PURPOSE: A case of primary Burkitt's cell lymphoma of the liver is reported. PATIENT: A 14-year-old Chinese boy presented with a 10-day history of postprandial epigastric pain and weight loss. RESULTS: Preoperative imaging studies revealed a large solid mass confined to the right lobe of the liver; there was no evidence of involvement of other sites. There was serological and immunohistochemical evidence of asymptomatic hepatitis B virus infection. Complete removal of the mass was achieved by right hepatic lobectomy. Histological examination revealed a small noncleaved cell lymphoma of Burkitt's type that immunostained positively for B-cell markers. The patient remains well, with no evidence of disease > 8 years after surgical resection and combination chemotherapy. CONCLUSIONS: Only five cases (two children and three adults) of primary small noncleaved cell lymphoma of the liver have been reported. We believe this is the second reported case of childhood hepatic lymphoma with long-term disease-free survival. Further work is needed to elucidate the relationship between hepatitis B virus infection and the development of a primary small noncleaved lymphoma of the liver.

Adolescent↗

PubMedDate not supplied

Hypoplastic right hepatic lobe with retrohepatic gallbladder complicated by hepatolithiasis and liver abscess: a case report.

A 37-year-old man with fever, jaundice, severe right upper quadrant abdominal pain and impending septic shock was pre-operatively diagnosed to have hypoplastic right lobe liver with retrohepatic gallbladder, left hepatolithiasis and liver abscess by computed tomography. An urgent operation with cholecystectomy, choledocholithotomy, operative choledochoscopy and T-tube drainage was performed. Postoperative cholangiograms depicted multiple residual stones behind the sharply angulated biliary strictures in the medial branches of the left intrahepatic duct, which could not be eradicated by biliary dilatation via the T-tube tract. The left hepatolithiasis might be coincidental, or secondary to the congenital anomaly of the liver, because of the distorted biliary architecture, and the hypoplastic right lobe liver was associated not only with the retrohepatic gallbladder, but also with the much more complicated left biliary strictures and the hepatolithiasis behind them.

Adult↗

PubMedDate not supplied

Serum levels of circulating intercellular adhesion molecule-1 in patients with breast cancer.

BACKGROUND: The outcome of breast cancer is usually determined by multiple factors. Circulating intercellular adhesion molecule-1 has been found to be increased in the circulation of patients with malignancy. This study was designed with the aim of evaluating the prognostic significance of circulating intercellular adhesion molecule-1 in breast cancer. METHODS AND MATERIAL: From December 1994 to May 1995, 50 patients with invasive breast carcinoma were included. Venous blood samples were collected before surgery and the serum levels of circulating intercellular adhesion molecule-1 were measured with an enzyme immunoassay method. The data of maximum tumor size, age, estrogen receptor status, lymph node status and TNM staging were collected and evaluated simultaneously with the serum levels of circulating intercellular adhesion molecule-1. Fifteen healthy subjects were used as control group. RESULTS: The mean value of circulating intercellular adhesion molecule-1 in patient group was 463 +/- 92 ng/ml and that of the control group was 346 +/- 68 ng/ml and the difference was significant (p < 0.01). In univariable analysis, patients with maximum tumor size of 5 cm or greater (p < 0.01), more advanced lymph node status (p < 0.01) and more advanced TNM staging (p < 0.01) were shown to have significantly higher serum levels of circulating intercellular adhesion molecule-1. However, in multivariable analysis, TNM staging was demonstrated to be the only independent factor (p < 0.01) related to significant, higher serum level of circulating intercellular adhesion molecule-1. CONCLUSION: Preoperative serum levels of circulating intercellular adhesion molecule-1 may reflect the severity of staging for invasive breast cancer and may be a promising, additive predictor which deserves further investigation.

Adult↗

PubMedDate not supplied

Imaging in pediatric liver transplantation.

In liver transplantation, the role of the imaging study in the evaluation of transplant candidacy is to define the conditions in which transplantation is contraindicated and to identify anatomic variations that may alter the surgical approach. Among pediatric recipients, the largest numbers of patients were suffering from biliary atresia, and metabolic diseases. Acquired and congenital vascular anomalies are usually associated with biliary atresia which may be hazardous to liver transplantation requiring a modification of standard surgical procedure. Therefore, confirmation of the patency of the vascular structure is the most essential prerequisite especially in living related liver transplantation. From June 17, 1994 to November 30, 1996, eleven living related liver transplantations were performed at Chang Gung Memorial Hospital, Kaohsiung Medical Center. The left liver or the left lateral segment of the liver was used as the graft. It is necessary to keep patency of the inflow and outflow of hepatic vessels and biliary trees of both donor and recipient. Both resected and remnant livers have to function well postoperatively. In order to achieve parenchyma dissection with minimal hepatic damage, various anatomical variations of the liver size, portal vein, hepatic veins and bile duct of the donor cannot be ignored. Therefore, the precise preoperative anatomical evaluation of the donor using various imaging modalities is mandatory for the safe partial liver transplantation. Ultrasound, computed tomography, magnetic resonance image and three dimensional computed tomographic cholangiography are the method of choice in demonstrating the anatomical structures. After the complex anatomical factors can be well evaluated we can assess the appropriateness and feasibility of the procedure that may correct problems during or after transplantation. Finally, noninvasive and safe examination procedures are our outmost concern and policy in doing this survey.

Angiography↗

PubMedDate not supplied

Histopathology of the liver in pediatric patients following transplantation.

Recognition of rejection and other hepatic complications by needle biopsy plays a significant role in the management of liver allograft recipients. In this report, 22 pediatric patients (below 18 years old) were selected from the 37 liver transplants. Seven of the 22 cases have an uneventful posttransplant course. The most common cause of allograft injury in these patients appeared to be acute cellular rejection. It occurred in 7 (31.8%) of the 22 cases and was the primary process in 8 of the 25 episodes of liver dysfunction. Other etiologies, such as opportunistic viral infection (3 cases), biliary obstruction (2 cases), preservation injury (1 case), and vascular obstruction (1 case) were less common. Acute graft rejection causing liver dysfunction was associated with a mixed portal inflammation, destruction of the interlobular bile ducts, and varied degree of venous endotheliitis, followed by centrilobular hepatocyte necrosis. Chronic rejection was not seen in our pediatric cases. Cold ischemic injury causing transient graft dysfunction as seen in one of our patients demonstrated focal, limited areas of hepatocyte necrosis, mild centrilobular hepatocyte ballooning, and cholestasis without evidence of bile duct damage. More severe ischemic injury resulted from vascular complication causing diffuse hepatocyte necrosis was seen in one patient with hepatic vein thrombosis. The histologic patterns observed were not pathognomic; however, liver biopsies were helpful in suggesting the probable cause of liver dysfunction and in predicting subsequent allograft recovery when used in conjunction with clinical information, radiologic, and other laboratory tests.

Adolescent↗