Primary small cell carcinoma of the liver is an extremely rare tumor. Extrapulmonary small cell carcinoma shares many features of pulmonary small cell carcinoma, including the histological appearance, the aggressive clinical behavior and the frequent short-lasting response to either chemotherapy or radiotherapy. We experienced a 56-year-old man with small cell carcinoma that arose in the liver. Abdominal CT scan showed an 8 cm size, low density mass in the segment 4 of the liver and also multiple lymphadenopathies. Chest X-ray showed no abnormal finding, but the chest CT showed a right lower paratracheal lymphadenopathy. The pathological findings showed nests of small round cells with fine granular chromatin, inconspicuous nucleoli and scanty cytoplasm. Distinct and strong immunoreactions were seen for CD56 and c-kit, and sparse immunoreaction was seen for synaptophysin. Thyroid transcription factor-1 showed no immunoreaction. The tumor did not decrease in size despite chemotherapy. We report this case along with a review of the relevant literatures.
Carcinoma, Small Cell/*diagnosis ; English Abstract ; Humans ; Liver Neoplasms/*diagnosis ; Male ; Middle Aged

We report here on a case of non-Hodgkin's lymphoma in which liver involvement was the predominant clinical manifestation. A healthy 44-year-old man presented with upper abdominal pain, hepatosplenomegaly, thrombocytopenia, elevated AST, ALT and bilirubin, and marked elevation of lactate dehydrogenase and alkaline phosphatase. The abdominal CT scan showed only diffuse hepatosplenomegaly and uneven contrast enhancement of the spleen without any definite mass of the liver and spleen. US-guided aspiration biopsy of liver and the histologic examination confirmed a diagnosis of non-Hodgkin's lymphoma, the diffuse large B cell type. Bone marrow biopsy showed the infiltration of malignant lymphoma cells. PET-CT showed an increased FDG uptake of the liver, spleen and long bones. The patient was treated with combination regimen of cyclophosphamide, doxorubicin, vincristine and prednisone chemotherapy. Even in the absence of a mass lesion or lymphadenopathy, primary hepatic or hepatosplenic lymphoma should be considered in differential diagnosis of hepatitis or liver cirrhosis, especially for patients with diffuse hepatosplenomegaly and markedly elevated LDH.
Adult ; Diagnosis, Differential ; English Abstract ; Hepatitis/*diagnosis ; Humans ; Liver Neoplasms/*diagnosis/pathology ; Lymphoma, B-Cell/*diagnosis/pathology ; Male

BACKGROUND/AIMS: Patients with hepatocellular carcinoma (HCC) may manifest paraneoplastic syndromes such as hypercholesterolemia, hypoglycemia, hypercalcemia and erythrocytosis. This study was aimed at evaluating the incidence and clinical significance of paraneoplastic syndromes in Korean HCC patients. METHODS: The medical records of 165 HCC patients who were diagnosed and died in the Kyung Hee University Hospital, were reviewed retrospectively. The following variables were analyzed: age, gender, hepatitis markers, platelet, liver function test, alpha-fetoprotein (AFP), Child-Pugh score, tumor features, and the duration of their survival. RESULTS: In total, paraneoplastic syndromes were presented in 43.6% of the HCC patients during the course of their disease. Hypercholesterolemia was solely presented in 14.5%, hypoglycemia in 12.7% and hypercalcemia in 7.8%. The patients who presented with more than 2 syndromes were 8.5%. While 80% of erythrocytosis (4/5) and 51.6% of hypercholesterolemia (16/31) was presented at the time of HCC diagnosis, hypoglycemia and hypercalcemia mainly occurred as terminal events. The patients with paraneoplastic syndromes were younger and had higher rates of portal vein thrombosis, bi-lobar tumor involvement and tumor more of more than 10 cm in diameter, compared to those patients without them. The proportion of patients with a serum AFP more than 400 ng/mL tended to be higher in the patients with paraneoplastic syndromes. The HCC patients with paraneoplastic syndromes, except for erythrocytosis, had a shorter survival than those patients without them. CONCLUSIONS: Paraneoplastic syndromes are not infrequently presented in HCC patients, especially at an advanced stage, and the survival of these patients is relatively shorter.
Aged ; Carcinoma, Hepatocellular/*complications/mortality ; English Abstract ; Female ; Humans ; Liver Neoplasms/*complications/mortality ; Male ; Middle Aged ; Paraneoplastic Syndromes/complications/diagnosis

