Diagnostic usefulness of FDG-PET for malignant somatostatinoma of the pancreas.

A 24-year-old female complaining of diarrhea and back pain was admitted to hospital where a tumor of the pancreatic head was revealed on a computed tomography (CT) scan. Abdominal ultrasonography, CT and celiac angiography revealed a hypervascular lesion on the pancreas. An endocrine tumor, particularly a somatostatinoma, was suspected and hormone levels in the blood were examined. Serum hormone levels were normal, so FDG-PET was performed. An abnormally high accumulation of FDG was detected on the FDG-PET image at the head of the pancreas, and the SUV of the lesion was 3.2, so the mass was considered to be malignant on FDG-PET. Pylorus-preserving pancreatoduodenectomy was performed with a preoperative diagnosis of malignant endocrine tumor. The resected specimen revealed a massive, yellowish-white tumor of the pancreas head measuring 50x 45x38mm. Histologically, the tumor was a malignant islet-cell tumor, and immunohistochemically the tumor stained with an anti-somatostatin antibody, but not with antibodies against glucagons, insulin or vasoactive intestinal polypeptide. The patient was discharged after the operation and has remained well without recurrence for 5 years. Liver metastatic tumors, however, appeared 6 years after the operation.

Efficacy of transplanting cryo-preserved and encapsulated xenogeneic fetal liver fragment as an auxiliary liver support in 90%-hepatectomized rats.

BACKGROUND/AIMS: Xenogeneic-hepatocyte or liver-fragment transplantation could be an attractive clinical option in hepatic surgery for patients with impaired liver function if xenogeneic hepatocytes or liver fragments could be preserved for lengthy periods and if immunoisolation could be more easily achieved. METHODOLOGY: Porcine fetal and adult livers were used as xenogeneic transplants in rats. The grafts were stored frozen for more than one year in liquid nitrogen. After thawing, they were evaluated histologically and for potential function for auxiliary liver support in 90%-hepatectomized rats. The efficacy of microporous polypropylene membrane as a macrocapsule for immunoprotection was also examined. RESULTS: Frozen liver fragments could be preserved in liquid nitrogen for more than one year. Fetal fragments were better able to survive under the given conditions than the adult fragments. Macrocapsules protected the grafts from xenoantibodies. The survival rate of encapsulated fetal liver fragment-transplanted recipients on the seventh day after 90%-hepatectomy was 72%, while transplant recipients of fragments of fetal-liver, adult-liver, and encapsulated adult-liver, were 0, 0, and 0, respectively. CONCLUSIONS: Porcine fetal liver fragments survived longer in liquid nitrogen than did the adult ones. The fragments retained their capacity to provide auxiliary liver support in 90%-hepatectomized rats.

Mucosa-associated lymphoid tissue lymphoma of the extrahepatic bile duct.

Mucosa-associated lymphoid tissue lymphoma of the extrahepatic bile duct has not yet been reported. Much more common than this is secondary involvement of the extrahepatic bile duct in cases of disseminated lymphoma. A 59-year-old man manifesting jaundice was referred to our hospital. PTC revealed an extrahepatic bile duct stenosis from the hilum to the lower part of the choledochus. On the operative specimen, we examined L26/CD20, Bcl-2, UCHL-1/CD45RO, cyclin D1 and p53. Histologically, follicular colonization, centrocyte-like cells and lymphoepithelial lesion was observed. Tumor cells were positive for L26/CD20 and Bcl-2 and were negative for intracytoplasmic immunoglobulins, UCHL-1/CD45RO, cyclin D1 and p53. Pathological diagnosis was mucosa-associated lymphoid tissue lymphoma of the extrahepatic bile duct. The authors present herein the first case of mucosa-associated lymphoid tissue lymphoma of the extrahepatic bile duct. It was very difficult to distinguish from hilar cholangiocarcinoma clinically. Only incomplete stenosis of the bile duct and 18-F fluoro-2-deoxyglucose positron emission tomography (FDG-PET) could suggest this unusual clinical entity.

Expression of EphA2 and E-cadherin in colorectal cancer: correlation with cancer metastasis.

