1/33. Effects of diabetes mellitus on patients with acute intermittent porphyria.OBJECTIVES: To study the effects of diabetes mellitus in patients with acute intermittent porphyria (AIP). Haeme deficiency in the liver of AIP patients stimulates an increase in ALA-synthase which triggers an escalating metabolic chain reaction, leading to an increase in the porphyrin content. This reaction can be reduced by treating AIP patients with haeme arginate or with glucose. DESIGN: A population-based study of all patients > 18 years of age having dna-verified AIP (n = 328) living in the two most northerly counties of sweden (Norrbotten and Vasterbotten, with 550,000 inhabitants) of whom 16 had type 2 diabetes. prevalence of diabetes was studied retrospectively in 26 AIP patients with hepatocellular carcinoma (HCC). RESULTS: None of the patients showed symptoms of AIP after the onset of their diabetes. Three patients had had recurrent, severe attacks for many years but when their diabetes became manifest, their urinary ALA and PBG levels decreased and the AIP symptoms resolved, to the relief of the patients. Amongst the 26 AIP patients with HCC, only one with signs of diabetes was identified (impaired glucose tolerance test). CONCLUSIONS: This study raises the possibility that diabetes mellitus may be beneficial for patients with severe AIP.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
2/33. Spindle cell carcinoma of the pancreas: a case report.We report on a resected case of spindle cell carcinoma of the pancreas in a 73 year-old Japanese male who has a history of diabetes mellitus. The patient visited his neighborhood hospital complaining of abdominal pain and was referred to our hospital for further examination of a pancreatic tumor discovered by abdominal ultrasonography. Upon the diagnosis of ductal carcinoma, a distal pancreatectomy with splenectomy was performed. Microscopically, the tumor was composed of spindle cells arranged in interlacing bundles with frequent mitotic figures. The diagnosis of spindle cell carcinoma of the pancreas was confirmed by immunohistochemical studies. To our knowledge, our case is the first resected case of spindle cell carcinoma arising from the pancreas in the English literature.- - - - - - - - - - ranking = 8.5900780090163keywords = carcinoma, ductal (Clic here for more details about this article) |
3/33. disseminated intravascular coagulation in a lung cancer patient after acute myocardial infarction.A 70-year-old man with adenocarcinoma of the lung suffered from an attack of acute myocardial infarction during hospitalization. Eleven days after the heart attack, clinically obvious disseminated intravascular coagulation (DIC) occurred. The intravascular coagulation abnormalities progressed and eventually the patient died. We suspect that both lung adenocarcinoma and the insult of myocardial infarction may have contributed to the development of DIC in this patient.- - - - - - - - - - ranking = 2keywords = carcinoma (Clic here for more details about this article) |
4/33. Hepatocellular carcinoma arising in non-alcoholic steatohepatitis.The incidence and significance of hepatocellular carcinoma (HCC) in non-alcoholic steatohepatitis (NASH) has not been previously evaluated in detail. We recently experienced a case of NASH with multicentric HCC in a female patient. At the age of 58 years, the patient was diagnosed with non-insulin-dependent diabetes mellitus, treated by insulin therapy. The patient did not drink alcohol. She was negative for all serological markers of hepatitis b and C virus infection. Because of liver dysfunction, a needle biopsy was performed at the age of 62 years, and pathological findings, such as fatty change, Mallory's body, nuclear glycogen and pericellular fibrosis, suggested a diagnosis of NASH. Subsequently, four nodules were detected in the liver by imaging. liver biopsies were performed from each nodule. One nodule was pathologically diagnosed as a pseudolymphoma, while three other nodules were moderately differentiated HCC (10 years after the diagnosis of non-alcoholic steatohepatitis), well-differentiated HCC (11 years later) and dysplastic nodule (11 years later), suggesting multicentric occurrence of HCC. This case suggests that HCC could be a late complication of NASH.- - - - - - - - - - ranking = 5keywords = carcinoma (Clic here for more details about this article) |
5/33. Carcinoma of temporal bone, base of the skull: diagnosis by needle aspiration cytology.We report on a 68-yr-old male with a destructive bone lesion involving the temporal bone at the skull base extending to surrounding osseous structures and the infratemporal fossa, defined by needle aspiration cytology as carcinoma in association with inflammatory reaction, bacterial type, and bone destruction. The technique of the aspiration, which was performed by a cytopathologist directing a spinal needle into the region of the destroyed temporal bone as outlined in the radiographs of prior magnetic resonance imaging (MRI), is discussed. The application of this technique in the cytologic sampling of deeper lesions usually of soft or osseous tissues not accessible to ordinary fine-needle aspiration is presented. There is also a brief discussion of neoplastic lesions involving the temporal bone at the skull base and the anatomic concerns in sampling lesions in this difficult-to-approach region of the body.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