BACKGROUND/AIMS: The aim of this study is to elucidate the efficacy of repeated hepatic arterial infusion chemotherapy (HAIC) and different chemotherapeutic regimens for treating patients having advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). METHODS: From Jan. 1999 and Dec. 2003, a total of 103 patients diagnosed as having HCC with PVTT, but without extrahepatic spreading, were enrolled in this study. They were stratified into two groups. Group I (67 patients) received intraarterial cisplatin (CDDP, 80 mg/m2 for 2 hours on Day 1), Group II (36 patients) received intraarterial CDDP (60 mg/m2 for 2 hours on Day 2) and 5-fluorouracil (5-FU, 500 mg/m2 for 5 hours on Day 1-3). They were scheduled to receive at least three consecutive courses of the HAIC at 1 month intervals. RESULTS: Among the 66 patients who completed the protocol, one (2.5%) and seven (17.5%) patients of group I, and one (3.8%) and four (15.4%) of group II, exhibited complete and partial responses, respectively. The median survival period of all the patients was 6 months. Group II showed a tendency to improve the median survival compared to group I (8.5 vs 5.0 months, respectively, P=0.45). The most common adverse reaction was nausea (58.2%). However, an elevation of the total bilirubin level was more frequent in Group I than in Group II (61.3% vs 20.7%, respectively, P<0.05). CONCLUSIONS: Repeated HAIC using CDDP achieved favorable results in a few patients with HCC with PVTT, and additional 5-FU may be useful.
Adult ; Antineoplastic Combined Chemotherapy Protocols/*administration & dosage ; Carcinoma, Hepatocellular/*drug therapy ; Cisplatin/administration & dosage ; English Abstract ; Female ; *Hepatic Artery ; Humans ; Infusions, Intra-Arterial ; Liver Neoplasms/*drug therapy ; Male ; Middle Aged ; *Portal Vein ; Venous Thrombosis/*complications

BACKGROUND/AIMS: Exclusion of liver disease from other causes such as autoimmune hepatitis is necessary for diagnosis of nonalcoholic fatty liver disease (NAFLD). However, there has been no study on the prevalence and significance of autoantibodies in the patients with clinically suspected NAFLD in Korea, where hepatitis B is endemic and autoimmune hepatitis is relatively uncommon. METHODS: We prospectively tested for anti-nuclear antibody (ANA), anti-smooth muscle antibody (ASMA), and anti-mitochondrial antibody (AMA) in 135 serially enrolled patients with suspected NAFLD. We compared the clinical characteristics and biochemical indices of the ANA-positive or ASMA-positive group with those of the autoantibody-negative group. RESULTS: Sixteen patients (11.8%) had serum autoantibodies; there was ANA in 8 patients (5.9%), ASMA in 7 (5.1%), and AMA in 2 (1.5%). Both ANA and AMA were positive in one patient. The ANA-positive or ASMA-positive group showed an older age (49.5+/-13.0 vs. 42.0+/-10.9 years, respectively, P=0.018) and higher levels of serum globulin (3.1+/-0.4 vs. 2.9+/-0.4 g/dL, respectively, P=0.037), compared with the autoantibody-negative group. Two cases with positive ANA or ASMA fulfilled the diagnostic criteria for probable autoimmune hepatitis and two cases with positive AMA were suspected as primary biliary cirrhosis. CONCLUSIONS: These findings suggest that autoantibodies could be found in some patients with suspected NAFLD in Korea, AMA-positivity or ASMA-positivity could be associated with old age and high serum globulin, and some of the autoantibody-positive cases could be diagnosed as autoimmune hepatitis or primary biliary cirrhosis. Further studies are necessary to clarify the clinical significance of autoantibody positivity in those patients.
Adult ; Aged ; Antibodies, Antinuclear/analysis ; Autoantibodies/*blood ; English Abstract ; Fatty Liver/*immunology ; Female ; Humans ; Male ; Middle Aged ; Muscle, Smooth/immunology

BACKGROUND/AIMS: Despite the improvement of personal and social hygiene, pyogenic liver abscess is still a common disease. We compared the incidence, infection route, underlying disease and major complications between two different local hospitals. METHODS: We reviewed the clinical data of 100 patients with pyogenic liver abscess who were treated at Seoul and Guri Hanyang University Hospital from 1999 to 2003. RESULTS: There were 64 males and 36 females in the study group; they were aged from 19 to 94 years with a mean of 56.5 years. Every year 19 to 23 pyogenic liver abscess patients were admitted to both hospitals. The most common organism isolated was Klebsiella pneumoniae in both local hospitals. In the Seoul hospital, diabetes (40.9%) was most common associated condition. In the Guri hospital, biliary tract disease or a history of hepatobiliary surgery (54.2%) was the most common associated condition. Catheter drainage and/or percutaneous needle aspiration were established as the standard treatment modality. CONCLUSIONS: In both regional hospitals, the incidence of pyogenic liver abscess did not decrease and Klebsiella pneumoniae was the most common organism. Diabetes and biliary tract disease, including, previous hepatobiliary surgery, were the most identifiable underlying disease.
Adult ; Aged ; Aged, 80 and over ; English Abstract ; Female ; Humans ; Klebsiella Infections/complications/diagnosis/therapy ; Klebsiella pneumoniae ; *Liver Abscess, Pyogenic/complications/microbiology/therapy ; Male ; Middle Aged

