Biomedical subjects
Publications and source records attributed to K Takayasu.
Although necessity for angiography has been reduced somewhat because of the development of newer imaging modalities, such as ultrasound and CT, celiac or hepatic arteriography, portography, and hepatic venography often prove useful in the diagnosis of liver disease. They can be utilized for therapeutic purposes as well in certain vascular abnormalities.
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In three patients who underwent hepatectomy for solitary hepatocellular carcinoma (HCC), adrenal metastases, on the right sides of two patients and the left side of the third were subsequently detected by ultrasonography (US) and/or computed tomography (CT), and successfully resected after an average interval of 16 months from hepatectomy. There were no metastatic lesions in the lung, lymph node or bone. Two patients, however, who were found to have metastasis in the right adrenal also had multiple small recurrent foci in the residual liver. The latter were controlled by arterial embolization therapy and the patients are alive at 12 and three months post-adrenalectomy. In the other patient, with left adrenal metastasis, the serum alphafetoprotein level of 3,000 ng/ml returned to normal and he is doing well three and a half years after adrenalectomy. Since there is no effective therapy for metastatic adrenal HCC after hepatectomy, surgery would appear to be indicated, should no other distant metastasis be recognized clinically.
Double primary liver cancer, i.e., hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC), was detected by ultrasound (US) during the follow-up of chronic liver disease, and was safely resected in two patients, one synchronously and the other metachronously. On admission, laboratory data were normal except for slightly abnormal liver function tests. One patient (case 1) had a 5.1-cm white firm CCC with several small daughter lesions around it which was enhanced late in computed tomography, and a 2.1-cm well-circumscribed HCC with a pseudocapsule; the two were situated very close to one another in the right posterior segment of the liver. Another patient (case 2) had a small 1.5-cm CCC in the anterior superior area, and 6 yr after the first resection, alpha-fetoprotein gradually increased and a 4-cm HCC was detected anew and resected; the preoperative diagnosis made by US and ethiadol-computed tomography was correct. The histopathological diagnosis of the noncancerous portion was chronic active hepatitis in both cases. However, it changed to precirrhosis in case 2 during the follow-up.
In 41 patients with 54 lesions which were resected ans studied histopathologically, there were 14 lesions of adenomatous hyperplasias (AH) in 9 patients, 28 AHs containing hepatocellular carcinoma foci (early HCC, e-HCC) in 22 and 12 borderline lesions which fell between these two lesions in 10. The detectability of these lesions on imagings was evaluated. Detection rates for all lesions and e-HCCs were as follows; intraoperative sonography, 70.0%, 87.5%; Portal-CT, 71.4%; sonography, 44.4%. 64.3%; Arterial-CT, 37.5%, 50.0%; CT, 32.7%, 57.7%; angiography, 17.0%, 30.8%; Lipiodol-CT, 9.1%. 25.0%. On angiography, tumor stain was recognized in only 8 patients with e-HCC. Arterial-CT showed a relatively low density mass compared to non-tumorous area in 2 patients with e-HCC and one with borderline lesion. The median size of 54 lesions was 1.2 +/- 0.4 cm in diameter and that of AHs was 0.8 +/- 0.3 cm, the latter being significantly smaller than the other two lesions (p less than 0.01). Liver cirrhosis coexisted in 35 of 41 patients (85.4%). No complete necrosis occurred in 13 e-HCC lesions following therapeutic embolization or infusion chemotherapy in the hepatic artery.
Two patients with surgically resected biliary cystadenocarcinoma are presented. Both were asymptomatic and the cancer was incidentally found by ultrasonography (US). In the first case, a huge multilocular tumor (21 X 15 cm in diameter) having many papillary projections and septa within it and small daughter lesions occupied both the right anterior and left medial areas of the liver. They were clearly demonstrated on US and computed tomography (CT). Angiography disclosed tumor vessels in some area of the lesion, these features strongly suggested cystadenocarcinoma. The second case had a solid mass (7 X 7 cm) in the left hepatic lobe, in which many septal structures within the lesion were seen on enhanced CT and light dot like stains were recognized on angiography. The former findings coincided with the internal gross feature of the resected specimen. Both patients are doing well 8 months and 1 year and 6 months after operation, respectively.
A guide wire made of a superelastic alloy coated with hydrophilic polymer has been developed for superselective catheterization in hepatic arteriography. In this study, the new wire was tested in 15 patients and a conventional spring wire was used in 25. Catheterization of the proper or more peripheral hepatic arteries was successful in 93.3% of cases in which the new wire was used versus 76.0% in which the conventional spring wire was used. Moreover, the frequency of complications, such as spasm and subintimal injury, was reduced from 28.0% to 6.7%.
A case of hepatocellular carcinoma (HCC) with tumor thrombi in the vein in the major omentum is reported. A 54-year-old man underwent a second operation for recurrent HCC. Intraoperative ultrasonography revealed a tumor thrombus in the vein of the adhering omentum. Part of the antero-inferior area of the liver adjacent to the tumor was resected with the major omentum. Since it is characteristic of HCC often to form tumor thrombi in the veins, it is not surprising that the tumor budded into the epiploic vein. This is apparently the first report of tumor thrombi of HCC in the epiploic vein.
