No abstract available.
Bile Duct Neoplasms/complications/*diagnosis/pathology ; *Bile Ducts, Intrahepatic/pathology ; Cholangiocarcinoma/complications/*diagnosis/pathology ; Female ; Humans ; Lithiasis/*etiology/pathology/surgery ; Liver Diseases/*etiology/pathology/surgery ; Middle Aged

The most common finding related to nonalcoholic steatohepatitis is obesity, but a status of severe malnutrition can also induce the steatohepatitis. The authors report a rare case of steatohepatitis leading to hepatic decompensation caused by malnutrition after pancreaticoduodenectomy. A 68-year-old female patient who had been previously diagnosed with pancreatic cancer and had undergone pancreaticoduodenectomy 5 months previously presented with abdominal distension. Routine CT performed 3 months after the surgery revealed severe fatty liver without evidence of tumor recurrence. After undergoing pancreaticoduodenectomy her food intake had reduced, and as a result she had lost 7 kg of body weight over 2 months. At this admission, CT revealed moderate amounts of ascites without tumor recurrence. Furthermore, her albumin and lipid profile levels were markedly decreased, and she had a flapping tremor and slurred speech suggestive of hepatic encephalopathy. Her liver biopsy findings were consistent with steatohepatitis and disclosed macrovesicular steatosis without definite fibrosis. After careful nutritional control, her symptoms disappeared and her laboratory findings improved.
Aged ; Ascites/etiology ; Fatty Liver/*diagnosis/etiology/pathology ; Female ; Humans ; Liver Function Tests ; Malnutrition/*complications ; Pancreatic Neoplasms/surgery ; Pancreaticoduodenectomy ; Tomography, X-Ray Computed

Spontaneous intrahepatic bleeding is a rare condition. In the absence of trauma, intrahepatic hematoma may be due to underlying liver disease. We report a case of hepatocellular carcinoma in the patient who had huge intrahepatic hematoma without definite intrahepatic tumor at the time of initial presentation. A 54-year-old man was admitted to our hospital with a sudden onset of upper abdominal pain. Initial abdominal CT scan showed huge hematoma measuring more than 13 cm in diameter in the right lobe of the liver. However, there was no enhancing lesion in the liver. Laboratory data showed high alanine aminotransferase, alpha-fetoprotein and positive HBsAg. The MRI and angiography could not also depict any mass in the liver. The patient was treated with percutaneous drainage on the intrahepatic hematoma. The cytology from drainaged blood revealed no malignant cell. After hematoma decreased, follow-up CT scan depicted an enhancing tumor in the liver. He underwent right hepatic lobectomy and histopathological examination showed hepatocellular carcinoma.
Carcinoma, Hepatocellular/*diagnosis/pathology/surgery ; Hematoma/*diagnosis/etiology ; Humans ; Liver Diseases/*diagnosis/etiology ; Liver Neoplasms/*diagnosis/pathology/surgery ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

To study the manifestations of endoscopic retrograde cholangiopancreatography (ERCP) in patients of obstructive jaundice associated with HCC, 32 cases of histopathologically diagnosed HCC with obstructive jaundice were successfully examined with routine ERCP. 31 patients were demonstrated by ERCP as having malignant obstructive jaundice. Among them, 19 were hepatic perihilar bile duct stricture, 7 bile ductile tumorous thrombus, 3 perihilar bile duct stricture complicated with thrombus, 2 metastasis to hilar lymph node, and 1 common bile duct stone as proven by sphincterotomy. The malignant perihilar stricture was all of type III and IV by Bismuth standard of Klastin tumor. In patients identified as having bile duct tumor thrombus, by the Ueda classification, none was of type I and II; 1 type III a; 4 III b; 2 type IV. HCC with obstructive jaundice was mainly caused by the malignant infiltration of tumor, and most stricture was of serious nature. When major extra-hepatic bile duct was involved by tumor thrombus, obstructive jaundice might develop. Malignant perihilar stricture and tumor thrombus might coexist in some patients. Jaundice was rarely caused by hepatic hilar lymph node metastasis. Jaundice was not necessarily caused by tumors and sometimes, it might be caused by common bile stones. Care should be exercised in differentiation diagnosis in such patients.
Adult ; Aged ; Carcinoma, Hepatocellular ; complications ; diagnosis ; pathology ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Humans ; Jaundice, Obstructive ; diagnosis ; etiology ; Liver Neoplasms ; complications ; diagnosis ; pathology ; Male ; Middle Aged

