Primary carcinoid tumor of the liver: report of two cases with an emphasis on US findings.

Primary carcinoid tumor of the liver is rare, and its sonographic (US) findings have rarely been reported. We present two histologically proven cases. Both patients were asymptomatic and huge masses, found incidentally by US, were echogenic with many cystic areas. Lesions were markedly hypervascular on color Doppler US and angiography. Thus, primary carcinoid tumor of the liver should be considered when US detects this type of mass in asymptomatic patients.

Ciliated hepatic foregut cyst: case report with an emphasis on US findings.

Ciliated hepatic foregut cyst (CHFC) is a rare mass, and its medical imaging findings are seldom reported. We present a histologically proven case of CHFC. The patient was asymptomatic, and a mass was found incidentally by sonography (US) in segment IV. The lesion was almost anechoic on fundamental US but filled with dense echoes with distinct posterior echo enhancement on second harmonic imaging. The lesion was avascular on color Doppler US and angiography. Thus, when US detects a mass in segment IV, the possibility of a CHFC should be considered regardless of the US results.

[Examination of the stability of chloral hydrate and its preparation by capillary electrophoresis].

Stabilities of chloral hydrate in an aqueous solution and its medicated syrup were examined by high performance capillary electrophoresis. Analysis of the concentration of chloral hydrate indicated that there was no obvious change in the concentration of chloral hydrate both in the aqueous solution and in the syrup preparation after keeping them for 3 months at room temperature or at 60 degrees C. The lowering of pH was more obvious in the syrup solution than in the aqueous solution, and this tendency was estimated to be due to the formation of hydrochloric acid. We propose that the stabilities of the preparation of chloral hydrate should be monitored by observing pH changes.

Centrifugal lipodystrophy of the face mimicking progressive lipodystrophy.

We report a Japanese boy with centrifugal lipodystrophy. The initial lesion developed on the forehead as an area of erythema which showed centrifugal spread and central fading to leave a residual depression. Three years later, similar erythematous lesions appeared on the cheeks, and he developed a cadaverous appearance. A central depression on the upper trunk was surrounded by an erythematous border and there was right cervical lymphadenopathy. Histological examination revealed inflammatory changes in the subcutaneous fat. Although this patient showed the characteristics of both centrifugal and progressive lipodystrophy (partial lipodystrophy), we consider that he has centrifugal lipodystrophy of the face because of the overall features of the lesions.

Papillomavirus-infected keratinous cyst on the sole. A histologic, immunohistochemical, and electron microscopic study.

A 17-year-old boy had a keratinous cyst on the sole. The keratinous cyst and its overlying epidermis had solitarily scattered keratinocytes, which contained a peculiar intracytoplasmic inclusion body above the lower spinous layer. Immunohistochemistry and electron microscopy revealed that the nuclei of these cells had virions of papillomavirus. These virions appeared above the spinous layer. The inclusion bodies were highly eosinophilic masses in the viable layer, and slightly basophilic, fine granules in the cornified layer. Their number at any time was usually one. Their histologic and ultrastructural features and their N-(7-dimethylamino-4-methylcoumarinyl)-maleimide staining property were different from those of keratohyalin and from those of amyloid or hyaline body. Also the keratinous cyst was associated with colloid bodies, showing the lamellated figure in the subepithelial area.

Biphasic amyloidosis arising from friction melanosis.

A 40-year-old woman who had used nylon towels in the bath for about 10 years noticed hyperpigmentation on the prominent regions over the bones of the trunk and extremities. She also developed lichenoid papules with itching on her back. Histologically, both the pigmented and the papular lesions had amyloid deposits beneath the epidermis. In this case it is presumed that the papular lesions with amyloid (lichen amyloidosus) developed initially from friction melanosis which became macular pigmented lesion (macular amyloidosis). The etiologic factor of these sequential pathologic changes is considered to be repeated scrubbing with nylon towels.

Quality check of heparin injections by 1H-nuclear magnetic resonance spectroscopy.

