1/97. Successful surgical treatment for implanted intraperitoneal metastases of ruptured small hepatocellular carcinoma: report of a case.We report herein the case of a 53-year-old man with disseminated intraperitoneal metastases caused by the rupture of small hepatocellular carcinoma (HCC). He was admitted to our hospital in shock after suffering a trauma injury to the upper abdomen. ultrasonography revealed a massive hemoperitoneum. At surgery, 4000 ml of blood was drained from the abdominal cavity and a ruptured tumor, 2 cm in diameter, was found in the right lobe of the liver. The tumor was resected with an adequate surgical margin and subsequent microscopic examination confirmed a diagnosis of moderately differentiated HCC without associated liver cirrhosis. The patient was readmitted 14 months later following the development of right lower quadrant pain. ultrasonography and computed tomography revealed extrahepatic abdominal tumors, and abdominal angiography demonstrated four intraperitoneal tumors. At surgery, four implanted metastases adhered to the greater omentum were found and resected. No other tumors were detected. Microscopically, all four tumors were confirmed as moderately differentiated hepatocellular carcinoma. Ruptured HCC may lead to implanted intraperitoneal metastasis, but rupture of small HCC is very rare. While hepatic resection is the treatment of choice for ruptured HCC, according to our review of the literature, only a few patients have survived long-term after resection of implanted metastasis.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
2/97. Generalized intraperitoneal seeding of hepatocellular carcinoma after microwave coagulation therapy: a case report.We first describe a case of generalized intraperitoneal seeding of hepatocellular carcinoma (HCC) after microwave coagulation therapy (MCT). A 61 year-old man underwent operative MCT for an exophytic HCC, 60 mm in diameter, in segment IV of his cirrhotic liver. Despite successful tumor ablation, the serum alpha-fetoprotein levels continuously rose after MCT. Five months later, radiographic examinations delineated several perihepatic masses with hypervascularity, and the patient presented with constipation. At the second laparotomy, there were numerous small peritoneal metastases involving the entire peritoneal cavity and slightly bloody ascites. An omental mass, 50 mm in diameter, involved the transverse colon. Most of these intraabdominal masses were removed together with the involved colon. Histologically, the initial tumor was a moderately differentiated HCC, and the peritoneal masses were poorly differentiated HCCs. The patient died of rapid tumor progression and bleeding 2 months later. In conclusion, we should be aware of the possible occurrence of peritoneal seeding after MCT for HCC. Every effort should be made to prevent this serious complication, particularly in cases of superficial, large, and less differentiated HCCs.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
3/97. Rare presentation of small bowel leiomyosarcoma with liver metastases.Intraabdominal sarcomas are rare tumours usually diagnosed at an advanced stage. These lesions at presentation are bulky and symptoms are often related to pressure effects on adjacent organs. This case report describes a rare presentation of a small bowel leiomyosarcoma whose initial presentation was free haemorrhage into the abdominal cavity and concomitant liver metastases. This case report also demonstrates that, even with such a rare presentation, an aggressive surgical approach is indicated in this type of tumour and helps a patient with advanced disease to live a few disease-free months with a good quality of life.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
4/97. Gingival lesions and nasal obstruction in an immunosuppressed patient post-liver transplantation.Although rare, metastatic hepatocellular carcinoma (HCC) presenting only to the mandible, gingiva, and nasal cavity in patients subsequently found to have primary HCC has been reported. In the age of transplantation, certain HCC patients may receive treatment with an orthotopic liver transplant. Due to the proclivity of HCC for early micrometastases, immunosuppressive therapy can induce significant metastatic lesions. Nasal mass obstruction, gingival lesions, or facial growths in this population must be considered metastatic until proven otherwise.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
5/97. Fine needle aspiration cytology of metastatic transitional cell carcinoma to the liver.A 63-year-old man presented with a three-month history of painless hematuria. A cystoscopic examination revealed a diffuse small nodulopapillary growth of the bladder mucosa. biopsy resulted in the diagnosis of a transitional cell carcinoma (TCC), grade II. Therefore, total cystectomy with an ileal conduit was performed and the pathologic examination demonstrated a TCC grade II/III apparently confined to the mucosa. However, an ultrasonographic study carried out one year later revealed tumor masses in the pelvic cavity and the liver. FNA and needle biopsy of the liver were carried out and the diagnosis of a metastatic TCC was made from the former. Needle biopsy results pointed to a metastatic undifferentiated carcinoma, most likely originating from the TCC. The advantage of FNA is discussed. It is being used with increasing frequency to diagnose mass lesions in the liver and can identify metastatic tumors which have specific cytologic features that are different from primary liver tumor.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