We report on a case of a 57-year-old male who underwent a curative resection for hepatocellular carcinoma (HCC) with histological confirmation of a spontaneously necrotized tumor. Initial serum AFP level was 4,778 ng/mL. A 3.7 cm hyperechoic mass in segment 6 of the liver was observed on ultrasonography and dynamic contrast-enhanced liver MRI showed a 3.7x3.1 cm sized HCC. He was scheduled to undergo curative surgical resection under the clinical diagnosis of an early stage HCC (Barcelona Clinic Liver Cancer stage A). Without treatment, the serum AFP level declined rapidly to 50 ng/mL over five weeks. He underwent curative wedge resection of segment 6 of the liver. Histology revealed complete necrosis of the mass rimmed by inflamed fibrous capsule on a background of HBV-related cirrhosis with infiltration of lymphoplasma cells. Exact pathophysiology underlying this event is unknown. Among the proposed mechanisms of spontaneous neoplastic remission of HCC, circulatory disturbance and activation of host immune response offer the most scientific explanation for the complete histologic necrosis of HCC in the resected mass seen in our patient.
Carcinoma, Hepatocellular/*diagnosis/diagnostic imaging/pathology ; Hepatitis B/complications/diagnosis ; Humans ; Liver/diagnostic imaging/pathology ; Liver Cirrhosis/etiology ; Liver Neoplasms/*diagnosis/diagnostic imaging/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Necrosis ; Radiography ; Remission, Spontaneous ; Ultrasonography ; alpha-Fetoproteins/analysis

Breast cancer is a rare disease in men. We report a case of 53-year-old obese male, with known cryptogenic cirrhosis and hepatocellular carcinoma, presenting a tender mass on left breast. He was diagnosed with invasive intraductal carcinoma, which was consistent with a sporadic lesion. On the basis of previous literatures, obesity can be regarded as a cause for breast cancer even in men. However, there has been inconsistent data about link between liver cirrhosis and male breast cancer, which can be due to heterogenity in the etiology of cirrhosis. Through this case, it can be postulated that the risk for male breast cancer may vary according to the etiology of cirrhosis.
Breast Neoplasms, Male/*etiology/secondary/ultrasonography ; Carcinoma, Hepatocellular/diagnosis/pathology ; Humans ; Immunohistochemistry ; Liver Cirrhosis/complications/*diagnosis/pathology ; Liver Neoplasms/diagnosis/pathology ; Male ; Middle Aged ; Receptors, Estrogen/metabolism ; Tomography, X-Ray Computed

BACKGROUNDLiver abscess is a serious complication following transcatheter arterial chemoembolization (TACE). Much attention has been paid to this condition as it may interfere with the treatment process and result in a poor prognosis of the patient. This study aimed to analyze the causes of liver abscess, a complication, after TACE for hepatic tumors and to summarize management approaches.

METHODSFrom June 2012 to June 2014, of 1480 consecutive patients who underwent TACE at our hospital, five patients developed liver abscess after TACE procedures for hepatic tumors. Of the five patients, each receiving conventional TACE, one underwent three sessions, two underwent two sessions, and the remaining two underwent one session of TACE. Demographic and clinical characteristics, together with management approaches and prognosis, were collected through a review of medical records.

RESULTSThese five patients were confirmed to have post-TACE liver abscess through clinical manifestations, laboratory, and imaging tests. After percutaneous drainage and anti-inflammatory treatments, the symptoms present in four patients with liver abscess significantly improved as evidenced by shrinkage or disappearance of the abscess cavity, and the patients recovered completely after sufficient drainage. The remaining patient experienced recurrent symptoms and abdominal abscess, achieved no significant improvement after treatment, and eventually died of severe infection and multiple organ failures.

CONCLUSIONSTACE must be implemented with extreme caution to avoid liver abscess. An effective management relies on an early diagnosis, prompt use of sufficient doses of appropriate antibiotics, and active implementation of abscess incision, drainage, and aspiration.

Adult ; Aged ; Carcinoma, Hepatocellular ; therapy ; Chemoembolization, Therapeutic ; adverse effects ; Humans ; Liver ; pathology ; Liver Abscess ; diagnosis ; etiology ; Liver Neoplasms ; therapy ; Male ; Middle Aged ; Retrospective Studies

