Primary Hepatic Tuberculoma Associated with Intrahepatic Duct Stones and Abscess

Tuberculosis is a systemic disease that can occur anywhere in body. Its incidence is various according to the organ or location, and TB in an organ where the general incidence is rare causes so many unexpected symptoms and complications that physicians can sometimes be baffled when attempting to make a diagnosis. If this rare occurrence of TB in an unusual location results in non-specific symptoms, then it is important not to overlook the possibility of tuberculosis. Hepatic tuberculosis is mainly a secondary type of disease that has disseminated from the lungs or other organs. Because a primary TB focus in the liver is rare, in the case in which the lung or other organs have no tuberculosis, it is extremely difficult to arrive at the proper diagnosis of primary hepatic tuberculosis. The authers experienced a case of primary tuberculous granuloma that was associated with intrahepatic duct stones and abscess. This patient was first diagnosed as suffering with intrahepatic duct stones and abscess only. We discovered the associated tuberculous granuloma of the liver by histologic examination after hepatectomy. We report on this case with a review of the relevant literature.

Clinical features of portal vein thrombosis in hepatocellular carcinoma / 대한내과학회지

BACKGROUND: Hepatocellular carcinoma is frequently accompanied by portal vein thrombosis. In the setting of cirrhosis, refractory ascites, variceal bleeding and hepatic encephalopathy leads to dramatic course. Portal vein thrombosis is a negative prognostic factor for therapy. We conducted this retrospective study to evaluate the relationship between hepatocellular carcinoma and portal vein thrombosis. We also studied the predictable factor of portal vein thrombosis by biochemical tests. METHODS: A total of 153 hepatocellular carcinoma were examined. We investigated the relationship between hepatocelluar carcinoma and the presence of portal vein thrombosis by CT scan. Correlations between the existence of portal vein thrombosis and the result of biochemical tests were examined. RESULTS: Portal vein thrombosis was found 60 patients (39%). The presence of portal vein thrombosis was not associated with size or number of tumor. Significant differences were seen in total bilirubin, AST, alkaline phosphatase, prothrombin time and AFP. CONCLUSIONS: Our result suggest that hepatocellular carcinoma can accompany portal vein thrombosis in spite of small size and uninodule. So we should be alert to find portal vein thrombosis in early stage of tumor. In such an event, it would be beneficial to additional information concerning the probability of portal vein thrombosis from elevated total bilirubin, AST and alkaline phosphatase.

A Case of Colonic Tuberculosis Presenting as Massive Bleeding / 대한소화기내시경학회지

Tuberculous involvement of the colon is an uncommon clinical entity. Other colonic disease which should be considered in the differential diagnosis include inflammatory bowel disease such as Crohn's disease, ulcerative colitis and colon cancer. Intestinal tuberculosis most frequently involves the ileocecal area. The common presenting symptoms are abdominal pain, fever, weight loss and malabsorption. Pathologically, tuberculous colitis may present as an ulcerative type, hypertrophic type or in combination. Massive bleeding is said to be very rare even in the ulcerative type because of an obliterative endarteritis. We report a case of colonic tuberculosis presenting with massive bleeding in 52-year-old man with alcoholic liver cirrhosis, which was diagnosed by colonoscopic biopsy and acid-fast stain.

A Case of Kaposi's Sarcoma Associated with Ulcerative Colitis / 대한소화기학회지

Kaposi's sarcoma is a rare and slowly progressive disease that primarily affects the skin but has an associated visceral involvement. It can occur in the HIV-positive patients or patients treated with immunosuppressants. However, it is extremely rare in the patients receiving the treatment for inflammatory bowel disease. We used corticosteroid for the treatment of ulcerative colitis in 60-year-old woman. Then, Kaposis's sarcoma occured in the skin and colon of the patient. Since she was HIV-negative, we believed that it was developed from the condition of corticosteroid-induced immunosuppression. We present a case of skin and colonic Kaposi's sarcoma in a HIV-negative woman following treatment with corticosteroid for ulcerative colitis.

A Case of Hepatocellular-cholangiocarcinoma Invading the Gallbladder / 대한간학회지

Metastasis of hepatocellular carcinoma occurs at a relatively late stage of the disease. Hematogenous and lymphatic metastases are the most common routes for dissemination of tumor cells. Hepatocellular carcinoma also extends into the adjacent portal vein and bile ducts. Since there is no peritoneum between the body of the gallbladder and the liver fossa, gallbladder cancer can easily cross the boundary. Gallbladder invasion of hepatocellular carcinoma, however, is quite rare. We report a case of hepatocellular- cholangiocarcinoma in a non-cirrhotic liver that invaded the gallbladder mimicking the gallbladder carcinoma complicated by cholecystitis and liver abscess.

