A Surgical Case of Inflammatory Myofibroblastic Tumor of the Liver: Potentially Characteristic Gross Features.

We herein reported a very rare surgical case of inflammatory myofibroblastic tumor (IMT) of the liver, showing potentially unique and specific gross findings on its cut surface: our IMT demonstrated a relatively well-demarcated and partly infiltrative and likely extrahepatic (ie serosal) but not intrahepatic mass, appearing firm and hemorrhagic, and yellow-whitish in color. The patient, who was a woman in her early 70s with 2-year follow-up for lung cryptococcosis and traffic accident, incidentally presented with unenhanced and low-density, heterogeneous mass on abdominal dynamic CT in the peripheral right lobe of the liver. We could conclusively diagnose the current lesion as the hepatic IMT after thorough analyses including a wide panel of immunohistochemical antibodies. Despite that, all clinicians and pathologists should be aware that the potentially characteristic, extrahepatic gross feature of IMT of the liver might also be one of the powerful supplementary tools for reaching its correct diagnosis. One of our aims in the presented case report is to emphasize that the hepatic IMT should be considered clinicopathologically in the differential diagnosis of mass lesions on the liver.

Ten Cases of Colovesical Fistula due to Sigmoid Diverticulitis.

Colovesical fistula (CVF) resulting from colon diverticulosis is a comparatively rare disease, and neither the diagnosis nor treatment has been established. Our experience with CVF due to sigmoid diverticulitis over a 9-year period was reviewed to clarify the clinical presentation and diagnostic confirmation. Ten patients with CVF were identified in this period, and chief complaints, laboratory findings, presenting symptoms, diagnostic investigations, and subsequent treatments were reviewed. Preoperative urinalysis showing bacteriuria (100%) was the most common presentation, followed by fecaluria (40%), abdominal pain (40%), pneumaturia (30%), hematuria (30%), pain on urination (30%), pollakiuria (10%), and dysuria (10%). The abilities of various preoperative investigations to identify CVF were: computed tomography (CT), 88.9%; magnetic resonance imaging, 40%; cystoscopy, 30%, and gastrografin irrigoscopy, 22.2%. Colonoscopy (0%) was not diagnostic. Bowel resection was performed in nine of ten patients. When inflammation was intense, covering ileostomy was performed, and an omental plasty was placed between the bowel anastomosis and bladder. When CVF is suspected, we recommend CT followed by colonoscopy and cystoscopy as a first-line investigation to rule out malignancy as a cause. Other modalities should only be used if the diagnosis is in doubt or additional information is needed to plan operative management. Primary colic anastomosis appears to be safely performed by applying omental plasty and covering ileostomy.

[Radiofrequency ablation therapy combined with hepatectomy for liver metastasis of colorectal cancer].

Radiofrequency ablation (RFA) therapy combined with hepatectomy was performed in 5 patients with synchronous liver metastases of colorectal cancer. RFA of liver metastases was performed using a Cool-tip electrode (Radionics; Burlington, MA, USA). The ablation time used in each session varied according to the tumor size and intraoperative impedance. In 2 patients, hepatectomy and resection of the colorectal primary lesion were performed synchronously. In patients with multiple liver metastases, relative curative resection was performed using the complementary RFA. In the other 3 patients, synchronous hepatectomy was considered difficult and systematic chemotherapy was performed after resection of the colorectal primary lesion. After systematic chemotherapy, the range of hepatectomy was restricted for liver injury, but relative curative resection was performed using RFA therapy. Computed tomography performed after hepatectomy showed that the region that underwent RFA appeared necrotic with a safety margin. The average observation period was 25 months (maximal survival period, 50 months) and 3 of the patients are alive.

[A case of multiple lung metastases of hepatocellular carcinoma after resection of liver and tumor thrombi in the inferior vena cava responding to chemotherapy using 5-FU, mitoxantrone and CDDP].

A 58-year-old man, who had a history of chronic type B hepatitis, was diagnosed as hepatocellular carcinoma with tumor thrombi in the inferior vena cava. He underwent resection of central bisegments and tumor thrombi, while postoperative chest CT demonstrated multiple lung metastases. Following 2 courses of chemotherapy using 5-FU, mitoxantrone, and CDDP (FMP therapy), multiple lung nodules disappeared and alpha-fetoprotein returned to the normal level. FMP therapy thus proved effective for a case of distant metastases of hepatocellular carcinoma.

New method of visualizing lymphatics in lung cancer patients by multidetector computed tomography.

OBJECTIVE: The aim of the present study was to investigate the safety and acceptability of a new method of visualizing lymphatics, including sentinel lymph nodes (SNs), in lung cancer patients using multidetector computed tomography (MDCT). METHODS: Images were obtained using an MDCT scanner (Asteion Multi 4 Detector-Row; Toshiba) at 1, 2, and 3 minutes after percutaneous injection of 1 mL contrast medium (iohexol) near the tumor in 15 patients with small peripheral lung cancers (cT1N0M0). A lymph node was confirmed to be an SN if the attenuation was more than 30 Hounsfield units greater on postcontrast images than on precontrast images. All patients underwent surgery, and definitive lymph node staging was assessed. RESULTS: The procedure was performed safely in all patients without significant complications. Lymphatic ducts or lymph nodes were visualized in all 15 patients. The SN was identified in 14 of 15 patients (93.3%) at lymph node 14 in 4 patients, lymph node 13 in 7, lymph node 12 in 6, and lymph node 6 in 1. In 1 remaining patient, the lymphatic duct running from the tumor toward the pleura was visualized. CONCLUSIONS: Lymphatics were visualized by this method in all patients without significant complications. This method should be useful not only to detect the SNs but to visualize pathways other than through the hilar lymph nodes.

[A review and development of sentinel node navigation surgery for lung cancer].

Sentinel node navigation surgery (SNNS) for lung caner has not yet been established. Sentinel node (SN) identification using dye or radioisotope has been developed; however, the SN identification rate was less than 50% in the dye method and use of radioisotopes is strongly restricted in Japan. The novel method using a CT or MRI contrast medium are expected. A study of local immune reaction for lung cancer in SN is also a very interesting issue.