Sclerotherapy using polidocanol foam for a giant splenic cyst.

Nonparasitic splenic cysts often cause nonspecific symptoms such as pain or early satiety. As it is relatively rarer than hepatic cysts, no established treatment exists for splenic cysts. A 24-year-old woman with a complaint of abdominal discomfort was referred to our hospital. Computed tomography revealed an 11-cm diameter splenic cyst, thought to be the cause of her symptom. Sclerotherapy was performed using polidocanol foam, administered at a volume of 40 mL through a catheter, under local anesthesia. After 2 sessions, the cyst measured 5 cm in diameter, 3 months after the first treatment. Sclerotherapy using polidocanol foam can treat large splenic cysts. It can be performed using local anesthesia and a single puncture, reducing sclerosant use.

Idiopathic bilateral adrenal haemorrhage related to acute adrenal insufficiency.

A 54-year-old woman presented with sudden epigastralgia and left back pain. She had no significant history. Laboratory data showed mild inflammation and no liver or renal dysfunction. Abdominal CT showed left adrenal enlargement and haemorrhage. Hydrocortisone therapy was started to prevent adrenal insufficiency before laboratory findings for ACTH (adrenocorticotropic hormone) and cortisol levels. On the second hospital day, abdominal CT showed additional right adrenal enlargement and haemorrhage. The serum cortisol level suggested adrenal insufficiency. No specific findings were detected by bilateral adrenal angiography. 6 to 12 months later, abdominal CT showed decreased bilateral adrenal haemorrhage. This case illustrates the importance of prompt diagnosis and treatment of acute adrenal insufficiency, and shows sequential changes in the size of bilateral adrenal haemorrhage. Rapid corticosteroid replacement is important if acute adrenal insufficiency is suspected. In a case with unilateral adrenal haemorrhage, the possibility of additional adrenal haemorrhage on the opposite side should also be considered.

IgG4-related inflammatory pseudotumors mimicking multiple meningiomas.

IgG4-related disease is an emerging clinicopathologic entity. Hypophysitis, diffuse thickening of dura, and enlargement of the trigeminal nerve are well-known intracranial involvements of IgG4-related disease. This report of a case of systemic IgG4-related disease is the first to present neuroimaging of apparent supratentorial meningioma-like lesions and thickening and contrast enhancement of the walls of the intracranial internal carotid arteries. It is important to recognize IgG4-related intracranial pseudotumors so that patients do not undergo unnecessary surgical procedures.

Successful treatment of pseudoaneurysm rupture after pylorus preserving pancreaticoduodenectomy by covered stent placement.

Serious complications after pancreaticoduodenectomy (PD) include pseudoaneurysm formation andABSTRACT rupture accompanying pancreatic fistula, and pancreatojejunostomy leakage, which is commonly associated with mortality or liver failure. We report a case of the successful treatment of pseudoaneurysm rupture after pylorus-preserving pancreaticoduodenectomy (PPPD) by covered stent placement. A 70-year-old man underwent PPPD for ampullary carcinoma. After the procedure, a pancreatic fistula was detected, and suction drainage was continued. The patient was discharged on the twenty-first post-operative day. On the same day, arterial bleeding was detected from the pancreatojejunostomy drain, and emergency abdominal angiography showed a pseudoaneurysm of 3-cm diameter at the proper hepatic artery (PHA). Multiple embolization coils were placed in a pseudoaneurysm. However, bleeding still continued, so hemostasis with coils was considered unfeasible. The next strategy was to place a covered stent, but the PHA was thick; thus, a biliary covered stent was implanted. Angiographic examination subsequently revealed that hepatic arterial flow was maintained, and there were no aneurysms. However, a few days later, a coil that had migrated into a peripheral branch of the right hepatic artery caused multiple hepatic abscesses, and percutaneous transhepatic abscess drainage was performed before the patient was discharged. Although coils were initially sufficient for hemostasis, repeatedly recurrent bleeding led to the consideration of a covered stent.

Squamous cell carcinoma of the lung in association with sarcoidosis.

A 76-year-old man who was known to have sarcoidosis, developed a lung tumor. He had previously undergone cardiac and abdominal vascular surgery, at which sarcoidosis was confirmed by lymph node biopsy. A right lower lobectomy was carried out. Postoperative pathology showed limited disease, but cancer recurred 1 year later. Issues regarding the combination of sarcoidosis and a malignant tumor are discussed.

Pancreatic endocrine tumor with partial acinar cell differentiation.

We examined a 70-year-old woman in whom a pancreatic endocrine tumor with partial acinar cell differentiation had been diagnosed. She had neither endocrine nor exocrine symptoms. The tumor was located in the pancreatic tail and measured 12.5 x 9.5 x 8 cm. It had a capsule, was composed of multiple adhesion nodules, and was elastically soft, medullary, and yellowish white. The neoplastic cells had large, irregular, oval nuclei; prominent eosinophilic nucleoli; and abundant eosinophilic cytoplasm with many fine granules. The cells had proliferated in islet-like solid medullary, trabecular, acinar, and papillary patterns. Most neoplastic cells were strongly positive for synaptophysin. 10 to 25% of the neoplastic cells were positive for alpha1-antitrypsin. Neuroendocrine and zymogen granules were simultaneously observed in the cytoplasm of the same neoplastic cells at the ultrastructural level. The tumor may be considered an amphicrine tumor.