Tetsushi Taniguchi

Ampullary somatostatinoma in a patient with von Recklinghausen's disease

We report a case of somatostatinoma of the ampulla of Vater associated with von Recklinghausens disease in a 44-year-old woman. On admission the patient was jaundiced, and percutaneous Cholangiodrainage was performed. Cholangiography revealed stenosis of the common bile duct at the lower end Duodenoscopy showed a yellowish tumor of the ampulla of Vater, and the biopsy specimens showed no malignant cells. Pylorus-preserving pancreaticoduodenectomy was performed. Histologically, the tumor was composed of small round cells with a solid or trabecular pattern and with multiple psammoma bodies. Immunohistochemical examination showed that the tumor cells stained for somatostatin. Genomic examination showed neither K-ras nor p53 gene mutations of the resected specimen.

A case of spontaneous intramural hematoma of the esophagus

SummaryThe authors experienced a case of spontaneous intramural hematoma of the esophagus (SIHE). This 44-year-old Japanese woman was admitted to our hospital bacause of chest pain accompanied hy minimal hematemesis. Endoscopy revealed an elevated intraluminal bleeding bulge. Barium esophagograms showed a smooth and giant elevated intraluminal lesion. CT and MRI also revealed thickening of the esophageal wall. Fasting and intravenous hyperalimentation were prescribed on admission. The conditions improved and she became asymptomatic on the fifth day of hospitalization. Subsequent examinations by esophagography and endoscopy showed that the elevated lesion had disappeared and that the inflamed mucosal lesion had improved. The prognosis of cases of SIHE is excellent under conservative therapy, but close follow-up care is necessary.

A case of septum formation of the common hepatic duct combined with an anomalous hepatic duct of the caudate lobe.

SummaryA 66-year-old Japanese woman was admitted to our hospital with upper right quadrant pain and jaundice. Laboratory data indicated the presence of obstructive jaundice. A diagnosis of cholecystocholedocholithiasis was made by ultrasonography. Endoscopic retrograde cholangiography revealed choledochal stones with septum formation in a portion of the common hepatic duct up to where an anomalous bile duct drained from the caudate lobe of the liver. We performed a cholecystectomy, T-tube drainage, and partial resection of the septum when these findings were confirmed at surgery. Histological examination of the removed septum showed fibrous stroma under atrophic mucosa. To our knowledge, this is the eighteenth reported case in Japan of septum formation of the bile duct. However, no other such case to date has been seen combined with an anomalous hepatic duct of the caudate lobe of the liver. Selective cholangiography by choledochoscope and computed tomography with a thin guide-wire inserted to the bile duct were useful in confirming the origin of the anomalous bile duct. This case may serve as further evidence of the assumption that septum formation of the common (hepatic) bile duct is a malformation of congenital origin.

Two cases of retained foreign bodies after cholecystectomy: Diagnosis by sonography, CT, angiography, and MRI

We encountered two cases of subphrenic abscesses around surgical sponges that had eeen left at cholecystectomy. These cases had been operated on either eight years or seven years earlier, respectively. These lesions resembled another diseases, especially, liver tumors. In order to make a differential diagnosis, various diagnostic procedures were carried out. Sonography showed a cystic mass with spongiform structures in one case. But in another case, no information of internal structures could be obtained because of the presence of a calcified wall. On CT, the lesions appeared as either round or elliptic masses that contained calcified foci in both cases. Angiography showed the extended and compressed branches of the hepatic artery. Spotty stains were also observed in one case. This appearance resembled a hepatic tumor. MR demonstrated both T1 and T2 elongated masses. The internal structures of the mass were clearly revealed by the improved version of the MR machine. MR proved to be extremely useful in making a differential diagnosis. It is, however, important to evaluate the findings of these imaging procedures synthetically and in association with a careful review of a patients prior surgical history.

CASE REPORT: Epidermoid Cysts of the Spleen Occurring in Sisters

A splenic cyst was first described by Andral in 1829, but it is a relatively rare occurrence (1). However, recently, small splenic cysts have been occasionally observed as a result of the development of diagnostic technology. Most cysts were a symptomatic and did not require treatment. On the other hand, large splenic cysts are very rare, but they often become symptomatic and critical due to enlargement, infection, and rupture. We observed two sisters with giant symptomatic splenic cysts. Histopathologically, both cysts were epidermoid. Moreover, the serum level of CA19-9 in both sisters was high before splenectomy. The familial occurrence of splenic cysts has been reported only in five studies to date (2–6). These cases, including the ones in our report, suggest genetic changes in familial splenic cysts.

Colorectal carcinoma evaluated by incremental dynamic CT: comparison of CT density, histology, and tumor size.

SummaryEvaluation of incremental dynamic CT scan and histologic findings were compared in order to clarify the cause of the differences in colorectal carcinoma as observed on CT after administration of contrast medium. In 48 cases demonstrated on postcontrast dynamic CT scan, the CT density of the tumor was homogeneous (Type 1) in 26 (54.2%) cases and heterogeneous (Type 2) in 22 (45.8%) cases. Well differentiated adenocarcinoma was seen as Type 1 in 11 of 13 (84.6%) cases while moderately differentiated adenocarcinoma was of Type 1 in 15 of 29 (51.7%) cases. Poorly differentiated and mucinous adenocarcinoma were detected as Type 2 in all cases. A comparison of CT types and tumor size showed that as tumor size increased, the number of Type 1 cases decreased while Type 2 cases increased. Histologically, high density areas consisted mainly of well-developed tubular, branching glands of adenocarcinoma, while low density areas were composed of fibrous or mucinous stroma or necrosis. Dynamic CT scans for colorectal cancer are useful not only for preoperative staging but also for tissue characterization.

An application of recombinant human granulocyte colony-stimulating factor (rhG-CSF) in a case of hepatocellular carcinoma combined with liver cirrhosis in which leukopenia developed after chemoembolization

SummaryA 63-year-old Japanese woman who was being treated for liver cirrhosis was diagnosed as having hepatocellular carcinoma in the caudate lobe of the liver. Transcatheter hepatic arterial chemoembolization was performed for this lesion, but severe neutropenia occurred. To restore white blood cell (WBC) counts, recombinant human granulocyte colony-stimulating factor (rhG-CSF) was administered (250 (μg per day during 10 days, intravenously). Subsequently, WBC counts recovered immediately without side effects. This suggests that rhG-CSF could be useful for the treatment of neutropenia after chemoembolization, even in cirrhotic patients.