Cases reported "Liver Neoplasms"

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1/949. Intact PTH-producing hepatocellular carcinoma treated by transcatheter arterial embolization.

    We report a case of hepatocellular carcinoma with hypercalcemia. There was no evidence of bone metastasis or increase in parathyroid hormone-related protein. The serum level of intact parathyroid hormone (intact PTH) was very high, and the results of the hepatic venous sampling suggested that the tumor produced intact PTH. Transcatheter arterial chemoembolization effectively controlled the humoral hypercalcemia.
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ranking = 1
keywords = metastasis
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2/949. Prolonged lactic acidosis after extended hepatectomy under in situ hypothermic perfusion.

    A 46-year-old woman underwent right extended hepatectomy under total vascular occlusion with in situ hypothermic perfusion for colorectal metastasis. Immediately after surgery, she developed severe lactic acidosis, which required correction with sodium bicarbonate solution and ventilatory support for 36 hours. After 2 days, her lactate normalized, and the acidosis was corrected. She made an uneventful recovery. Persistent lactic acidosis after major hepatic resection under in situ hypothermic perfusion is a rare but reversible problem.
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ranking = 1
keywords = metastasis
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3/949. Primary pericardial mesothelioma with cardiac tamponade and distant metastasis: case report.

    Although cardiac tamponade is a well-known complication of malignancy, it is uncommon as the initial manifestation. The antemortem diagnosis is difficult and distant metastasis is extremely rare. The presentations of primary pericardial mesothelioma are nonspecific. Pathologically, mesothelioma is the most common in primary tumors of the pericardium. Radical surgery can be used to treat a localized mesothelioma. However, the therapy for advanced primary pericardial mesothelioma is usually palliative because it is resistant to irradiation, and chemotherapy does not markedly improve the outcome. The prognosis is uniformly poor. The median survival from the onset of symptoms is 6 months. We present a 67-year-old woman with cardiac tamponade 4 months prior to a definitive diagnosis of primary pericardial mesothelioma. A computed tomogram confirmed multiple well-enhanced nodules in the pericardium, lungs and liver. Unfortunately, the patient died of multiple organ failure.
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ranking = 5
keywords = metastasis
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4/949. Metastatic melanoma of the vulva identified by peritoneal fluid cytology.

    Malignant melanoma of the vulva is an uncommon disease, with a significant portion of cases demonstrating metastasis to inguinal lymph nodes with potential distal spread. Identification of such metastases often requires fine-needle aspiration or biopsy. The cytologic diagnosis of metastatic vulvar melanoma from peritoneal effusions has not been previously described. We present the case of a 54-yr-old woman who underwent en bloc radical vulvectomy with bilateral inguinal lymphadenectomy for melanoma of the right labium minora. No evidence of metastatic disease was identified, and all surgical margins were free of tumor. Despite chemotherapy, the patient returned approximately 2 yr later with abdominal pain and distention. Computed tomography revealed marked ascites and three hepatic lesions. Cytologic examination of the ascites revealed recurrent, metastatic melanoma. Although very rare, metastatic melanoma of the vulva may present as a malignant effusion. In such an event, the diagnosis may be rendered by exfoliative cytology.
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ranking = 1
keywords = metastasis
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5/949. Severe thyrotoxicosis due to hyperfunctioning liver metastasis from follicular carcinoma: treatment with (131)I and interstitial laser ablation.

    liver metastases from differentiated thyroid tumors are unusual clinical findings, and are only rarely hyperfunctioning. We report a case of thyrotoxicosis caused by a huge and surgically unresectable liver metastasis from follicular thyroid cancer, unresponsive to treatment with large doses of thionamides. To avoid the hazardous side effects of (131)I treatment in a severely thyrotoxic patient, a preliminary debulking of the liver mass was performed by means of percutaneous interstitial laser photocoagulation. Three treatments (total energy delivery: 7200 J) were performed under ultrasound guidance, with no serious complications, during a 2-week period. One month later, serum thyroid hormones had decreased, general condition was improved, and magnetic resonance evaluation revealed large and well-defined areas of necrosis of metastatic tissue. During the following 10 months, the patient underwent 3 radioiodine treatments. Eighteen months after diagnosis, thyroid hormones were within normal levels, liver mass decreased, and the clinical condition markedly improved. The combination of percutaneous interstitial laser photocoagulation treatment and radioiodine therapy made possible the effective management of a hyperfunctioning and surgically untreatable liver metastasis from thyroid follicular carcinoma, avoiding the side effects of (131)I therapy in a thyrotoxic patient and increasing the effectiveness of radioiodine-induced neoplastic tissue ablation.
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ranking = 6
keywords = metastasis
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6/949. Management of adrenal metastasis of hepatocellular carcinoma by asynchronous resection of bilateral adrenal glands.

