with ductal adenocarcinoma, were nonspecific. We reported a case of pancreatic tumor in a 23-year-old woman, who presented as a prominent abdominal mass with jaundice. Laboratory data showed elevation of bilirubin, lipase and CA19-9. Image study including ultrasound and computerized tomography revealed an encapsulated tumor arising from pancreas with common bile duct compression. After operation, acinar cell carcinoma was proved by pathology. The tumor, measuring about 11X 10X 8cm in size, looked fleshy and relatively circumscribed grossly. Microscopically, high cellularity without desmoplastic stroma were noted. Besides, typical acinar and solid patterns of growth were identified with characteristic diastase resistant periodic acid-Schiff staining. The differential diagnosis included islet cell tumor, solid and papillary epithelial neoplasm, pancreatoblastoma and so on.

Congestive gastropathy in cirrhotic patients: correlation between endoscopic and histological findings.

Congestive gastropathy is a common cause of gastrointestinal bleeding in cirrhotic patients. Forty-six patients with cirrhosis of the liver and 225 control subjects matched in age and sex without cirrhosis of the liver entered the study. We studied the prevalence of congestive gastropathy in cirrhotic patients, and the relationship between endoscopic and histological findings. Congestive gastropathy seen endoscopically was found to be more common in the cirrhotic group than in the control (85% vs. 5%, P < 0.05). The sensitivity, specificity and positive predictive value were 85%, 95% and 76%, respectively. The presence of endoscopic congestive gastropathy was correlated with the severity of liver disease (P < 0.05), but not to the etiology of cirrhosis and the size of esophageal varices with or without red color sign. Endoscopic congestive gastropathy showed no correlation with the histological features including gastritis, interstitial edema, vessel ectasia/congestion and hemosiderin in endoscopic biopsy specimens. In conclusion, congestive gastropathy is a common finding in cirrhotic patients. Its appearance is closely correlated with the severity of liver disease. There is no good correlation between endoscopic congestive gastropathy and mucosal histology.

Giant Polypoid Carcinoid of the Stomach

Gastric carcinoids are epithelial tumors with potential malignancy. Generally they are small yellow or gray submucosal nodules. When tumors become enlarged, they are grossly indistinguishable from carcinomas. Some big gastric carcinoid tumors simulate Borrmann type II or III, rarely Borrmann type I gastric carcinomas macroscopically. We herein report a 76-year-old man with a giant polypoid carcinoid of the stomach, locating at the antrum, which is a rare morphological picture of gastric carcinoid in the literature.

Retrospective Analysis of Adenomatous Polyps of Colon and Rectum: With Emphasis on the Malignant Potential

Due to the fact that epithelial neoplastic polyps in the colon and rectum are reported as having malignant potential elsewhere in the world, it intrigued our group and impelled us to conduct this retrospective analysis. One hundred and forty-six patients reviewed and 213 adenomas in total found by colonoscopy in about 2,000 times of in-and outpatients examined and subsequently removed by the procedure of colonoscopic polypectomy. All the specimens were subjected to histopathological study. The observation of adenoma tends to appear most commonly in aging colon. The interval for the development of atypia is estimated about 10 years. Polyps smaller than 0.5 cm in diameter rarely show malignancy, whereas polyps between 2-2.9 cm in diameter, the frequency of malignancy of tubular and villous adenomas is 10% and 33.3% respectively. If the size over 3 cm in villous adenoma, 71.4% resulted in malignant propensity. Villous adenomas have a marked malignant predilection up to 55.6% of villous lesions showing evidence of carcinoma. Thus, size and histological feature are two parameters involved in determining the malignant potential of an adenoma. Furthermore, while tubular adenomas are distributed throughout the large intestine, villous adenomas occur predominantly in the rectum and sigmoid. The anatomic distribution of the adenomas bears a relationship to potential for adenomas in the distal descending, sigmoid and rectum have a greater frequency of malignancy than those elsewhere in the colon. This correlates well with the predominant distribution of colorectal cancer. Contrary to the expectation, the risk of cancer is greater in those patients with single adenoma than those with multiple adenomas. In clinical setting, proctosigmoidoscopy is a very important single procedure to detect the polyps. In our series, more than half of the tubular adenomas and all villous adenomas are disclosed by this procedure alone. It is simple, safe and not cumbersome. In order to ensure that no secondary lesions existed, a detailed examination of the entire colon by colonoscope may be required. A vigorous surveillance programme including colonoscopic examination for both screening and follow-up in patients with colonic polyp is recommended. Therapeutic endoscopic polypectomy is worthwhile, since it may reduce the incidence of colorectal cancer because of adenomacarcinoma sequence.

Solid and Papillary Neoplasm of the Pancreas: A Case Report

A 20-year-old female was found to have a mass at left upper abdomen without remarkable clinical symptoms. Laparotomy revealed a well-encapsulated mass, 151×141×13cm in size, arising from the body and tail of the pancreas. Histologic examinaiion disclosed a solid and papillary neoplasm of the pancreas with the following features: 1) solid areas with polygonal shaped cells which were arranged uniformly around delicate fibrovascular stalks in papillary or pseudorosette features, 2) large foci of degeneration with cystic necrosis and hemorrhage, 3) huge size, well-encasulation with no evidence of invasiveness, and 4) the mucin and PAS stains were all negative. Ultrastructurally, the tumor cells contained zymogen-like granules. The patient has been followed up for half a year with no evidence of recurrence and metasiasis. Only a few cases of this tumor has been reported in the past. We report this rare case and review the relevant literature.