Cerebellar Arteriovenous Malformation with Coexistent Hemangioblastoma.

BACKGROUND: This is a case of a man aged 40 years with a past medical history of smoking, hypertension, polycythemia vera, intellectual disability, and schizophrenia who presented with generalized headaches, progressive loss of balance, and visual disturbance for 1 month. CASE DESCRIPTION: Head computed tomography and magnetic resonance imaging revealed a right cerebellar hematoma associated to heterogenous lesion with cystic components and flow-voids in the right cerebellar hemisphere. A ventriculoperitoneal shunt was placed with partial improvement of symptoms. Further vascular studies confirmed presence of a vascular nidus with significant arteriovenous shunting. The patient later required intervention for cerebellar arteriovenous malformation (AVM) removal. Microscopic evaluation of the lesion showed the AVM nidus, as well as large, vacuolated stromal cells and numerous thin-walled vessels. Immunostaining with inhibin and S-100 highlighted the stromal cells with numerous lipid-containing vacuoles. The earlier mentioned findings were consistent with the diagnosis of an AVM with coexistent hemangioblastoma of the right cerebellar hemisphere. CONCLUSIONS: Coexistence of hemangioblastomas and AVMs are extremely rare, and only 3 cases have been reported previously in the literature.

Viral hepatitis and hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide, and one of the fastest rising tumors as a result of chronic hepatitis B and C infection. The patients at risk for developing HCC are those with underlying cirrhosis secondary to viral hepatitis. External factors such as alcohol, tobacco, obesity, and diabetes increase the risk of HCC among those with chronic viral hepatitis. Surveillance of patients with cirrhosis with alpha-fetoprotein and ultrasound has been shown to reduce survival. The diagnosis of HCC is established by the presence of an arterially enhancing mass in the presence of cirrhosis. Viral hepatitis represents an opportunity for prevention of HCC.

Hepatocellular carcinoma.

PURPOSE OF REVIEW: This year the number of papers published regarding hepatocellular carcinoma (HCC) continued to increase compared with last year, coinciding with an increase in incidence and awareness of this tumor. RECENT FINDINGS: Molecular clock studies determined that hepatitis C-related HCC will continue to increase over the next 20 years mimicking the Japanese epidemic. Non-alcoholic fatty liver disease, the most common chronic liver disease in the US, has been associated with HCC. Obesity has been shown to be an important risk factor for the development of HCC. Glypican-3 was shown to be able to discriminate between cirrhosis and HCC, and therefore has the potential to be a novel tumor marker. Dynamic gadolinium MRI is the preferred imaging of choice for the evaluation of HCC. Liver transplantation continues to be the preferred treatment of HCC. However, in nonsurgical HCC transarterial chemoembolization and radiofrequency ablation have been shown to improve survival. SUMMARY: As the incidence of HCC continues to increase, identifying those at risk for developing this tumor is of paramount importance. Therefore, the findings of obesity as an important risk factor and Glypican-3 as a potential tumor highlight significant advances for the early detection of this tumor so therapies, such as liver transplantation and chemoembolization, can be applied.