This report describes a patient with hepatic congestion due to right heart failure mimicking liver tumor. The patient had a history of breast cancer and left total mastectomy 30 years ago, tricuspid valve regurgitation and tricuspid valve replacement 4 years ago. Three years ago, abdominal contrast-enhanced computed tomography (CT) was performed to evaluate inguinal hernia, which revealed multiple small hepatic nodules. After 1 year, the number and size of liver nodules were increased in CT scan. The patient underwent gun biopsy and histopathology revealed sinusoid enlargement. The patient recently had jaundice, abdominal distension, and peripheral edema. Liver dynamic CT scan was done to evaluate the palpable liver. The number and size of liver nodules were more increased in CT than 2 years ago. In magnetic resonance imaging (MRI), numerous variable sized ill-defined nodules replacing entire liver with progressing centripetal enhancement, which were suggestive of malignancy such as angiosarcoma, were noted. MRI finding suspects malignancy or hemangiosarcoma. Finally, the patient received repeated gun biopsy, and histopathology revealed findings compatible with hepatic congestion.
Biopsy, Needle ; Female ; Heart Failure/*complications ; Humans ; Liver Diseases/*diagnosis/etiology/pathology ; Liver Neoplasms/diagnosis ; Magnetic Resonance Imaging ; Middle Aged ; Tomography, X-Ray Computed

BACKGROUND/AIMS: Liver cirrhosis and malignant tumors are two major causes of ascites according to the reports from Western countries, 80% and 10% respectively. Assuming that there might be regional differences in etiologies and changes in their frequency over time, we investigated causes of ascites and the diagnostic usefulness of various laboratory tests. METHODS: Medical records of 366 patients, who underwent diagnostic paracentesis in the mid-1990s (1996 and 1997) and early 2000s (2001 and 2002), were retrospectively reviewed. The etiology was confirmed by histology, imaging studies, and ascites analyses. RESULTS: The frequency of cirrhotic ascites was 59.6%, cancer-related 25.7%, tuberculous peritonitis 6.6%, and others 8.1%. Among cirrhotics, the frequency of cases related to hepatitis B decreased significantly from 72% to 55% over time, and alcoholic cirrhosis increased from 18% to 34%. Among cancer-related ascites, peritoneal carcinomatosis type was 75.5% (primary sites: stomach 24.5%, pancreas 15.9%, colon 15.9%, lung 7.4%, etc), metastatic liver cancers 8.5%, hepatocellular carcinoma without cirrhosis 6.4%, etc. The sensitivity of serum-ascites albumin gradient for the diagnosis of cirrhotic ascites was 91.4%, and total protein in ascites also revealed a comparable diagnostic sensitivity, 90%. The diagnostic sensitivity of adenosine deaminase for tuberculous peritonitis was 94.2%, and its positive predictive value was 75%. CONCLUSIONS: Liver cirrhosis is the leading cause of ascites, especially alcoholic cirrhosis has significantly increased. The next common etiology is cancer-related, and its frequency in Korea is higher than in western countries. Tuberculous peritonitis is still prevalent, and adenosine deaminase could precisely differentiate it from other causes.
Adenosine Deaminase/analysis ; Adult ; Aged ; Ascitic Fluid/chemistry/pathology ; Female ; Humans ; Liver Cirrhosis/*diagnosis/epidemiology/etiology ; Liver Cirrhosis, Alcoholic/*diagnosis/epidemiology ; Male ; Middle Aged ; Neoplasms/*diagnosis/epidemiology/etiology ; *Paracentesis ; Peritonitis, Tuberculous/*diagnosis/epidemiology ; Predictive Value of Tests ; Prevalence ; Retrospective Studies

OBJECTIVETo assess the value of magnetic resonance imaging (MRI) in mid- and long-term complication monitoring after liver transplantation.

METHODSTwenty-one recipients receiving orthotropic liver transplantation between Feb 2003 and May 2005 were enrolled in this study. FLASH T(1)-weighted, T(2)-weighted fast spin echo, T(2)-weighted fat suppression, dynamic gadolinium-enhanced, MR cholangiopancreatography (MRCP) and three-dimensional dynamic gadolinium-enhanced FISP MRA images were obtained.

RESULTSOf the 21 patients, bile duct complications were detected in all cases and liver arterial and venous complications in 8 cases. Liver cancer relapse occurred in 5 cases and allograft failure in 4.

CONCLUSIONMR imaging allows effective monitoring of mid- and long-term complications of liver transplantation, which provides valuable clues for their clinical treatment.

Adult ; Arterial Occlusive Diseases ; diagnosis ; etiology ; Bile Duct Diseases ; diagnosis ; etiology ; Female ; Hepatic Artery ; diagnostic imaging ; pathology ; Humans ; Liver Cirrhosis ; surgery ; Liver Neoplasms ; surgery ; Liver Transplantation ; adverse effects ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Radiography ; Reproducibility of Results ; Sensitivity and Specificity