    We report on a 65-year-old man who received asynchronous bilateral adrenalectomy for adrenal metastasis of hepatocellular carcinoma. Fifteen months after curative resection of right hepatic lobe for hepatocellular carcinoma, a metastatic lesion of the left adrenal gland was detected and left adrenalectomy was performed. Ten months after the second operation, a metastatic lesion in the right adrenal gland, associated with tumor thrombus in the inferior vena cava, was revealed. Transcatheter arterial embolization of the arteries feeding the metastatic tumor was performed, but its effects were incomplete. As there was the tumor thrombus in the inferior vena cava and no other intrahepatic recurrence or extrahepatic metastasis was found, resection of the right adrenal gland with tumor thrombus, without the employment of veno-venous bypass, was performed, followed by postoperative hormonal supplementation. Changes in the patient's alpha-fetoprotein level were clinically useful for the detection of the metastatic lesions and the evaluation of therapeutic effects. Metastasis to adrenal gland from hepatocellular carcinoma should be actively managed, and the appropriate surgical treatment selected, if intrahepatic recurrence and/or other extrahepatic metastasis are controlled. To achieve higher curability and better outcome in patients with bilateral adrenal metastasis of hepatocellular carcinoma, bilateral total adrenalectomy is indicated, accompanied by effective postoperative hormonal supplementation.
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ranking = 8
keywords = metastasis
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7/949. A case of hepatocellular carcinoma with bone metastasis responding to radiotherapy after successful hepatectomy of primary lesion.

    Radical hepatectomy was carried out on a patient with hepatocellular carcinoma (HCC) located in segment VIII of the liver. The patient was a 56-year-old man who showed positive for hepatitis c antibody and negative for hepatitis b surface antigen. Six months after hepatectomy, a lumbar plane X-ray and computed tomography examination revealed bone metastases in the lumbar vertebrae. The patient was subsequently treated by radiation to the lumbar vertebrae in response to lumbago. The metastatic lesion has been well controlled by radiotherapy on an outpatient basis with no recurrence for 5 years and 3 months. The prognosis of patients with HCC with distant metastases is poor. It is believed that the long survival of this patient can be attributed to successful radiotherapy of the bone metastasis after hepatectomy and the lack of recurrence in the liver.
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ranking = 5
keywords = metastasis
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8/949. 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.
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ranking = 1
keywords = metastasis
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9/949. Repeat hepatic resection for recurrent metastatic melanoma.

    We present an unusual case of a recurrent metastatic hepatic melanoma that had undergone a repeat hepatic resection. A 62 year-old female patient was diagnosed with a plantar melanoma and was managed with resection and regional lymphadenectomy. Eight months later, a solitary liver metastasis was diagnosed and a right hepatectomy performed. Sixteen months later, a recurrent solitary metastasis was diagnosed in the caudate lobe and resection was performed. She has since been asymptomatic with no evidence of recurrence of the disease at a 2-year follow up. We recommend surgical removal of hepatic metastatic melanoma in selected cases where the disease is confined to the liver and surgery can be performed without unacceptable risk.
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ranking = 2
keywords = metastasis
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10/949. Extraosseous metastases of hepatocellular carcinoma detection and therapeutic assessment with Tc-99m PMT SPECT.

    Owing to recent advances in imaging technology and radiologic intervention, survival rates in patients with hepatocellular carcinoma have improved markedly. However, such prolonged survival has resulted in an increase in extrahepatic metastases. Tc-99m (Sn)-N-pyridoxyl-5-methyltryptophan (Tc-99m PMT), developed for hepatobiliary scintigraphy, has been used to visualize extrahepatic metastases, with most related reports limited to osseous metastases. The authors report two cases of hepatocellular cancer presenting as a hypopharyngeal metastasis and intraperitoneal dissemination along the tract of a fine-needle biopsy. Lesions undetectable on planar imaging could be visualized by Tc-99m PMT SPECT.
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ranking = 1
keywords = metastasis
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