A 61-year-old male with hepatocellular carcinoma (HCC) complicating liver cirrhosis presented hypophosphatemia progressing with HCC expansion and serum alpha-fetoprotein elevation. These changes were associated with an increased fractional excretion of phosphate and decreased theoretical phosphate threshold. There was increased nephrogenous cyclic adenosine monophosphate despite normal serum parathyroid hormone. Serum 1,25-dihydroxyvitamin D levels were markedly reduced with normal 25-hydroxyvitamin D levels. There were no symptoms of osteomalacia, however, a slightly increased osteoid seam was elicited on autopsy. The hypophosphatemia could be explained by presumed secretion from HCC of humoral factors which have a phosphaturic effect and also inhibit 25-hydroxyvitamin D-1 alpha-hydroxylase in renal tubular cells.

Biomarkers, Tumor↗

PubMedDate not supplied

Computed tomography density of gallbladder stones may aid in predicting the rate of stone fragmentation with extracorporeal lithotripsy.

Thirty-six patients with gallbladder stone(s), 21 with solitary stone and 15 with multiple stones up to five in number, were treated by a single session of extracorporeal shock wave lithotripsy. In eight patients (group A), stones were gradually fragmented from the surface, producing fine powderlike fragments which made residual stones invisible, leading to reduced therapeutic efficacy. In 13 patients (group B), residual stones remained visible up to 2,400 shocks, though they showed similar fragments. Such fragments did not appear throughout treatment in 14 patients (group C). Computed tomography (CT) attenuation number, when the region of interest was settled on the whole stone, increased in the order of group A, B, and C. When the distribution of CT density on stones was analyzed, the density was diffusely lower than 50 HU in all patients in group A, higher than 50 HU only on the surface in all patients except for two in group B, and diffusely higher than 50 HU in all patients except for one in group C. CT findings may be useful for predicting the fragmentation mode of gallbladder stones by extracorporeal shock wave lithotripsy.

Adult↗

PubMedDate not supplied

Tongue cancer: correlation of MR imaging and sonography with pathology.

Ten patients with tongue cancer underwent both MR imaging and sonography. In seven of these patients, pathologic findings from glossectomies were correlated with MR and sonographic results. MR images of resected specimens also were obtained in two patients, and relaxation time was calculated in one of these patients. MR images (5- to 7-mm thick slices) were obtained by using a 0.1-T resistive magnet with a 128 x 256 acquisition matrix. MR and sonography had almost the same sensitivity for detecting primary-site tongue cancer. However, in the three patients with extraorgan spread of tumor, MR was superior, showing three of three cases, compared with sonography, which showed extraorgan spread in only one of the three cases. Although MR failed in one patient to differentiate postradiation scar tissue from tumor, because of similar relaxation time of both, this imaging technique proved to be an important adjunct to the physical examination in the staging of tongue cancer.

Adult↗