Breast cancer is a common malignancy in women and frequently metastasizes to various organs such as liver, lung, brain, bone and so on. But metastasis to gastrointestinal tract is rare. We describe a 73-year-old woman with small intestinal metastasis of breast cancer. She was diagnosed as right breast cancer in stage I, received modified radical mastectomy 6 years ago and had been followed up without any evidence of residual disease. During investigation for lower abdominal pain and weight loss of 9 kg, we found a small bowel mass. The histology of the tissue taken from small bowel mass was adenocarcinoma, poorly differentiated. The immunohistochemical stain of this specimen showed 75% positivity of estrogen receptor and 90% positivity of progesterone receptor. This is a case of small bowel metastasis from breast cancer and we report this case with a review of literatures.
Adenocarcinoma/*secondary ; Aged ; Breast Neoplasms/*pathology ; English Abstract ; Female ; Humans ; Intestinal Neoplasms/diagnosis/*secondary ; Intestine, Small

A biloma is an encapsulated bile collection outside the biliary tree. Most cases of biloma are caused by iatrogenic injury or trauma. Intrahepatic rupture of the biliary tree due to nontraumatic cause is a rare event. A 68- year-old man was admitted because of abdominal pain and fever. He had no past history of abdominal surgery, instrumentation or trauma. Computed tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) demonstrated a large subcapsular fluid collection in the right liver associated with choledocholithiasis and cholecystitis. Biloma was confirmed by sono-guided percutaneous needle aspiration and was drained through a pigtail catheter. After the successful treatment by percutaneous drainage and endoscopic sphincterotomy, the patient recovered. Here, we report an uncommon case of spontaneous biloma formation in association with choledocholithiasis with a review of literatures.
Aged ; *Bile ; Cholecystitis/*complications/diagnosis ; Choledocholithiasis/*complications/diagnosis ; English Abstract ; Humans ; Male

BACKGROUND/AIMS: Pancreatic cancer is the 5th leading cause of cancer death in Korea and its incidence is increasing. At present, surgical resection offers the best chance of cure. However, most of pancreatic cancers are already unresectable at initial diagnosis. Thus, the majority of patients depend on chemotherapy, radiotherapy, or supportive care. We investigated the effect of treatment modalities on the survival in pancreatic cancer. METHODS: Between September 1994 and May 2003, one hundred and fifty four patients with pancreatic cancer were treated by surgery, radiotherapy, chemotherapy or conservative management. The clinical datas were analyzed retrospectively for survival according to stage and treatment modality. RESULTS: Overall median survival time was 5.7 months and 1 year survival rate was 18.3%. In patients with stage I to III disease, the median survival time was 13.9 months in surgery group, 10.2 months in radiation group, and 6.1 months in supportive care group (p<0.01). Survival rate according to treatment modality was significantly different among groups. In patients with stage IV disease, the median survival time was 6.1 months in radiation therapy group, 7.1 months in chemotherapy group, and 2.7 months in supportive care group. Overall survival was significantly higher in treatment groups than in supportive care group (p<0.01), but there was no difference in survival between chemotherapy group and radiotherapy group. CONCLUSIONS: In patients with stage I to III pancreatic cancer, surgery can improve median survival. In patients with stage IV, either chemotherapy or radiotherapy can prolong survival compared to supportive care. These results suggest that more active treatment of pancreatic cancer even in advanced stage will be needed to prolong the survival.
Adult ; Aged ; Aged, 80 and over ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; Pancreatic Neoplasms/*mortality/pathology/therapy ; Survival Rate

BACKGROUND/AIMS: Endoscopic papillectomy is reported to be relatively safe and reliable for complete resection of benign tumors of the major duodenal papilla. We evaluated methods and treatment outcome of the patients who have undergone endoscopic papillectomy. METHODS: Medical records of 22 consecutive patients with tumor of the major duodenal papilla (10 women, 12 men; mean age 55.8+/-2.8 yrs) who have undergone endoscopic papillectomy were reviewed retrospectively. Endoscopic papillectomy was defined the successful when complete excision of the tumor was achieved. RESULTS: Mean duration of follow-up was 8.4+/-2.4 months (range 1-43 months). Endoscopic papillectomy was successful in 16 patients (72.7%), but incomplete resection occurred in 6 patients. Only one patient showed recurrence. Histopathologic evaluation after endoscopic papillectomy revealed adenoma (n=11, 50%), high-grade dysplasia (n=3, 13.6%), adenocarcinoma (n=2, 9.1%), carcinoid (n=1), chronic inflammation (n=3, 13.6%), papillary adenomatous hyperplasia (n=1), and cavernous lymphangioma (n=1). The mean size of the resected lesions was 10.3+/-1.2 mm (range 2-20 mm). There was no factor which could predict the endoscopic success statistically. A pancreatic duct stent was placed in 11 patients (50.0%) and was removed after 3 to 39 days. There were 8 (36.8%) procedure-related complications: bleeding (n=4), papillary stenosis (n=1), perforation (n=1), cholangitis (n=1), and asymptomatic liver function abnormality (n=1). There was no pancreatitis or mortality. All the complications resolved with conservative management. CONCLUSIONS: Endoscopic papillectomy in selected patients seemed to be highly successful and safe. Longer follow-up is needed to assess the long-term efficacy.
Adult ; Aged ; Ampulla of Vater/*surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms/diagnosis/*surgery ; English Abstract ; Female ; Humans ; Male ; Middle Aged ; *Sphincterotomy, Endoscopic ; Treatment Outcome