Shu-Wen How

Early detection of hepatocellular carcinoma by real-time ultrasonography. A prospective study

For early detection of hepatocellular carcinoma (HCC), real‐time ultrasonography (US) was performed prospectively in 528 patients, including 236 with cirrhosis, 81 with chronic hepatitis, 168 asymptomatic hepatitis B surface antigen carriers, and 43 with a family history of HCC. Simultaneous measurement of serum alpha‐fetoprotein (AFP) level was also done. In addition, 233 patients had regular controls at 3‐ to 6‐month intervals, with an average follow‐up period of 1.4 years. On initial screening, a total of 17 patients were found to have HCC: 13 in the cirrhotic group, 3 in the HCC family group, and 1 in the asymptomatic carriers. Of these HCCs, 7 were smaller than 3 cm, 6 were between 3 to 5 cm, and 4 were larger than 5 cm. In patients with tumors smaller than 5 cm, the AFP levels were normal in 46.2%, between 20 to 400 ng/ml in another 46.2%, and only 7.6% were over 400 ng/ml. On follow‐up, another seven patients, all in the cirrhotic group, were found to have HCCs varying from 1.6 to 4.7 cm; three of them had normal serum AFP level. The authors conclude that real‐time US is more sensitive than AFP assay in early detection of HCC, and the high‐risk subjects should receive this procedure at regular intervals.

Arsenical cancer of skin: Histologic study with special reference to Bowen's disease

A total of 238 arsenical skin cancers in 153 patients (98 men and 55 women) were histologically studied; 117 patients (76.47%) were older than 50. Of the 238 lesions, 46 were epidermoid carcinoma, 36 basal cell (23 deep and 13 superficial), 139 intraepidermal (18 type B keratoses and 121 classical Bowens lesions and variants) and 17 combined forms. Clinically, it was often impossible to differentiate superficial basal cell carcinoma, intraepidermal carcinoma and combined forms. Bowens variants (10 with squamous eddies, 6 with features of seborrheic keratosis and 5 with horn formation) were described and illustrated. The combined forms were mixtures of superficial basal cell carcinoma, Bowens lesion or its variants and Jadassohn epithelioma, Among the 36 basal cell carcinomas, ten revealed bizarre multinucleated giant cells and nuclear atypicalities, three in deep and seven in superficial. Arsenical keratoses consisted of benign type A and malignant type B (intraepidermal carcinoma). Among the 81 type A keratoses 57 revealed no cell atypicalities and 24 only mild ones. Relationships of Bowens lesions to keratoses and to invasive and metastasizing carcinomas and of keratoses type A to type B and to epidermoid carcinomas were discussed.

Small Hepatocellular Carcinoma—A Clinicopathological Study in Thirteen Patients

Abstract To investigate the diagnosis and clinicopathological features of hepatocellular carcinoma at its early stage, 13 patients with carcinoma ≤3.0 × 3.0 cm in size (small hepatocellular carcinoma) were studied with radionuclide scan, celiac arteriography, computed tomography, ultrasonography, and peritoneoscopy. Most of the patients were found from prospective studies in hepatoma high-risk subjects and were asymptomatic, with liver tests showing only mild abnormalities. Hepatitis B surface antigen was positive in all except one who was hepatitis B core antibody positive. Serum α-fetoprotein level was normal in 3 patients and in the remaining patients it increased to an extent far lower than in patients with advanced hepatocellular carcinoma. For detecting small tumors, ultrasonography, computed tomography, and celiac arteriography were superior to radionuclide scan or peritoneoscopy (detection rate: 95%, 94%, 89% vs. 16%, 12%, respectively). Small hepatocellular carcinoma was characterized as a hypoechoic shadow with weak internal echoes on ultrasonography, hypodense lesion on computed tomography, and hypervascular stain in angiography. None of these three examinations detected all the tumors in every patient and thus at least two of the three examinations should be done to avoid missing any tumor. Among them, the real-time ultrasonography was most practical for localizing small hepatocellular carcinoma and the diagnosis could be confirmed by ultrasound-guided biopsy. Ultrasonography was indispensable for identifying the small tumor during laparotomy in 3 patients. Ten patients had a single tumor. The small tumors were resected successfully in 10 patients. The tumor was frequently surrounded by a thin fibrous capsule and the most common cell type was of the trabecular pattern.

Pancreatic carcinoma associated with chronic calcifying pancreatitis in Taiwan: a case report and review of the literature

A 62-year-old Chinese woman suffering from pancreatic carcinoma coexisting with chronic calcifying pancreatitis is reported. Ultrasonography and computed tomography disclosed multiple intraductal calcifications in the pancreatic head and body and a tumor at the tail. Laparotomy revealed cancerous peritonitis in addition to verifying the presence of calcifications at the head and body and a cancer at the tail. Histology confirmed adenocarcinoma. The incidence of pancreatic carcinoma in chronic calcifying pancreatitis varied from 0.8 to 25% in a thorough review of the literature. It is emphasized that patients with chronic calcifying pancreatitis should be closely followed for detection of possible coexisting pancreatic malignancies.

Carcinoma of the gallbladder from an anomalous connection between the bile duct and the pancreatic duct.

Anomalous connection between the common bile duct and the pancreatic duct has recently been reported to be associated with cancerous changes of the biliary tract. A 52-year-old Chinese man had a fungating tumor in the gallbladder, and a long common channel between the bile duct and the pancreatic duct. The association of these two rare disease entities especially in a Chinese man may imply a close relationship between pancreatobiliary anomalous connection and the gallbladder cancer. It is thus prudent to monitor patients with such an anomalous connection closely by serial ultrasonic examination. More aggressively, prophylactic cholecystectomy and reconstruction of the biliary tract may be indicated.