6/33. Lipid-rich clear-cell hepatocellular carcinoma arising in non-alcoholic steatohepatitis in a patient with diabetes mellitus.A case of lipid-rich clear-cell hepatocellular carcinoma arising in non-alcoholic steatohepatitis is described in a patient with diabetes mellitus. The patient was a 67 year-old Japanese female with a history of tuberculosis, appendicitis, ischaemic heart disease, and non-insulin-dependent diabetes mellitus. The patient denied alcohol consumption. A liver mass was diagnosed as hepatocellular carcinoma of clear-cell type with early cirrhosis of the peri-tumoral liver tissue. Tumour cells had clear cytoplasm containing lipid droplets, and mallory bodies. Surrounding non-tumoral liver tissue also showed lipid, and fibrosis in peri-portal areas with moderate bridging fibrosis. The features were consistent with clear-cell hepatocellular carcinoma arising in the fibrosis of non-alcoholic steatohepatitis. By electron microscopy, tumour cells had lipid droplets, glycogen, swollen mitochondria, rough endoplasmic reticulum, mallory bodies, small bile canaliculi, desmosomes and gap junctions. Surrounding non-tumoral hepatocytes had a largely normal ultrastructure with prominent glycogen and lipid droplets. Clear-cell hepatocellular carcinoma within non-alcoholic steatohepatitis associated with diabetes mellitus is an extremely rare condition, and this report provides a detailed histopathological description with both immunohistochemical and ultrastructural data.- - - - - - - - - - ranking = 8keywords = carcinoma (Clic here for more details about this article) |
7/33. Asymptomatic acute pancreatitis due to tamoxifen-induced severe hypertriglyceridemia in a patient with diabetes mellitus and breast cancer.We report tamoxifen-induced hypertriglyceridemia and asymptomatic acute pancreatitis in a 51 year-old women with type 2 diabetes mellitus and stage III-b infiltrative ductal carcinoma, admitted to the hospital with weakness, oliguria and glucose dysregulation. On admission, there was no fever, abdominal or back pain, rebound tenderness, nausea, or vomiting. Following 1 year of tamoxifen treatment, triglycerides increased from 400 to 1344 mg/dl (blood urea nitrogen 52 mg/dl, creatinine 2.0 mg/dl, glucose 341 mg/dl). hypertriglyceridemia was considered to be due to either diabetic dyslipidemia and/or tamoxifen. On computerized tomography, pancreatic enlargement, heterogenity, hypodensity and a pancreatic pseudocyst (5 x 7.5 cm diameter) were found. Acute pancreatitis was suspected, and serum amylase level was found to be increased (273 IU/L). tamoxifen was discontinued and gemfibrozil was started. triglycerides decreased to 301 mg/dl and amylase decreased to 66 IU/L a week later and remained normal thereafter. This case indicates that tamoxifen-induced hypertriglyceridemia may cause acute pancreatitis without classical symptoms which might be due to autonomic neuropathy in diabetic patients. Effects on lipid metabolism should be considered and triglycerides should be closely followed in patients on tamoxifen.- - - - - - - - - - ranking = 1.5900780090163keywords = carcinoma, ductal (Clic here for more details about this article) |
8/33. Treatment of parotid ductal stenosis and concomitant resolution of autonomic symptomatology.Salivary retention and recurrent sialadenitis as a result of ductal stenosis is an uncommon condition that presents difficult management problems. Ductal dilation with small angioplasty balloons is recognized to be of low morbidity and can eliminate the possible need for surgical intervention. This case report is interesting in that the successful treatment of parotid duct stenosis was accompanied by the resolution of a spectrum of autonomic symptoms that had seriously compromised the patient's quality of life.- - - - - - - - - - ranking = 2.9503900450817keywords = ductal (Clic here for more details about this article) |
9/33. panophthalmitis due to clostridium septicum.PURPOSE: To describe patient survival in a rare case of endogenous clostridium septicum sepsis with panophthalmitis. DESIGN: Observational case report. methods: Both eyes of a female patient were examined in a hospital setting. RESULTS: A 68-year-old woman had right orbital pain, proptosis, panophthalmitis, mental confusion and fever for 2 days. Blood cultures were significant for clostridium septicum. The patient did not improve after treatment with intravenous broad-spectrum antibiotics and the right eye was enucleated. The patient survived the acute infection and extensive systemic evaluation revealed an undiagnosed colon carcinoma that may have been responsible for colonization and vascular dissemination of clostridium septicum. CONCLUSIONS: clostridium septicum panophthalmitis and sepsis can be the presenting sign in patients with unsuspected malignancies, particularly colon cancer. patients can survive the infection with aggressive therapy with systemic antibiotics combined with removal of the infected tissue.- - - - - - - - - - ranking = 1keywords = carcinoma (Clic here for more details about this article) |
10/33. Hepatocellular carcinoma with nonalcoholic steatohepatitis.Nonalcoholic steatohepatitis (NASH) was originally believed to be a benign disease. However, it has been recently revealed that NASH could lead to irreversible liver disease in some patients. We report an unusual case of hepatocellular carcinoma (HCC) in a 76-year-old man with NASH. He had no history of alcohol consumption, drug use, or blood transfusion. He was negative for all serological viral markers and autoantibodies. In addition, he was obese (body mass index [BMI], 30.75 kg/m(2)) and had type 2 diabetes mellitus. A liver biopsy specimen showed moderate steatosis with necroinflammatory changes, ballooning degeneration, mallory bodies, pericellular fibrosis, and evidence of nodular regeneration. He was diagnosed with NASH with cirrhosis. Simultaneously, a liver tumor, measuring 19 mm in diameter, was detected in segment 6. A tumor biopsy specimen revealed well-differentiated HCC, and imaging modalities confirmed the characteristics of HCC. To our knowledge, ten patients who had HCC with NASH were reported. In all patients with NASH and HCC, cirrhosis was present. patients with NASH and cirrhosis may progress to HCC, and regular screening, based on tumor markers and imaging modalities, is needed to detect HCC in patients with NASH and cirrhosis.- - - - - - - - - - ranking = 5keywords = carcinoma (Clic here for more details about this article) |
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