Seiji Ogiso

Intrabiliary polypoid growth of liver metastasis from colonic adenocarcinoma with minimal invasion of the liver parenchyma

Liver metastases from colorectal cancer easily invade the Glisson’s triad and sometimes have intrabiliary tumor growth. This behavior is by no means rare, and causes the cut end of the Glisson’s triad to be positive for cancer. We report here a 72-year-old Japanese man with a medical history of ascending colon cancer in whom enhanced computed tomography (CT) showed a low-density mass in the caudate lobe of the liver and dilatation of the peripheral intrahepatic bile duct. He underwent right hemihepatectomy and caudate lobectomy. The resected specimen showed a polypoid tumor in the bile duct lumen, with minimal invasion of the liver parenchyma; the tumor was similar to cholangio-carcinoma. Histological findings proved it to be well-differentiated adenocarcinoma. Immunochemically, the tumor cells were positive for cytokeratin (CK) 20, but negative for CK7, and we finally diagnosed him with intrabiliary polypoid growth of liver metastasis from colonic cancer. For complete surgical resection, it is very important to diagnose intrabiliary tumor growth. However, we could not diagnose it preoperatively in spite of the CT detecting an intrabiliary polypoid tumor, because the CT revealed no extrabiliary tumors in the liver parenchyma. We have to pay attention to the fact that CT rarely demonstrates only intrabiliary growth without extrabiliary tumors.

Follicular cholangitis and pancreatitis – clinicopathological features and differential diagnosis of an under‐recognized entity

Zen Y, Ishikawa A, Ogiso S, Heaton N & Portmann B 
(2012) Histopathology 60, 261–269 
Follicular cholangitis and pancreatitis – clinicopathological features and differential diagnosis of an under‐recognized entity

Skip lymph node metastases from a small hepatocellular carcinoma with difficulty in preoperative diagnosis.

Abstract  Recent autopsy studies have clarified the frequency of lymph node (LN) metastases from hepatocellular carcinoma (HCC). However, LN metastases commonly occur in advanced and poorly differentiated HCC and are very rare in small HCC. We encountered a patient with skip LN metastases from a small HCC, 10 mm in diameter. An intra‐abdominal tumor adjoining the duodenum was detected by follow‐up ultrasonography for viral hepatitis C. Computed tomography showed, in addition to the tumor bordering the duodenum, a small low‐density area of the liver (S6), 2 cm in diameter, and a swelling of LN adjacent to the common hepatic artery. Upper gastrointestinal rentogenography revealed a compression of the duodenal second portion without irregularity of the mucosa. Our pre‐operative diagnosis was duodenal gastrointestinal stromal tumor with LN metastasis and HCC or liver metastasis. However, laparotomy proved them to be LN metastases from a small HCC and partial hepatectomy and LN dissection were performed. The patient is doing well 22 months after surgery with no signs of recurrence. In the cases of HCC with LN metastases, the prognosis is generally very poor. However, in small HCC, the clinical characteristics are not fully evaluated. In treatment, we have to keep LN metastases, particularly skip LN metastases, in mind, even in cases of small HCC.

The role of polyamines in liver regeneration after hepatectomy with ischemic injury.

A total of 175 rats were divided into: (1) a sham operation group, in which the liver was slightly mobilized after laparotomy; (2) a control group in which 68% of the liver was resected without the blockade of blood flow; (3) an ischemia + hepatectomy group, in which the vessels entering the right and caudate lobes were clamped for 30 min, and the nonischemic lobes were resected; (4) a DFMO + ischemia + hepatectomy group, in which the same procedure as for the ischemia + hepatectomy group was performed, but the animals received α-difluoromethylornithine (DFMO); (5) a DFMO + Put + ischemia + hepatectomy group, in which the animals underwent the same procedure, but were given putrescine (Put) in addition to DFMO. There were 6 to 7 rats in each of the five groups. The putrescine level and ornithine decarboxylase (ODC) activity were significantly higher in the ischemia + hepatectomy group than in the control group, but were markedly decreased in the DFMO + ischemia + hepatectomy group. However, the lipid peroxide level was significantly higher in the DFMO + ischemia + hepatectomy group than in the ischemia + hepatectomy group. The incorporation of [3H]thymidine in the DFMO + ischemia + hepatectomy group was significantly lower than that in the control group. The increase in the lipid peroxide level and the decrease in [3H]thymidine found in the DFMO + ischemia + hepatectomy group tended to be reversed by the administration of putrescine. These results suggest that putrescine suppressed the production of lipid peroxides and promoted DNA synthesis in regenerating the liver after ischemia-reperfusion injury.

Effects of Exogenous PQQ on Mortality Rate and Some Biochemical Parameters During Endotoxin Shock in Rats

Effects of exogenously administered PQQ on mortality rate and some biochemical and hematological parameters were studied in rats during endotoxin shock induced by a E. coli toxin. PQQ administration (6mg/kg i.p.) reduced their mortality rate from 68.8% to 28.6%. Aspartate aminotransferase (GOT), alanine aminotransferase(GPT), blood urea nitrogen(BUN), uric acid, lipoperoxide and calcium in rat sera were all improved by PQQ administration platelet counts, prothrombin time(PT), and antithrombin III (AT III) were also improved markedly.

A Case of Abscess for Appendicitis during Treatment of Leukemia in Adult

症例は51歳の男性で, ふらつき感を契機に精査で急性骨髄性白血病(M5a), 化学療法を施行約3週間後に右下肢痛と発熱が出現, 腹部CTで腸腰筋内膿瘍を認めた. 骨髄抑制の状態のため保存的に治療したところ, 症状は軽快, CT上膿瘍は著明に縮小した. 再度化学療法施行, 約2週間後に右下腹部痛, 右下肢痛, 発熱が出現, CTで膿瘍の再燃を認めた. 今回も骨髄抑制の状態で保存的に治療, 症状は軽快し, CT上膿瘍は著明に縮小した. 注腸検査で虫垂から膿瘍内への漏出像を認め, 虫垂炎性膿瘍と診断した. 化学療法後の骨髄抑制から回復後, 虫垂切除術, ドレナージを施行した. 組織学的所見は炎症のみで白血病細胞は認めなかった. 虫垂炎を併発し, 手術を施行した成人白血病の本邦報告例は, 自験例を含めて13例ときわめてまれで, 若干の文献的考察を含めて報告する.

A Case of Lymphangioma of the Duodenum.

十二指腸リンパ管腫はまれな疾患で本邦では1965年から16例の報告があるのみである.今回われわれは特徴的な肉眼所見を呈した十二指腸リンパ管腫の1例を経験したので報告する.症例は45歳の女性で, 胃集団検診で異常を指摘され精査目的で当院を受診した.低緊張性十二指腸造影検査, 胃内視鏡検査にて十二指腸第2部に中心陥凹を伴う隆起性病変を認め, 肉眼的には表面が透明, 平滑で光沢があり, その下に黄色, 小結節集族様の腫瘍本体を透見できた.同部の生検ではリンパ管腫が疑われた.十二指腸部分切除術にて腫瘍を摘出し, 病理組織学的に海綿状リンパ管腫と診断された.自験例を含めた本邦報告17例を検討し, 若干の文献的考察を加えて報告した.