A case of large cell neuroendocrine carcinoma of gallbladder presenting with pyogenic liver abscess / 대한내과학회지

Pyogenic liver abscess is a rare but highly lethal disease. The diagnosis and treatment of pyogenic liver abscess has been evolving owing to specific antibiotic therapy, ultrasonography, abdominal computed tomography with improved percutaneous and operative techniques. However, pyogenic liver abscess may present as a rapidly fatal outcome. These unfavorable results are mainly attributed to the increasing numbers of patients with malignant disease and biliary tract disease. Carcinoma of the gallbladder has remained an uniformly fatal neoplasm characterized by early metastasis and rapid fatal course. In early stage, the symptom is nonspecific and often mimics benign biliary tract disease. We experienced a case of the gallbladder carcinoma presenting with pyogenic liver abscess in a 78-year-old female patient. Surgical drainage and cholecystectomy were done. The microscopic finding of resected gallbladder revealed large cell neuroendocrine carcinoma of gallbladder.

A case of gastric variceal bleeding associated with pancreatic endocrine tumor in the pancreas tail / 대한내과학회지

Isolated obstruction of the splenic vein leads to segmental portal hypertension, which is mainly originated from pancreatic disease, such as chronic pancreatitis, pancreatic pseudocyst, pancreatic cancer. The clinical manifestation are devoid of ascites and encephalopathy, but presented with gastric variceal bleeding. We experienced 27-year-old male patient who complained of hematochezia and melena. After work-up with CT and angiography, we performed operation with the impression of pancreatic tumor associated with splenic vein occlusion. It resulted nonfunctioning pancreatic endocrine tumor. Often called islet cell tumor, pancreatic endocrine tumor has various names according to secreted hormones, such as insulinoma, Zollinger-Ellison syndrome and glucagonoma. It was classified as nonfunctioning tumor if there were any evidence of hormone secretion by radioimmunoassay and immunohistochemistry. Surgical excision and adjuvant medical therapy is the mainstay of therapy. We performed tumor resection and splenectomy for control of gastric variceal bleeding due to splenic vein occlusion.

A Case of Intestinal Tuberculosis Extensively Involving the Upper and Lower Intestinal Tract, Accompanied by Tuberculous Lymphadenitis / 대한소화기내시경학회지

The prevalence of intestinal tuberculosis has been markedly decreased with the development of anti-tuberculous chemotherapy, preventive medicine, vaccinations, early detection and treatment of pulmonary tuberculosis, and improved eeonomic conditions. Nowadays, intestinal tuberculosis is a disease that should be differentiated from the inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, Behcet's disease, and colon cancer and amebic colitis. This disease also has a new clinical significance in that it has an increased infection rate and unfavorable outcomes in patients infected by HIV or in those who undergo organ transplantation or receive immunosuppressive agents. Tuberculosis of the duodenum was a rare disease and was not reported in the last decade. Moreover Intestinal tuberculosis extensively involving the small bowel including the duodenum and colon was very rarely reported in the various relateid literature. Recently we experienced a case of advanced intestinal tuberculosis involving the duodenum, jejunum, ileum, and colon accompanied by tuberculous cervical and abdominal lymphadenopathies, in a 49-year-old woman who manifested profound general weakness, diarrhea, and marked weight loss. She was diagnosed pathologically by upper gastrointestinal endoscopy, colonoscopy, and fine needle aspiration cytology as well as by roentgenologic examination. The patient was given antituberculous medication which resulted in dramatic clinical improvement. In this report, we present this case with review of the related literature.

A Case of Hepatocellular Carcinoma Mimicking Focal Nodular Hyperplasia / 대한간학회지

Distinction of hepatocellular carcinoma from benign entities such as focal nodular hyperplasia is important because failure of prompt diagnosis could result in a missed opportunity for curative resection. The differential deagnosis, especially among focal nodular hyperplasia and adenoma and even hepatocellualr carcinoma, may have difficult; and when using inly a single imaging method, the diagnosis is often equivocal. Therefore, a combination of imaging modalities is preferred. For focal nodular hyperplasia, the combination of computerized tomography (CT ), magnetic resonance imaging (MRI), and radionuclide scintigraphy showed a high sensitivity and specificity. But, histologic examination is required for the differential diagnos is of hepatic mass. We report a case of hepatocellular carcinoma without clinical evidence of malignancy or serum elevation of tumor marker, that mimicked the CT , MRI, and radionuclide scint igraphic appearance of focal nodular hyperplasia.