Cases reported "Liver Neoplasms"

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1/17. Malignant Brenner tumors of the ovary and tumor markers: case reports.

    We investigated the tumor marker for malignant Brenner tumors, which had not been established because of the rarity and variable histological criteria. Representative areas of two cases of malignant brenner tumor were investigated by means of the peroxidase-antiperoxidase method using monoclonal antibody to CA125 and CA72-4 antigen and the streptavidin-biotin immunoperoxidase complex method using monoclonal antibody to SCC antigen. Based on clinical course and immunohistochemical studies, serum CA125 and CA72-4 for Case 1 and SCC and CA72-4 for Case 2 were appropriate tumor markers for the establishment of the extent of tumor burden before treatment and to monitor the response to therapy. The discrepancy of the tumor markers of the two present cases is considered to be a reflection of the difference in the malignant component of these cases. However, serum CA72-4 was an appropriate tumor marker for both malignant Brenner tumors.
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2/17. Manifestations of hypercholesterolaemia, hypoglycaemia, erythrocytosis and hypercalcaemia in patients with hepatocellular carcinoma: report of two cases.

    BACKGROUND: Hypercholesterolaemia, hypoglycaemia, hypercalcaemia and erythrocytosis, are well-known paraneoplastic manifestations in patients with hepatocellular carcinoma (HCC). Hepatocellular carcinoma patients manifesting with two or three paraneoplastic manifestations have been previously reported. However, HCC patients presenting with four paraneoplastic syndromes have not been previously reported. methods AND RESULTS: This manuscript describes two HCC patients who manifested with hypercholesterolaemia, hypoglycaemia, hypercalcaemia and erythrocytosis during their clinical course. Erythrocytosis appeared early when HCC was diagnosed and declined to within normal range after optimal therapy for HCC. Hypercholesterolaemia manifested initially after the diagnosis in case 1, declined to within normal range after lobectomy and was re-elevated after tumour recurred. With disease progression, hypercalcaemia and hypoglycaemia occurred 1-3 months after diagnosis and the both patients subsequently died several days later. CONCLUSIONS: Similar features found in both patients were large tumour burden, high serum alpha-fetoprotein level and rapid downhill clinical course even with optimal therapy. The clinical significance of these paraneoplastic manifestations is discussed.
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keywords = tumour burden, burden
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3/17. Hepatic angiosarcoma: an unusual cause of congestive heart failure.

    Hepatic angiosarcoma is a rare form of liver cancer. The history, physical examination, and liver biopsy are nonspecific. As a result, diagnosis of angiosarcoma can be challenging. We report the case of an elderly woman with congestive heart failure caused by a hepatic angiosarcoma. The massive tumor burden created extensive arteriovenous shunting and a high-cardiac-output state.
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4/17. A preventable cause of acute abdomen.

    Haemoperitoneum is an extremely rare presentation of hepatocellular carcinoma in the industrialised world. We present the first reported case in the UK. In contrast, up to 10% of hepatocellular carcinomas in africa present in this way, the median time between presentation and death being just six weeks. hepatitis b infection at birth and during childhood is the major cause of hepatocellular carcinoma in the developing world. The world health Organisation, UNICEF and the World Bank have all advocated routine hepatitis b vaccination of children. This can reduce the burden of disease in these communities, among people in their productive years of life.
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5/17. Vasoactive intestinal polypeptide-secreting tumor (vipoma) with liver metastases: dramatic and durable symptomatic benefit from hepatic artery embolization, a case report.

    neuroendocrine tumors often manifest an excess production of hormones that create severe metabolic abnormalities resulting in significant patient morbidity, independent of the tumor burden itself. VIPomas are rare neuroendocrine tumors arising from the pancreas and are associated with secretory diarrhea and electrolyte disturbances. We present a patient with vipoma and hepatic metastases who had greater than 10 loose stools a day for 4 yr since diagnosis, despite debulking surgery, multiple antidiarrheal medications, large doses of octreotide, and targeted radioisotope injections. The patient required several hospitalizations for treatment of dehydration and electrolyte disturbances, despite receiving daily intravenous fluids at home. hepatic artery embolization (HAE) immediately stopped the patient's diarrhea and provided a return to normal formed stools without any other symptom-support measures. One year after HAE, the patient remains asymptomatic and has returned to a productive life. HAE can be a very effective and durable treatment modality for patients with metastatic VIPomas (or other neuroendocrine tumors) and who are clinically symptomatic from the effects of hormone hypersecretion.
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6/17. Monitoring hemangioblastoma tumor burden using plasma erythropoietin levels.

    We report a 39-year-old female patient with a hepatic hemangioblastoma, polycythemia and elevated plasma erythropoietin (Epo) levels. Following orthotopic liver transplantation (OLTx), her plasma Epo levels and hematocrit normalized but began to rise several months later. This rise correlated with the appearance of multiple lung metastases. The tumor was implicated as the source of excess Epo production using Northern analysis of a resected metastatic lung nodule. Based on our results, the measurement of plasma Epo levels in patients with Epo secreting tumors could be of general utility in assessing tumor burden.
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7/17. Analysis of 13 postmortem examinations with regard to the effect of chemotherapy on neuroblastoma patients.