6/97. Cystic neuroblastoma with hepatic metastasis: report of one case.neuroblastoma is the most common infant malignancy, but cystic neuroblastoma is a rare presentation of this disease. There were only thirty-one reported cases in literature. Here we report another case. A 4-month-old female baby presented with a huge abdominal mass which was histologically proved to be a cystic neuroblastoma. Her urinary vanillylmandelic acid (VMA) was elevated. The image studies, including abdominal sonography, computed tomography, and magnetic resonance image, revealed a huge main mass with calcification and septa in the abdominal cavity, and multiple metastatic nodules with septation in the liver. A three-layer fluid-fluid level was found in the main mass and also in the metastatic nodules. No previous report showed a three-layer fluid-fluid level in the cystic component of neuroblastoma like the case presented here. It may be evidence of easy hemorrhagic character of this tumor.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
7/97. Peritoneal seeding of hepatocellular carcinoma after ethanol injection therapy.The tumor seeding due to percutaneous ethanol injection therapy has been considered to be a very rare complication. Four cases of peritoneal seeding of hepatocellular carcinoma following percutaneous ethanol injection therapy are presented here. All patients had been initially treated for hepatocellular carcinomas with percutaneous ethanol injection therapy. Between 5 and 20 months after the percutaneous ethanol injection therapy, peritoneal seeding tumors were detected and resected surgically. Three patients recurred in the liver and one patient recurred in the abdominal cavity. Two died of cancer and 2 are still alive. The incidence of seeding following percutaneous ethanol injection therapy should not be so rare as considered referring to that due to fine needle biopsy, therefore careful attentions should be paid during the follow-up of those patients after percutaneous ethanol injection therapy.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
8/97. Successful surgical treatment for implanted intraperitoneal metastases of hepatocellular carcinoma.We report here two patients with hepatocellular carcinoma who experienced implanted metastases in the abdominal cavity after hepatectomy or microwave coagulo-necrotic therapy. Hepatic resection and microwave coagulo-necrotic therapy were successful for these tumors, and the postoperative status was satisfactory in both patients. Implanted metastases were discovered in the abdominal cavity of each of these two patients 6 months after surgery. It is necessary to look not only for the presence of liver metastasis but also for the recurrence of the tumor in the abdominal cavity during the follow-up period. Generally, surgical resection for intraabdominal implanted tumors arising from any other abdominal organs is not indicated for improving the patient's quality of life. However, resection of metastatic tumors that occur in the abdominal cavity, arising from hepatocellular carcinoma may be of value in improving patient survival.- - - - - - - - - - ranking = 4keywords = cavity (Clic here for more details about this article) |
9/97. Pleural dissemination as a complication of preoperative percutaneous transhepatic biliary drainage for hilar cholangiocarcinoma: report of a case.One potential risk of percutaneous transhepatic biliary drainage is tumor seeding along the catheter tract. A 57-year-old woman with obstructive jaundice due to hilar cholangiocarcinoma underwent an extended left hepatic lobectomy, a regional lymph node dissection, and a right hepaticojejunostomy 2 weeks after percutaneous transhepatic biliary drainage. Multiple right pleural masses were found on a chest radiogram 14 months after the operation. No recurrent lesions were detected in the abdominal cavity. A right panpleuropneumonectomy was performed; however, the patient died of respiratory failure due to tumor recurrence 9 months after the second operation. Preoperative percutaneous transhepatich biliary drainage was considered to have resulted in pleural implantation.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
10/97. Treatment of ruptured undifferentiated sarcoma of the liver in children: a report of two cases and review of the literature.Undifferentiated (embryonal) sarcoma of the liver (USL) is a highly malignant tumor of early life. Treatment choices for USL, especially with intraperitoneal rupture, are uncertain. Outcomes have been almost uniformly poor until recently. We describe two 7-year-old girls treated for ruptured USL. In the more recent patient, operative biopsy was followed by three cycles of cisplatin (CDDP), adriamycin (ADR), and cyclophosphamide (CPM). A fluid-filled cavity in the tumor showed enlargement and was drained. Two cycles of CDDP, ADR, vincristine (VCR), and ifosfamide were accompanied by reduction in tumor size, and trisegmentectomy was performed. She has no evidence of disease 3.5 years after surgery. In the other patient, left lobectomy was followed by a less intensive regimen, including CPM, VCR, and fluorouracil. This patient died of dissemination within 5 months. In 170 reported pediatric patients with USL, the 2-year disease-free survival was 17%. For the 96 such patients reported since 1980, 2-year disease-free survival had improved to 27%. More aggressive chemotherapy has been associated with this change. Of 8 patients with tumor rupture whose details have been reported (including the 2 present patients) after resection of the tumor, 4 died, 1 was alive with disease, and 3 were free of disease at 8, 49, and 58 months, respectively, after diagnosis. Ruptured USL should be treated with combination chemotherapy including CDDP and ADR, as well as with curative resection.- - - - - - - - - - ranking = 1keywords = cavity (Clic here for more details about this article) |
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