Primary hepatic marginal zone B-cell lymphoma with mantle cell lymphoma phenotype.

We report a rare case of primary hepatic lymphoma, Stage II disease, in a 48-year-old male who had a solitary hepatic tumour measuring 4 x 4.5 x 3 cm. The tumour showed a nodular growth pattern and lymphoepithelial lesions with bile ducts. Some neoplastic nodules had a non-neoplastic atrophic germinal centre and/or a thin mantle cell layer. Morphologically, the neoplastic cells were centrocyte-like cells or intermediate lymphocytes. They expressed L26(CD20)+/LN-1(CDw75)+/-/LN-2(CD74)+/cyclin D1- and had a monotypic immunoglobulin of cytoplasmic IgM (kappa) on paraffin sections. The neoplastic cells or neoplastic nodules expressed surface IgM+/surface IgD+/-/Leu-1(CD5)+/DRC-1+/alkaline phosphatase+/B1(CD20)+/B4(CD19)- on fresh frozen sections. We therefore diagnosed this case as primary hepatic marginal zone B-cell lymphoma with mantle cell lymphoma phenotype. We confirm that it is difficult to differentiate extranodal marginal zone B-cell lymphoma (low grade B-cell lymphoma of mucosa-associated lymphoid tissue type; MALT lymphoma) and mantle cell lymphoma.

Propofol improves recovery from paraquat acute toxicity in vitro and in vivo.

OBJECTIVE: To investigate whether the antioxidative sedatives propofol and thiopental can improve recovery from acute paraquat toxicity in A549 cells and in mice. DESIGN: Prospective, controlled, dose-response, in vitro study and prospective, controlled animal study. SETTING: A university animal research laboratory. SUBJECTS: Established human lung cultured cells and male SPF ICR mice. INTERVENTIONS: Paraquat-treated (0.2 mM) A549 cells were incubated either with the antioxidative sedatives propofol (0-0.56 mM) or thiopental (0-2.0 mM), or the nonantioxidative sedatives diazepam (0-3.0 mM), midazolam (0-3.0 mM) and ketamine (0-9.0 mM), as well as the antioxidative drugs, trolox (0-2.0 mM), alpha-tocopherol (0-4.4 mM), antioxidative-processed food (AOB; 0-1.0 mg/ml), superoxide dismutase (SOD; 0 and 3,000 U/ml) and ulinastatin (0 and 50,000 U/ml), for 48 h. Paraquat-treated mice received i.v. injections of 10 mg/kg propofol, 5 mg/kg thiopental, 4.0 mg/kg trolox, 100 mg/kg alpha-tocopherol, 10 mg/kg AOB or 5,000 U/kg SOD, b.i.d. for 4 days (n = 10 each). MEASUREMENTS AND RESULTS: Post-administered propofol and thiopental, as well as the antioxidative drugs, trolox, alpha-tocopherol and AOB, improved A549 cell survival in vitro. The non-antioxidative sedatives SOD and ulinastatin were not protective. An i.p. injection of 50 mg/kg of paraquat resulted in a survival rate of 40% in mice at day 6. Propofol, trolox, alpha-tocopherol and AOB significantly lowered the mortality rate (80% survival), while thiopental did not. CONCLUSION: Post i.v. injection of propofol is protective against paraquat-induced damage. Propofol can be given during mechanical ventilatory support after paraquat poisoning.

Imaging of small pancreatic ductal adenocarcinoma.

Symptoms and laboratory studies provide only limited assistance in the diagnosis of small pancreatic carcinomas. Ultrasound and computed tomography are best suited for screening small pancreatic carcinomas because of their ease and accuracy. When findings of ultrasound and computed tomography suggest small pancreatic carcinomas, MR cholangiopancreatography and endoscopic ultrasound should be indicated. Both techniques can show very small tumors. Follow-up of 77 patients with pancreatic carcinoma in whom the tumor was resected showed a 100% 5-year survival rate of patients with tumor limited to the duct epithelium. The majority of these tumors were <1 cm. These tumors are considered early pancreatic carcinoma.

[Double contrast examination of the bile ducts (author's transl)]. / Die Doppelkontraströntgendarstellung der Gallenwege.

Efficacy of double contrast X-ray study of the bile duct was studied. Using barium sulfate it was possible to demonstrate fine mucosal pattern (FMP) of the bile duct in the surgical specimen. Utilizing decompression catheter in 44 patients with extrahepatic jaundice, double contrast study was clinically performed. It was also possible to demonstrate FMP of the bile duct mucosa. Mucosal and intramural spread of bile duct carcinoma were revealed preoperatively. It was also useful in the differential diagnosis of the biliary tract diseases.

[Transhepatic biliary drainage for obstructive jaundice (author's transl)]. / Transhepatische Gallengangsdrainage bei Verschlussikterus.

Sixty-five patients with obstructive jaundice out of a total of 71 patients, were treated successfully by PTCD. The markedly elevated total bilirubin and alkaline phosphatase in the serum were reduced significantly and the general condition of the patient improved rapidly. On the other hand, severe obstructive jaundice which had persisted for several weeks was not amenable to treatment in this way. Occlusion of the extrahepatic bile ducts by tumour was treated by internal PTCD; this provided satisfactory flow of bile into the duodenum for at least six months. PTCD is simpler for the patient than surgery and is therefore the method of choice in obstructive jaundice. Finally, PTCD can be used for the introduction of antibiotics for the treatment of suppurative cholangitis or liver abscesses. This rapidly leads to reduction in fever and absorption of the abscesses.

