[A case of multiple pulmonary and remnant liver metastases of hepatocellular carcinoma (HCC) after partial hepatic resection remarkably responding to S-1].

A 73-year-old woman was admitted to our hospital for hemorrhagic shock due to HCC rupture and treated by transcatheter arterial chemoembolization (TACE) in July 2007, followed by partial hepatic resection two months later. Multiple pulmonary and remnant liver metastases were detected by CT six months after the surgery. Since treatment with UFT for two months was not effective, the chemotherapy was changed to S-1 100 mg/body/day in June 2008. After S-1 treatment for three months, lung metastases remarkably diminished, as did the serum AFP level. Meanwhile, although the S-1 dose was gradually reduced to 50 mg/body/day due to adverse effects, pulmonary lesions and serum AFP level remained stationary for five months. While there is no established regimen for distant metastases of HCC, S-1 may be effective even at a reduced dose.

An autopsy case of granulocyte-colony-stimulating-factor-producing extrahepatic bile duct carcinoma.

A 79-year-old man was referred to this department due to the presence of extrahepatic bile duct carcinoma with a tumor at the left chest wall. The lesion was suspected to be a metastasis of bile duct carcinoma to the left wall, however, computed tomography (CT) revealed no regional lymph node or liver metastases. In addition, cytological and pathological examinations did not show malignancy. At the time of admission, the white blood cell count was 21460 cells/muL (neutrophils, 18240 cells/muL) and this elevated to 106040 before death. In addition, serum granulocyte colony-stimulating factor (G-CSF) was elevated. At 28 d after admission, the patient died. An autopsy showed a poorly differentiated adenocarcinoma with sarcomatous change, which had slightly invaded into the pancreas around the bile duct, and was found in the distal bile duct with multiple metastases to the chest wall, lung, kidney, adrenal body, liver, mesentery, vertebra and mediastinal and para-aortic lymph nodes, without locoregional lymph node and liver metastasis. The cancer cells showed positive immunohistochemical staining for anti-G-CSF antibody. This is believed to be the first report of an extrahepatic bile duct carcinoma that produces G-CSF. Since G-CSF-producing carcinoma and sarcomatous change of the biliary tract leads to poor prognosis, early diagnosis and treatment are needed. When infection is ruled out, the G-CSF in serum should be examined. In addition, examinations such as bone scintigraphy and chest CT should also be considered for distant metastasis.

Pulmonary glomus tumor: CT and MRI findings.

Pulmonary glomus tumor is rare and its manifestations on magnetic resonance imaging (MRI) have not, to our knowledge, been reported previously. A round mass was detected in the right upper lung field on a routine chest radiograph. With dynamic contrast-enhanced MRI, the mass showed strong, early-phase peripheral enhancement that expanded in a centripetal direction with time. Postoperative pathologic examination confirmed the diagnosis of glomus tumor.