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To avoid major complications, such as intraperitoneal bleeding after percutaneous transhepatic catheterization, a new technique has been developed. In this procedure, a stick-like gelfoam sponge compressed manually and loaded in a cartridge, is inserted through an outer sheath catheter after the removal of the catheter, and the puncture hole is plugged. No bleeding has been experienced in 56 patients with various hepatic diseases since using this method.
A patient with typical manifestations of von Hippel-Lindau disease is presented. In this 44 year-old man, cerebellar hemangioblastoma was found initially and he was operated upon at the age of 25. This was followed by retinal angiomas treated by cryocoagulation and, recently, by paresthesia of both legs and frequent shooting pains over the lower abdomen. A computed tomography disclosed multiple small cysts of the pancreas, bilateral multicentric renal carcinomas and a spinal angioma in the lumbar portion, confirmed by magnetic resonance imaging, and consistent with neurogenic manifestations. Multiple enucleations of the renal cell carcinomas were carried out, most of which were histologically well differentiated adenocarcinomas. There was no family cluster. Six months postoperative, the patient is doing well.
Review of 61 surgically resected small hepatocellular carcinomas (HCC) less than or equal to 3 cm in diameter yielded a simple gross classification system of five types based on tumor shape, which is highly correlated with microscopic and clinical features, including prognosis. Type 1 (single nodular type) tumors (n = 13) are expansile, roughly spheric, and often encapsulated. In Type 2 tumors (single nodular type with extranodular growth) (n = 21), replacing growth is often seen in the area of extranodular growth. Type 3 tumors (contiguous multinodular type) (n = 19) consist of small nodules growing in contiguity, often with replacing growth at the periphery. Type 4 (poorly demarcated nodular type) is a rare tumor showing infiltrating growth at its border. The authors define early HCC (n = 5) as the presence of tumor without destruction of the underlying liver structure. The lesions experienced are tiny (less than or equal to 1.2 cm) and well differentiated. Poorly differentiated histologic characteristics and elevated alpha fetoprotein are more common in Types 2 and 3 than in Type 1. Type 1 has the highest rates of positive serum hepatitis B surface antigen and liver cirrhosis; portal vein tumor thrombus (PT) and/or intrahepatic metastasis (IM) is rare (7.7%), and the effect of transcatheter arterial embolization (TAE) is remarkable. This contrasts with Type 2, which has a high rate of PT and/or IM (71.4%) and multiple local recurrences (40%), and with Type 3, which shows a poor response to TAE.
A large lipoma and a large angiomyolipoma of the liver, one case each, are described. In the first case, a 24 X 14-cm homogeneous mass demonstrated a fatty density (-96H) on computed tomography (CT), echogenicity on sonography, and fine neovascular vessels on angiography in the right lobe of the liver. Histopathologic diagnosis of the resected specimen was lipoma. The second case showed a 9-cm fatty mass (-66H) with some enhanced interior nodules in the left lateral area of the liver on CT. Sonography disclosed a large echogenic mass with echolucent nodules, which were seen as stains on the angiogram. Angiomyolipoma was the histopathologic diagnosis. Among these diagnostic modalities, the CT scan provided the most specific and reliable findings. Both patients are doing well more than 2 years and 9 months after resection.
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Thirty-one patients with hepatocellular carcinoma (HCC) were given either an intraarterial injection of iodized poppyseed oil (Lipiodol) alone (group A, n = 6), an emulsion of iodized oil and doxorubicin hydrochloride (Adriamycin) (group B, n = 15), or chemoembolization with the same emulsion followed by gelatin sponge (Gelfoam) particles (group C, n = 10). Hepatic resection was subsequently performed. The frequencies of complete necrosis of tumor in the main lesion, daughter tumors, tumor thrombus, and foci of intracapsular invasion were evaluated in the cut surface of the resected specimen. Group C demonstrated the best therapeutic effects, showing complete necrosis of the main lesion in 83% (P less than .01), daughter tumors in 53% (P less than .01), tumor thrombus in 17%, and foci of intracapsular invasion in 67%. These results are superior to those reported previously for chemoembolization without iodized oil. Group B showed better results than group A, but the difference was not significant. Iodized oil alone (group A) had practically no therapeutic effect but was helpful in differentiating small HCC from regenerative nodules.
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Among the accessory hepatic veins, the thickest one is the IRHV and is a significant vessel in 20 to 24 per cent of the patients. In these patients, if the right hepatic vein is totally resected, the right posteroinferior area can be preserved with the IRHV. Four types of hepatectomies n which the IRHV was preserved were proposed and three of the four procedures were performed upon five patients. In these five operations, the hepatectomies were successfully performed and blood losses were from 1,020 to 3,200 milliliters. These operative procedures, which have not been described before, could widen the indication of hepatectomy in patients with reduced liver function and tumor involving the right hepatic vein. In order to perform these operative procedures successfully, intraoperative sonography is indispensable.
A case of epithelioid hemangioendothelioma of the liver is reported. Both immunohistochemical and electron-microscopic examinations revealed the neoplastic cells to share many characteristics with endothelial cells. We discuss and compare this rare tumor, which represents a low-grade sclerosing hemangiosarcoma of the liver, with its pulmonary counterpart, which is known as intravascular bronchioloalveolar tumor (IVBAT).