[A critical comparison of methods for diagnosing carcinoma of the pancreas (author's transl)]. / Kritischer Vergleich der Untersuchungsmethoden bei der Frage nach einem Pankreaskarzinom.

Our investigations have shown that only those carcinomas of the pancreas of less than 3 cm. can be cured. In our experience the only way to diagnose such tumours preoperatively is a combination of angiography, ERCP and/or percutaneous transhepatic cholangiography.

5-fluorouracil continuous infusion combined with cisplatin for advanced pancreatic cancer: a Japanese Cooperative Study.

BACKGROUND/AIMS: The prognosis of patients with advanced pancreatic cancer is extremely poor. To improve their prognosis, providing effective chemotherapy is necessary. The aim of this study was to evaluate the anti-tumor activity and toxicity of combined chemotherapy (FP therapy) using 5-fluorouracil and cisplatin in Japanese chemo-naive patients with advanced pancreatic cancer. METHODOLOGY: Thirty-seven previously untreated patients with histologically proven pancreatic adenocarcinoma were treated with FP therapy. 5-fluorouracil was administered at 500 mg/m2/day by continuous intravenous infusion for 5 days and cisplatin was administered at 80 mg/m2 intravenously on the 1st day. Therapy was repeated every 4 weeks until there was evidence of disease progression or unacceptable toxicity. RESULTS: Three patients achieved partial responses, whereas none exhibited a complete response. The overall response rate was 8% (95% confidence interval, 2-22%) and the response durations were 6, 9 and 12 months, respectively. The median survival time of patients was 5 months. Toxicities were generally mild and acceptable, although nausea/vomiting was the most commonly observed toxicity. CONCLUSIONS: FP therapy on this schedule had limited anti-tumor activity for pancreatic cancer, indicating that, practically, it should not be performed in Japanese patients with advanced pancreatic cancer.

Integrated approach to the diagnosis of pancreatic carcinoma.

A prospective comparison of sensitivity, specificity and predictive value of ultrasonography (US), computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP) and angiography was performed in 112 patients with proven pancreatic carcinoma. ERCP had the highest sensitivity and specificity in evaluation of pancreatic carcinoma. CT was the least sensitive in detecting pancreatic malignancy. Angiography had the highest positive predictive value. US and ERCP had a high negative predictive value. The initial examination of a patient with suspected pancreatic carcinoma is by US. Should this produce an abnormal result, CT is then used to confirm a lesion. A diagnosis of unresectable pancreatic carcinoma could be made by US and CT without the need for additional imaging procedures. If not, ERCP is indicated when there is some distinct reason to suspect pancreatic carcinoma. If ERCP reveals an abnormality, then angiography is performed to determine whether the lesion is benign or malignant, and if malignant whether it is resectable or not.

[Detection and prognosis of small pancreatic ductal adenocarcinoma].

Symptoms and laboratory studies provide only limited assistance in the screening of small pancreatic carcinomas. Ultrasound and CT are best suited for screening small pancreatic carcinomas because of their ease and accuracy. When ultrasound and CT findings suggest small pancreatic carcinomas, MR cholangiopancreatography and endoscopic ultrasound should be indicated. Both techniques can show very small tumors noninvasively. Follow-up of 79 patients with pancreatic carcinoma in whom the tumor was resected showed that 5-year survival rate of patients with tumor limited to the duct epithelium was 100%. Majority of these tumors were smaller than 1 cm. These tumors are considered early pancreatic carcinoma.

[Clinical evaluation of MRCP].

Recently, MRCP can be obtained with good spacial resolution within a few seconds using half fourier fast spin echo technique. From July 1995 to August 1997, 1000 patients suspected of having pancreatobiliary diseases were examined with MRCP. MRCP was performed with 1.5 T scanner using Fast Asymmetric Spin Echo sequence (FASE). Satisfactory images of the main pancreatic duct were obtained in 98%, of Santorini's duct in 90%, and of uncinate process branch in 83%. Pancreas divism was accurately diagnosed. In the patients with pancreatic ductal adenocarcinomas, MRCP depicted stenosis and proximal dilatation of the main pancreatic duct in 89%, and in the remaining patients no abnormalities were seen in the main pancreatic ducts because tumors were limited to side branches or Santorini's duct or distal end of the tail of the pancreas. Diagnosis of small pancreatic carcinomas (smallest lesion measured 10 mm in diameter) were feasible. In the patients with intraductal papillary neoplasms, dilatation of the main pancreatic duct and cystic dilatation of side branches were depicted, and polypoid lesions were detectable with source images. In the patients with serous cystadenomas, accumulation of the microcysts were visualized. In the patients with chronic pancreatitis, dilatation and stenosis of the main pancreatic duct, as well as side branch dilatation was depicted despite overestimation of the extent of the stenosis. Stones in the main pancreatic duct were well visualized as intraductal filling defects. In conclusion, MRCP is an effective imaging technique in the diagnosis of various pancreatic diseases.

[Cystic lesions of the pancreas].

The number of the literature and classification of the cystic pancreatic diseases is increasing recently. We describe MR cholangiopancreatography (MRCP) findings of the cystic pancreatic diseases according to the clinical oriented classification. Intraductal papillary tumor, mucinous cystadenoma and serous cystadenoma showed characteristic MRCP findings. However small non-neoplastic true cysts are difficult to differentiate from cystic tumors even by MRCP.