Recently, overexpression of EphA2, a member of the Eph family of receptor tyrosine kinases, has been reported in several cancers. Reduced expression of E-cadherin, an intercellular adhesion molecule of epithelial cells, has been reported to be associated with aggressive clinicopathological phenotypes in various cancers. In epithelial cells, EphA2 and E-cadherin co-localize to sites of cell-cell contact, and it has been shown that E-cadherin regulates EphA2. This study aimed to clarify the relationship between the expression of the EphA2 and E-cadherin proteins and clinicopathological characteristics, with reference to the expression levels of both EphA2 and E-cadherin, in patients with colorectal cancer. We performed immunohistochemical staining of EphA2 and E-cadherin with EphA2 and E-cadherin monoclonal antibodies in samples from 194 primary lesions of colorectal cancer. The expression level of EphA2 had a statistically significant relationship with liver metastasis, lymphatic vessel invasion and clinical stage (p=0.0477, 0.0316 and 0.0467, respectively). In addition, the positivity rate of EphA2 was significantly higher in primary lesions with lymph node metastasis than in those without metastasis (p=0.0014). However, the expression level of E-cadherin had an inverse relationship with both differentiation level of the tumor and lymphatic vessel invasion (p=0.0430 and 0.0320, respectively). Furthermore, a significant relationship between the expression of EphA2 and E-cadherin was observed. In conclusion, our study revealed that the overexpression of EphA2 protein in colorectal carcinoma tissue correlates closely with cancer progression and hematogenous and lymphogenous metastasis, suggesting that both EphA2 and E-cadherin may play an important role in tumor metastasis in colorectal cancer.

Antitumor effect of a splenic injection of 5-fluorouracil on metastatic liver cancer in mice.

The regional administration of 5-fluorouracil (5-FU) has been the fundamental therapy against liver metastases for the improvement of patient prognosis; however, there have been few reports about the immunological effects of this agent. It is also unknown whether it affects the spleen, one of the major lymphoid organs. The objective of the present study was to determine the immunological effect of an intrasplenic injection of 5-FU against liver metastases. We investigated the effect of an intrasplenic injection of 5-FU on the formation of experimental liver metastasis resulting from an intraportal vein injection of colon 26 carcinoma cells in BALB/c mice and elucidated some of the underlying mechanisms involving the effects of this on cellular immunity. Liver metastases were significantly diminished by the splenic injection of 5-FU, particularly in comparison with the portal injection or systemic administration. This was followed by augmentation of the interleukin-12 (IL-12) level in the spleen and activation of hepatic mononuclear cells. In those cells, NK1.1+ (NKT) cells played a central role against metastases. A splenic injection of 5-FU is more effective on the involution of liver metastases than portal or systemic injection. This effect may be attributed to the augmentation of the IL-12 level in the spleen and of NKT cells in the liver rather than to the original effect of 5-FU, which is the so-called inhibition of DNA synthesis.

Resected case of a double cancer, a hepatocellular carcinoma and a cholangiocellular carcinoma, and their spread to the skin.

Combined hepatocellular and cholangiocellular carcinomas are rare. Moreover, double cancer cases of hepatocellular carcinoma and cholangiocellular carcinoma are very rare. This report describes a patient with double cancer. A correct clinical diagnosis was made with successful resection, and cutaneous metastases occurred near the exit site of an abdominal drain after the resection of the tumor. The patient, a 66-year-old man with chronic hepatitis C, was admitted to our hospital because he was suspected of having primary liver cancer. Two liver masses in the anteroinferior segment were detected by using angiography, computed tomography during angiography, and computed tomography during arterioportography. These clinical findings indicated that the tumor in the right lobe was hepatocellular carcinoma. A resection of the S5 subsegmentectomy was performed. One mass was diagnosed histologically as hepatocellular carcinoma, and the other mass was diagnosed as cholangiocellular carcinoma. One year after the operation, the patient palpated a hard subcutaneous nodule 4.0 cm in diameter in the right lower abdominal wall. A subcutaneous tumor was excised, and a histological examination revealed moderately differentiated hepatocellular carcinoma. The patient is currently doing well without further recurrence of hepatocellular carcinoma or cholangiocellular carcinoma, 18 months after subsegmentectomy and six months after excision of the subcutaneous tumor.

