Gigantic hepatocellular carcinoma, treated by transcatheter oily chemoembolization (TOCE) and wedge hepatic resection.

Four cases of gigantic hepatocellular carcinoma, considered by surgeons to be inoperable, were treated with repeated transcatheter chemoembolization (TOCE) until the serum alfafetoprotein reduced to normal or less than half of the original level or until the tumor reduced to less than half of the original size documented by CT scan and angiogram. Wedge hepatic resection was performed using ultrasonic dissector. Histologic section of the resected tumor mass revealed tumor necrosis. The extent of tumor necrosis was related to tumor size and corresponded inversely to the thickness of the tumor capsule. The survival periods were 48 to 108 months with only one to two episodes of recurrence during follow-up. Repeated wedge hepatic resection was performed successfully for recurrent cases. Serum alfafetoprotein (AFP) is a very sensitive and reliable tumor marker for follow-up results and appears to be a sensitive indicator for tumor recurrence.

Copper vapour laser treatment of café-au-lait macules.

Café-au-lait macules are skin lesions known to resist all kinds of treatment. Green light at a wavelength of 511 nm from a copper vapour laser through a built-in computerized scanner (SCANALL) was employed to treat café-au-lait-macules in 16 patients. The laser was used in continuous mode with a mean energy density of 8.9 J/cm2 (range 7-22 J/cm2). The mean number of treatment sessions was two. The response was good to excellent in 15 cases and poor in one. Transient hyperpigmentation at the periphery and temporary non-homogeneous hypopigmentation at the centre of the treated area was observed in some cases. These eventually returned to normal after a few months, without any textural change. Pre- and postoperative histological finding are also presented. There was no recurrence at a mean follow-up time of 22 months. Copper vapour laser is an effective modality for the treatment of café-au-lait macules.

Fungal sinusitis the important role of the histopathology in the clinical management.

Four cases of fungal sinusitis are reported. These include one case of aspergillus sinusitis alone, one case of combined aspergillus and paecilomyces sinusitis, and two cases of mucormycotic (zygomycotic) sinusitis. Although fungal sinusitis appears to be rare, it can pose difficulty in clinical diagnosis and we have demonstrated how the pathologist can help to alert the otolaryngologists of possible fungal sinusitis. Since the histopathological examination is important, a specimen for biopsy is mandatory.

Enterobiasis: a histopathological study of 259 patients.

Enterobius worms or their eggs, or both, are present in preserved tissue sections or tissue specimens of 259 patients whose medical records are on file at the Armed Forces Institute of Pathology, Washington D.C., U.S.A. The most common site of infection (86.5%) was found to be the lumen of the appendix, where the worms provoke no reaction. Of the 259 patients 11 (4.2%) had worms and/or eggs in granulomas of the abdominal and pelvic peritoneum, and an equal number had granulomas on the peritoneum of the salphinx or on the surface of the ovary. There were also ectopic worms and/or eggs in granulomas on the peritoneum of the small and large intestines (2.7%). These Enterobius granulomas form around degenerating adult worms, around discrete eggs, around clusters of eggs, and, we believe, also around the tracks of migrating worms. Three patients (1.2%) had worms in perianal abscesses. A necrotic granuloma, removed from the lung of one patient, surrounded a degenerating adult worm. This suggests that the worm, carried to the lung as an embolus, impacted in a pulmonary arteriole. A stool specimen of one patient contains eggs of Enterobius, and that of another patient contains an adult Enterobius. This is the largest recorded histopathological study of enterobiasis in man.