1/157. Solitary hepatic hemangioma in a newborn infant complicated by cardiac failure, consumption coagulopathy, microangiopathic hemolytic anemia, and obstructive jaundice. Case report and review of the literature.A newborn infant with a large hepatic hemangioma developed congestive heart failure, consumption coagulopathy, microangiopathic hemolytic anemia, and obstructive jaundice. The patient was mildly heparinized (250 units per kg and day) and underwent successful resection of the tumor without lobectomy at the age of 3 days. blood volume increased from 93.9 ml/kg at the age of 5 h to 124.2 ml/kg prior to surgery. Red-cell mass simultaneously decreased from 53.8 to 39.4 ml/kg. The increase of blood volume is explained by congestive heart failure, the decrease of red-cell mass by intravascular coagulation within the tumor resulting in formation of thrombi and microangiopathic hemolytic anemia. A review of the literature on infants with symptoms caused by an intrahepatic hemangioma during the first month of life confirms that surgical intervention is the treatment of choice for infants with giant solitary hemangioma of the liver.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/157. A case of primary adenosquamous/squamous cell carcinoma of gallbladder directly invaded duodenum.A rare case of primary gallbladder carcinoma is reported. A 67 year-old woman was admitted to our hospital for treatment of suspected duodenal carcinoma. A series of radiographic examinations demonstrated a giant tumor involving the duodenum, gallbladder, pancreatic head, and transverse colon. These extensions made it difficult to identify the primary origin of the carcinoma. Pancreatoduodenectomy, cholecystectomy, and resection of the transverse colon were performed. Macroscopically, ulcerative lesions were seen in both the gallbladder and the duodenum. Microscopic examination revealed adenosquamous cell carcinoma of the gallbladder, invasive of the adjacent organs, including circumferential invasion of the second portion of the duodenum. The patient tolerated the operation well and was discharged 28 days post-operatively, but died of liver metastasis 4 months after surgery. Local invasion of the surrounding tissues is characteristic of adenosquamous/squamous cell carcinoma of the gallbladder. Although surgery for cure is deemed possible, the rapid growth rate of this type of tumor may cast doubt on the value of extensive radical surgery.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/157. Rapid evolution of chronic viral hepatitis into hepatocellular carcinoma after beta-interferon treatment.A 62-year-old man, affected by Chronic Active hepatitis (discovered in 1993) and treated with interferon, referred to our department with increased abdominal volume, persistent abdominal pain, continuous-remittent fever and jaundice. CT scan of the liver revealed a hypodense, not capsulated, infiltrative, solid formation in the right lobe. US guided biopsy showed multinucleated giant cells, with eosinophilic cytoplasm and pleomorphism of the nuclei, arranged in several thick trabecula lined by endothelial cells or formed bile containing acini. In our case, the rapid evolution of chronic viral hepatitis towards HCC calls for a careful evaluation of the role of IFN therapy, since this drug is widely used in chronic liver diseases.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/157. Primary liver hemangiopericytoma associated with hypoglycemia: report of a second case.hemangiopericytoma is an uncommon vascular tumor which usually develops in soft tissues. It has been exceptionally described in the liver and only one case associated with hypoglycemia has been reported in this organ. A giant hemangiopericytoma which was revealed by life-threatening hypoglycemia is described. Imaging and pathological features are presented. The patient, a 73 year-old woman, was treated by hepatectomy. She is perfectly well after a 3-year follow-up, without any evidence of recurrence.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/157. Combined hepatocellular and cystadenocarcinoma presenting as a giant cyst of the liver--a case report.Primary cystic lesions of the liver are very rare. Most of the solid tumours are hepatocellular carcinomas (HCC) with a smaller number being cholangiocarcinomas. The association of HCC with other primary liver malignancies is also extremely rare. This case report is about a 27 year old male patient who presented with a giant cystic lesion of the left liver. A CT scan showed a cystic lesion with internal septations and a thrombus in the main portal vein. The patient underwent an extended left hepatectomy and a portal venotomy with removal of the thrombus. Coexistent hepatocellular and cystadenocarcinoma were reported on histopathological examination. The patient was put on 5-FU postoperatively. He is doing well 11 months after surgery.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