Carcinoid of the papilla of Vater; a case report.

A 68-year-old Japanese man, without any symptoms, was found to have a carcinoid tumor of the Ampulla of Vater. A physical examination indicated no anemia or jaundice and no abnormal findings at all in the chest or abdomen. Except for glucose intolerance, the routine laboratory data were normal. An endoscopic biopsy was performed that suggested malignant tumor cells. There were no signs of carcinoid syndrome. A pylorus-preserving pancreatoduodenectomy with extensive lymph node dissection was performed. Histological and immunohistochemical studies resulted in the diagnosis of a carcinoid of the papilla of Vater, without regional lymph node metastases. Although postoperative, an anastomotic leakage of pancreaticogastrostomy was noted; the pancreatic fistula was closed seven weeks later to use the somatostatin analogue.

Laparoscopic resection of splenic artery aneurysm; a case report.

We report a case of a patient who underwent three-dimensional arterial computed tomography, color Doppler sonography and laparoscopic splenectomy for splenic artery aneurysm. Helical computed tomography revealed a splenic artery aneurysm, 3.0 x 1.8 cm in diameter. Color Doppler sonography reveals a weak pulsatile flow from the aneurysm. Surgical treatment is indicated for such cases since approximately 10% of these aneurysms tend to rupture which thus results in fatal hemorrhaging. As a result, a laparoscopic splenectomy was performed. According to our experience, three-dimensional computed tomography and color Doppler sonography can be performed for the arterial and venous information with less invasion than angiography and a laparoscopic splenectomy for splenic aneurysm can be performed which is safer and less invasive than conventional open procedure.

Left hepatectomy for the choledochal cyst (type IV-A) with intrahepatic stenosis: report of a case.

The case of a 16-year-old male with expansion of the gallbladder and dilatation of the common bile duct is reported. Ultrasonography and computed tomography imaging showed expansion of the gallbladder and eminent cystic dilatation in the common bile duct and the left intrahepatic bile duct. Endoscopic retrograde cholangiopancreatography indicated expansion-like beads of the bilateral hepatic ductus and the left intrahepatic bile duct, including anomalies of the pancreaticobiliary ductal junction. Because relative stenosis of the membranous diaphragm was revealed in the porta hepatis, we diagnosed this case as a type IV-A choledochal cyst, using Todani's classification. Intraoperative cholangiography and cholangiofiberscopy showed a pinhole stricture and re-expansion of the tip of the left intrahepatic bile duct. As the narrow segment could not be expanded though we put proper pressure there, left hepatectomy was performed as a preventive measure in addition to extended biliary tract excision and cholangiojejunostomy. Hepatectomy seems to be an appropriate choice in a case of intrahepatic stenosis to help increase the patient's postoperative quality of life.

A comparison of right-lobe and left-lobe graft for living-donor liver transplantation.

BACKGROUND/AIMS: The practice of living-donor liver transplantation has been widely established. However, in adult cases, the issue of graft liver volume has been raised. Recently, liver transplantation using the right lobe has been done in cases requiring a larger graft volume. We compared right lobectomy with left lobectomy for hepatocellular carcinoma not accompanied by liver cirrhosis and examined the safety of hepatic right lobectomy for donation. METHODOLOGY: In total, 124 hepatocellular carcinoma patients without liver cirrhosis, 89 who had undergone right hepatectomy and 35 who had undergone left hepatectomy, were studied. For each group, we statistically examined the patients' profiles. RESULTS: The resected right lobe was significantly heavier than the left lobe. There were significant differences between the two groups in terms of the number of blood transfusions needed. Moreover, delayed recoveries in terms of hemoglobin, total bilirubin, and clotting disorder on postoperative day 7, as well as the frequency of any complications, were more prevalent in the right-lobe group. CONCLUSIONS: It was confirmed that right lobectomy is more invasive than left lobectomy. It is necessary to prioritize the donor's safety and quality of life in living-donor liver transplantation, and adequate medical and ethical consideration is demanded.