Angiomyolipoma is a benign renal tumor composed of thick- walled blood vessels, smooth muscle cells, and adipose tissue. Despite the aggressive biological and histological features associated with angiomyolipoma, the lack of distant metastasis led us to conclude that angiomyolipoma is a benign neoplasm. Epithelioid angiomyolipoma is a recently described variant type of angiomyolipoma of the kidney. Diagnosis is usually made by histological method and immunohistochemical staining with HMB-45. Several reports suggested the presence of malignant epithelioid angiomyolipomas showing multiple metastases and local aggressiveness. We report a case of epithelioid angiomyolipoma with multiple metastases. Local recurrence and liver, bone and lung metastases developed 11 months after radical nephrectomy. Right hepatectomy and wedge resection of left lobe of the liver with radiation therapy were done.
Adipose Tissue ; Angiomyolipoma* ; Blood Vessels ; Diagnosis ; Hepatectomy ; Kidney ; Liver ; Lung ; Myocytes, Smooth Muscle ; Neoplasm Metastasis* ; Nephrectomy ; Recurrence

BACKGROUND/AIMS: The diagnosis and treatment of benign hepatic lesions remain controversal. The widespread availability of ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI), and their frequent application in evaluating abdominal pain, has resulted in more frequent discovery of incidental benign hepatic lesions. To address these points, the clinical data of patients with benign hepatic lesions treated with surgical resections at our hospital were reviewed retrospectively. METHODS: We reviewed the clinical records of thirty nine patients with benign hepatic lesions who had undergone hepatic resection from January, 1985 to August, 2002 at Hanyang University Hospital. RESULTS: There were 39 patients, whose mean age was 47.0 years. The ages ranged from 24~74 years. There were 14 male patients and 25 female patients. The ratio of male and female was 1:1.8. Major symptoms were right upper quadrant pain, mass, epigastric pain, and non-specific GI symptoms. 22 cases of anatomical resections (10 right lobectomy, 5 left lobectomy, 7 left lateral segmentectomy) and 17 non anatomical resections were done. There were no postoperative deaths in this series. Fourteen patients (35.9%) developed operative complications. All of them were minor complications. During the mean follow up time, symptomatic relief was achieved in patients out of patients who we could contact with opd follow up or telephone interview. Three patients died of massive pleural effusion 4 years after operation, myocardial infarction 14 months after operation, alcoholic liver cirrhosis and diabetes mellitus 33 months after operation. CONCLUSION: Hepatic resection in patients who had benign hepatic lesions in the liver was safe and effective treatment modality if patients were selected with suitable indications.
Abdominal Pain ; Diabetes Mellitus ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Interviews as Topic ; Liver ; Liver Cirrhosis, Alcoholic ; Magnetic Resonance Imaging ; Male ; Myocardial Infarction ; Pleural Effusion ; Retrospective Studies ; Ultrasonography

The incidence of duodenal diverticulum found incidentally during upper gastrointestinal roentgenographicexamination varies between 2% and 5%. The majority of cases occur along the medial aspect of the second portion of the duodenum, within 2.5cm of the ampulla of Vater. The majority of duodenal diverticula are asymptomatic, but insome cases, complications such as diverticulitis, hemorrhage, perforation, and fistula formation occur in thethird and fourth portions of the duodenum. We describe a case of giant diverticulum of the transverse duodenum,revealed by UGI and angiography, massive gastrointestinal bleeding in a 80-year-old patient.
Aged, 80 and over ; Ampulla of Vater ; Angiography ; Diverticulitis ; Diverticulum* ; Duodenum* ; Fistula ; Hemorrhage* ; Humans ; Incidence

Adult polycystic liver disease (APLD) is an inherited, benign rare condition, often associated with polycystic kidney disease. Liver failure is unusual, but some patients may require therapy. Surgery appears to be more effective in relieving the symptoms of APLD for an extended period than nonsurgical therapies. We report on the successful surgical treatment of a case of APLD located in the left lobe of the liver.
Adult* ; Humans ; Liver Diseases* ; Liver Failure ; Liver* ; Polycystic Kidney Diseases