    Thirteen postmortem examinations on neuroblastoma patients were reviewed clinicopathologically. Commonly found metastatic sites were bone, liver and lung. The introduction of massive doses of cyclophosphamide and cisplatinum into chemotherapy protocol markedly reduced the tumor burden: no tumor focus in liver or lung, small tumor burden in bone. lymph node metastasis remained, however, and was refractory to the chemotherapy. The intensive chemotherapy caused severe side effects: interstitial or bacterial pneumonia and intrathecal bleeding, which sometimes proved fatal. Such side effects must, therefore, be carefully controlled in order to maximize the survival rate.
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8/17. Metastatic head and neck carcinoma to a percutaneous endoscopic gastrostomy site.

    BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tube placement is a safe and widely accepted alternate route for enteral alimentation in the head and neck cancer patient population. Cancer metastatic to a PEG tube exit site is a rare but serious complication of this procedure. We sought to determine the route of spread responsible for PEG site metastases such that we may prevent further occurrences of this highly morbid condition. We also report a case of PEG site metastasis at our institution. methods: We performed a medline search for the years 1962 to 2002 and conducted a review of the literature. In the case at our institution, a 63-year-old man was referred to our institution with recurrent squamous cell carcinoma of the right base of tongue; he also had a 1.5-cm left apical lung nodule. He underwent PEG tube placement at the time of staging panendoscopy. Six months after the original tube placement, he had an ulcerated mass develop at the PEG site; biopsy of the mass revealed squamous cell carcinoma histologically identical to the base of tongue tumor. He also had recurrent lung cancer and four hepatic lesions develop. RESULTS: In our medline search, of the five patients diagnosed with PEG site disease >10 months after PEG placement, all five (100%) had synchronous distant metastatic disease. In the group of patients diagnosed with PEG site metastases < or =10 months after PEG placement, only four (24%) of 17 had synchronous distant metastatic disease. All patients underwent PEG placement by means of the "pull" technique. Direct implantation with a variable-sized initial tumor burden can explain all cases of PEG site metastasis. The presence of distant metastases is representative of the natural history of advanced head and neck malignancies. Smaller initial tumor implants present later than would larger initial tumor burdens, when the patient is more likely to have distant metastatic disease. In the case at our institution, the patient did not respond to treatment for his hepatic and PEG site metastases and his lung cancer, and he died 4 months after detection of the PEG site metastasis. CONCLUSIONS: PEG site metastases are iatrogenic complications of PEG tube placement in patients with squamous cell carcinoma of the upper aerodigestive tract. The use of laparoscopic, open, or the "push" technique of PEG tube placement in patients with head and neck cancer may prevent direct implantation of malignant cells into an enteral access site.
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9/17. The role of cytoreductive hepatic surgery as an adjunct to the management of metastatic neuroendocrine carcinomas.

    BACKGROUND: patients with metastatic neuroendocrine cancers to the liver often present with disabling endocrinopathies and pain associated with bulky disease. quality of life for these patients is poor and can require long-term therapy with somatostatin analogs for control of their symptoms. Alternative therapies to decrease tumor burden and subsequent hormone release have been investigated. Of these, cytoreductive surgery was found to have the most consistent and profound impact on symptom regression and overall survival. methods: Several cases are reported that illustrate an aggressive multimodality approach in the treatment of metastatic neuroendocrine cancers to the liver. The literature is reviewed and the role of cytoreductive surgery in the management of hepatic neuroendocrine metastases is discussed. RESULTS: Cytoreductive surgery can be performed safely with minimal morbidity and mortality. Regression of symptoms occurs in the majority of patients and survival is prolonged. CONCLUSIONS: Surgical intervention as part of an aggressive multimodality treatment plan results in improved outcomes for patients with advanced hepatic metastases of neuroendocrine origin. Future directions may include earlier surgical intervention with adjuvant therapies reserved for aggressive recurrent disease.
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10/17. Spontaneous regression of hepatocellular carcinoma.

    A surgically unresectable, biopsy-proven hepatocellular carcinoma (HCC) developed in a 63-year-old man with cirrhosis. He survived 24 months without treatment. During that time the tumor burden decreased as demonstrated both radiologically and by the normalization of alpha-fetoprotein levels. The patient died of complications secondary to repeated esophageal variceal hemorrhage. Necropsy demonstrated prominent, ulcerated esophageal varices and liver cirrhosis without evidence of neoplasia either grossly or on a subsequent thorough microscopic examination. This case represents the first confirmation of HCC spontaneous regression in which a primary histologic diagnosis was confirmed by immunohistochemical and flow cytometric dna analysis, and where tumor regression was proven by a thorough necropsy examination.
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