The quality of commercial heparin injections was examined by 400-MHz proton nuclear magnetic resonance (1H-NMR) spectroscopy using several measuring modes. The signals of the N-acetyl protons, as well as the sugar-ring protons, attached to the sulfamino and sulfato group-bearing carbons could be easily distinguished from other proton signals and quantified. Measuring at a high temperature (60 degrees C) enabled clear isolation of the H-5 proton signal in the sulphated iduronic acid residue (Is-5) from other proton signals including that of water. The heparin contents of various heparin injections were estimated by using this signal as an index. However, the signal intensity was not parallel with anticoagulant activity. On the other hand, the N-acetyl proton signal was highly correlated to anticoagulant activity. The present method was also useful for concurrent identification of additives in heparin injections.

Hepatocellular carcinoma and bladder cancer as complications following five years of chemotherapy for acute myeloblastic leukemia.

Acute myeloblastic leukemia (AML) was diagnosed in a 54-year-old male, a chronic hepatitis B surface antigen (HBsAg) carrier, in June, 1983. Prompt remission was achieved, and maintenance and intensification chemotherapy were given for five years. He was readmitted in March, 1988 because of a mass in the liver and was diagnosed as having hepatocellular carcinoma (HCC). Curative right segmentectomy was performed in May, 1988. In December, 1988, transitional cell carcinoma of the bladder was discovered, and resected transurethrally. These secondary neoplasms, HCC and bladder cancer, were thought to be associated with the long-term chemotherapy given for the AML.

Microcystic adnexal carcinoma. Electron microscopic and immunohistochemical study.

We present a patient with microcystic adnexal carcinoma. The lesion was an indurated plaque on the skin of the right upper lip of a 58-year-old woman which was slowly growing during 27 years. Carcinoembryonic antigen was immunoreactive in the luminal contents of the tumor ducts and in the cytoplasm of cells surrounding ducts. S-100 protein was positive in the cytoplasm of a few cells at the lower dermis. These observations suggested that this tumor was related to sweat glands. Furthermore, electron microscopy revealed that tumor cells had features of eccrine ductal cells. These observations confirm that this tumor appeared at least capable of eccrine duct differentiation.

Cutaneous focal mucinosis.

A 39-year-old man had typical cutaneous focal mucinosis on the left forearm. The fibroblasts in the myxomatous lesion had many cytoplasmic vesicles, and on electron microscopy, these were compatible with condensing vacuoles or secretory granules. The fibroblasts in this case were considered to be mucoblasts involved in the over-production of the ground substance, that was mainly composed of hyaluronic acid.

[Hepatocellular carcinoma treated with a curative segmentectomy five years after complete remission of acute myeloblastic leukemia].

Acute myeloblastic leukemia (AML) was diagnosed in a 54-year-old male who had been known to carry a chronic hepatitis B surface antigen (HBsAg) from June, 1983. Prompt remission was achieved with combination chemotherapy of BHAC-DMP. Follow-up maintenance and an intensification of this chemotherapy had been given for five years. He was readmitted to our hospital in March, 1988 because a mass was detected in the right lobe of the liver by ultrasonography. His serum alpha fetoprotein (AFP) level was found to be 180.1 ng/ml, and was diagnosed as having a hepatocellular carcinoma though there was no evidence of liver cirrhosis. A curative right hepatectomy was performed in May, 1988 after transcatheter arterial embolization and portal embolization. After resection of the tumor, the AFP level decreased to 10.7 ng/ml and no HbsAg was detected in the serum.

Effects of bile duct obstruction and decompression on hepatic microsomal mixed function oxidase system in rats.

The effects of biliary obstruction and drainage on the hepatic microsomal mixed function oxidase system were studied in rats. Bile duct obstruction produced a significant reduction in the hepatic cytochrome P-450 dependent mixed function oxidase system. After release of the bile duct obstruction, the reduction in microsomal enzymes was practically reversible; however, the process of recovery was slow and differed with the microsomal enzymes in question. Increases in cytochrome b5 content and NADH-cytochrome b5 reductase activity were slower than increases in cytochrome P-450 content and NADPH-cytochrome c reductase activity. Aniline hydroxylase activity increased more rapidly and corresponded to cytochrome P-450 contents more so than did the aminopyrine demethylase activity. After the release of bile duct obstruction, however, the bile acids which had accumulated in the liver during cholestasis were reduced rapidly, to a normal range. These results suggests that there is a discrepancy between reductions in hepatic bile acids and those in the hepatic microsomal mixed function oxidase system after biliary decompression.