Clival Metastasis of Hepatocellular Carcinoma with an Initial Histopathological Diagnosis of Atypical Pituitary Adenoma.

Histologically, hepatocellular carcinoma (HCC) and atypical pituitary adenoma are similar, posing a potential clinical problem. A 76-year-old woman, whose past medical history was significant for hepatitis C virus (HCV), positivity without liver cirrhosis was presented with abducens nerve (CN VI) palsy. Contrast-enhanced magnetic resonance imaging (MRI) showed a clival tumor with infiltration of the right cavernous sinus. Subtotal resection was performed using a right anterior petrosal approach. Histological diagnosis was pituitary adenoma. Thirty-four days after the operation, MRI imaging showed residual tumor growth without any liver masses on computed tomography (CT). The patient underwent a second operation using an endoscopic transnasal transsphenoidal approach. Histological examination of the specimen gave a positive reaction for α -fetoprotein. Repeat whole-body CT showed an enhanced liver mass. Based on these findings, the lesion was diagnosed as metastatic HCC. The patient died of liver failure 6 months later. In this case, tumor diagnosis was difficult because of the histological similarity of HCC and pituitary adenoma, and the fact that the clival tumor grew prior to presentation of the liver mass on CT. This case emphasizes the importance of comparing the pathological diagnosis with the patient's clinical course.

[Development of a simple quantitative method for the strontium-89 concentration of radioactive liquid waste using the plastic scintillation survey meter for beta rays].

Strontium-89 (89Sr: pure beta, E; 1.495 MeV-100%, halflife: 50.5 days) chloride is used as pain relief from bone metastases. An assay of 89Sr is difficult because of a pure beta emitter. For management of 89Sr, we tried to evaluate a simple quantitative method for the 59Sr concentration of radioactive liquid waste using scintillation survey meter for beta rays. The counting efficiency of the survey meter with this method was 35.95%. A simple 30 minutes measurement of 2 ml of the sample made the quantitative measurement of 89Sr practical. Reducing self-absorption of the beta ray in the solution by counting on the polyethlene paper improved the counting efficiency. Our method made it easy to manage the radioactive liquid waste under the legal restrictions.