6/157. Asymptomatic gastric perforation by a toothpick. A case report.BACKGROUND: Many cases of gastric perforation with peritonitis, pylephlebitis, hepatic abscesses, or lethal bleeding, caused by ingested long and sharp objects, are reported in the literature. methods: During a right hepatectomy for a giant hemangioma, a wooden toothpick was found between the two layers of the hepatogastric ligament. It was not possible to find the passage of the foreign body through the gastric wall. The patient did not report any correlated symptoms. RESULTS: There was no sign of inflammation around the toothpick, which was enveloped in thin scar tissue. The removal of the foreign body was performed without complications. CONCLUSIONS: The peculiarity of our case is the total absence of symptoms during and after the perforation. Despite the benign evolution of our case, toothpicks must be considered as potentially dangerous, like other pointed objects, and, therefore, removed immediately. copyright copyright 1999 S. Karger AG, Basel- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/157. polymyalgia rheumatica as a manifestation of a large hepatic cavernous hemangioma.A 59-year-old woman presented with polymyalgia rheumatica which was refractory to conventional anti-inflammatory and steroid therapy. A full investigation for an underlying occult malignancy showed only the presence of a giant cavernous hepatic hemangioma. To our knowledge, polymyalgia rheumatica has never been described in association with giant cavernous hepatic hemangioma; resection of the latter lesion resulted in complete and, to this date, definite resolution of rheumatologic complaints in our patient.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
8/157. Giant hepatic hemangioma with kasabach-merritt syndrome: is the appropriate treatment enucleation or liver transplantation?We present a case of giant cavernous hemangioma of the liver with disseminated intravascular coagulopathy (kasabach-merritt syndrome) which was cured by enucleation. The 51 year old woman presented with increased abdominal girth and easy bruisability. Workup elsewhere revealed a massive hepatic hemangioma and she was started on radiation therapy to the lesion and offered an orthotopic liver transplant. After careful preoperative preparation, we felt that resection was possible and she underwent a successful enucleation. The operation and postoperative course were complicated by bleeding but she recovered and remains well in followup after 6 months. All coagulation parameters have returned to normal. Enucleation should be considered the treatment of choice for hepatic hemangiomas, including those presenting with kasabach-merritt syndrome. The benefits of enucleation as compared to liver transplantation for these lesions are discussed.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/157. Spontaneous rupture of a giant hemangioma of the liver.Hemangiomas are frequent benign tumors of the liver. Symptoms (abdominal pain and fullness) are mostly seen in giant lesions. rupture is the most severe complication, can occur spontaneously, with intraperitoneal bleeding, in 1-4% of hemangiomas and has been described in about 30 cases in the international literature with a high mortality (about 60%). This complication is the principal indication for surgery. Although spiral CAT scan and MR are actually the most efficacious imaging methods for study of liver hemangiomas, after Echography, emergency techniques that allows a simultaneous therapeutic approach--as is angiography--are preferable. Trans-arterial embolization (TAE) is in fact useful to stop bleeding and then to perform a safer surgery. A successful embolization can delay the surgical resection of the hemangioma for the time necessary to recover from the hemodynamic distress. Aside from the success of angiographic approach, surgery remains mandatory, effective in stopping the bleeding and in preventing re-bleeding or other complications of TAE such as abscess, fever, etc.. Intraoperative echography currently is the best method to identify vasculo- biliary anatomy and to perform a correct resection. The absence of risk factors for spontaneous rupture of liver hemangiomas, makes this event unpredictable. The best treatment for non-ruptured hemangiomas is still controversial but surgery is usually limited to symptomatic tumors larger than 10 cm.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
10/157. Metastatic angiosarcoma of the liver preoperatively presenting as giant hemangioma.BACKGROUND: Hepatic angiosarcomas are rare tumors most often associated with exposure to vinyl chloride or other carcinogens. Only a few cases have been published without such a history. CASE REPORT: We report the case of a 73-year-old woman who was admitted to our medical department with unclear upper abdominal pain, thrombocytopenia and anemia. Both computed tomography and magnet resonance imaging revealed a giant hemangioma in the right liver with multiple small hemangiomas. To cure the problem of thrombocytopenia due to sequestration of blood cells in the hemangioma, we decided to resect the large tumor. Intraoperatively, however, the diagnosis of angiosarcoma with multiple metastases was made. The patient died 6 weeks after surgery. CONCLUSION: Problems in diagnosing angiosarcoma include the brief duration of antecedent symptoms, difficulties in radiological diagnosis, and patients without a history of professional exposure to carcinogens.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
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