Fibrolamellar hepatocellular carcinoma--an atypical MR manifestation.

We report the imaging findings, specifically magnetic resonance pictures of a non-cirrhotic case of fibrolamellar hepatocellular carcinoma in an older patient (60 years). Computed tomography revealed non-enhanced hypodense central scar without notable intratumoral calcification. MR imaging revealed a mass, which was homogeneously hypointense on T1-weighted images (T1WI) and turned hyperintense on T2-weighted images (T2WI). Stellate central scar was depicted with more hypointensity on T1WI, however, it became markedly hyperintense on T2WI. This manifestation is very different from the typical pattern reported in the literature. In gadolinium enhanced T1WI, the mass other than the central scar got enhanced. Fibronodular hyperplasia and fibrolamellar hepatocellular carcinoma should be differentiated with reference to the clinical and imaging findings. Collagenous central scar was described pathologically within the latter. However, a discrepancy between the pathological and magnetic resonance pattern concerning the central scar which was collagenous and corresponding to hyperintensity on T2WI was found. To our knowledge no similar entity has been described in the literatures so far.

Afferent loop syndrome complicated by a duodenal phytobezoar after Billroth-II subtotal gastrectomy.

We illustrate a rare late onset (10 yr) complication of gastric surgery with a combination of afferent loop syndrome and a large duodenal bezoar. The patient underwent a subtotal gastrectomy with Billroth II gastrojejunal anastomosis for benign peptic ulcer 10 yr ago. It was not until several days before this presentation that he suffered from epigastralgia and abdominal distension. Leukocytosis and abnormal blood biochemistry were found including amylase, lipase, alkaline phosphatase, total bilirubin, GOT, and GPT in which amylase was markedly elevated to 1188 U/L. Abdominal ultrasound scan and especially CT scan confirmed the diagnosis of a large bezoar in the dilated duodenal afferent loop. To our knowledge, the rare entity in our case is the first reported in the literature.