The intrahepatic stones and associated cholangitis result in progressive biliary stricture, hepatic atrophy, hepatic abscess and ultimately in irreversible liver cirrhosis and biliary malignancy of the liver. Although removal of intrahepatic stones using stone fragmentation and cholangioscope has been a general treatment modality, hepatic resection with removal of the affected ducts should be required for a permanent cure. We experienced hepatic resection of 100cases with intrahepatic duct calculi from November 1978 to May 1996 in the Department of Surgery, Hanyang University Hospital. The results were as follows: 1) The peak incidence of age was noted in the 4th decade (35 cases, 35.0%),5th decade (26 cases, 26.0%). 2) The male to female ratio was 46(46.0%):54(54.0%) in 100 cases. 3) Previous biliary operation(cholecystectomy with T-tube choledochostomy) was done in 30(30.0%) cases. 4) The most common clinical symptom and sign were RUQ pain(75 cases, 75.0%) and RUQ tenderness(75 cases, 75.0%). 5) In the lab findings, Alk P(55 cases, 55.0%) and ALT(52 cases, 52.0%) were especially increased. 6) 80 cases(80.0%) of intrahepatic stones were found in the left intrahepatic duct and 60 cases(60.0%) of Intrahepatic duct stones were associated cholelithiasis and/or choledocholithiasis. 7) 79 out of 100 cases had left lateral segmentectomy,15 out of 100 cases had left lobectomy, 3 cases had right lobectomy, 1 case pleurisegmentectomy, 1 case bisegmentectomy and 1 case atypical resection of the liver. 8) The incidence of residual stones was 10.0% and the incidence of recurrent cholangitis was 9.0%(9 cases). 9) The postoperative complications were wound complications(16 cases, 16.0%), chest complications(13 cases, 13.0%), bile leakage(4 cases, 4.0%), subhepatic abscess(3 cases, 3.0%). 10) The intrahepatic stones were combined with 3 cholangiocarcinoma,2 hepatocellular carcinoma and 1 GB cancer.
Atrophy ; Bile ; Calculi ; Carcinoma, Hepatocellular ; Cholangitis ; Choledocholithiasis ; Cholelithiasis ; Constriction, Pathologic ; Female ; Humans ; Incidence ; Liver ; Liver Abscess ; Liver Cirrhosis ; Male ; Postoperative Complications ; Thorax ; Wounds and Injuries

BACKGROUND/AIMS: Gallbladder carcinoma has been associated with a dismal overall prognosis. Tumorigenesis of gallbladder carcinoma is complex and not completely understood. An association of gallbladder carcinoma with cholelithiasis or an anom alous arrangement of the panceraticobiliary duct suggests that long-term inflammation may modulate tumorigenesis and progression of carcinoma. COX-2 is a rate limiting enzyme of PG synthesis and related to chronic inflammation. Several report suggested the close relationship between and COX-2 and GB cancer. METHODS: We reviewed the clinical records of sixty-two patients with GB cancer who had undergone operation from January, 1990 to December, 1999 at Hanyang University Hospital. COX-2 expression of GB cancer were evaluated with im\munohistochemical staining and expression intensity was graded on a scale of 0-2 RESULTS: There were 62 patients, whose mean age was 52.5 years. The ages ranged from 28 years to 84 years. There were 27 male patients and 35 female patients. Generally, COX-2 expression was found in chronic inflammatory area and its level increased in dysplastic area and mucosal tumor. stromal tumor showed relatively weaker COX-2 expression level. COX-2 expression is related to depth of tumor invasion, lymph node metastasis, stage (TNM, Nevin) in a negative way. CONCLUSION: Early stage of GB cancer shows relatively increased level of COX-2. Its increased level means COX-2 can modulate early stage of GB cancer carcinogenesis. COX- 2 inhibitor, cancer chemopreventive agent in colon cancer, can be regarded as same one in GB cancer.
Carcinogenesis ; Cholelithiasis ; Colonic Neoplasms ; Female ; Gallbladder ; Humans ; Inflammation ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Prognosis

BACKGROUND: Mirizzi syndrome is a rare presentation of long-standing cholelithiasis. It occurs when gallstones become impacted in either the gallbladder neck or the cystic duct, causing an obstruction of the common hepatic duct by extrinsic compression. Furthermore, impacted stones may cause pressure necrosis of the adjacent bile duct and produce a cholecystobiliary fistula. Although the definition of this syndrome varies somewhat among authors, Csendes et al. defined four evolving stages of patients with Mirizzi syndrome and cholecystobiliary fistulas. The aim of this study was to observe the clinical characteristics and to review the literature for better management in this clinical situation. METHODS: We retrospectively observed 7 patients who had been diagnosed with Mirizzi syndrome and cholecystobiliary fistulas perioperatively at Hanyang University Hospital. RESULTS: The 6 male patients and the one female patient had an average age of 58 years (range, 39 to 74 years). Jaundice was present in all patients. Six patients complained of abdominal pain, and two patients had acute inflammatory signs, such as fever/chill. Preoperative evaluations suggested Mirizzi syndrome in only two patients. A cholecystectomy was performed in all patients, followed by repair of the common hepatic duct and T-tube choledochostomy in three patients. A hepaticojejunostomy was required for the three difficult patients. The Csendes et al. classification was type I in one patient, type II in four, and type III in two. CONCLUSIONS: Since preoperative diagnosis of Mirizzi syndrome remains difficult, a high index of suspicion is required to diagnosis the condition, and awareness of the cholecystobiliary fistula condition is of the utmost importance for safe and optimal management.
Abdominal Pain ; Bile Ducts ; Cholecystectomy ; Choledochostomy ; Cholelithiasis ; Classification ; Cystic Duct ; Diagnosis ; Female ; Fistula* ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Jaundice ; Male ; Mirizzi Syndrome* ; Neck ; Necrosis ; Retrospective Studies