Expression Patterns of Tumor Related Proteins for Differential Diagnoses of Intrahepatic Adenocarcinomas

Background : Differential diagnoses of intrahepatic adenocarcinomas (IHAC) play an important role in the detecting primary sites and the determining type of treatment and overall prognosis of the patient. However, histopathologic findings alone have limitations of differential diagnoses of IHAC. Methods : To clarify which tumor related proteins (TRP) are useful for differential diagnoses of IHAC, TRP expression were investigated immunohistochemically, using MUC5AC, MUC2, mAb 91.9H, MUC1, and pS2, and by high iron diamine (HID) staining in 61 clinically confirmed IHACs. Results : MUC5AC (9/18, p0.05) displayed the most frequent expression in cholangiocarcinomas, and MUC2 (11/18, p0.05) was expressed more often in pancreatic adenocarcinomas than other IHAC, while MUC2 and 91.9H were not expressed at all in pancreatic adenocarcinomas. The positivity of several TRP did not correlate with tumor differentiation. Conclusions : MUC5AC, MUC2, mAb 91.9H, and HID may be useful in differentiating cholangiocarcinomas from colorectal adenocarcinomas.

Venous Island Flap for Reconstruction in the Hand

The venous flap uses skin and superficial veins for the inflow and outflow of its blood supply. In hand reconstruction procedure, the venous island flap can provide a natural appearance and function. Also its elevation is easily obtained, the operation is simple, and a thin flap can be formed. From November 2000 to July 2002, we performed unipedicled venous island flap procedure on the hand over exposed bone, tendon or joint in 16 cases of 14 patients. The donor sites were on the forearm in 2 cases and dorsal surface of the hand in 14 cases. Flaps were proximally based in 4 cases and distally based in 12 cases. The sizes of the flap ranged from 4.5 cm(2) to 25 cm(2) and the pedicles were a minimum 3 cm and a maximum 7 cm. During elevation of the flap, the pedicle of the flap included one superficial vein of hand and its perivenous areoalr tissue. On donor site direct closure was performed in 11 cases and a full thickness skin graft was performed in 5 cases. In the cases in which the pedicle length was less than 4 cm, the flaps completely survived whether the base of the pedicle was proximal or distal. However, in the cases of distally based flaps with pedicle lengths greater than 5 cm and large rotation angle, congestion developed frequently. In the latter cases, we could raise the survival rate through external bleeding using heparin. Finally, flaps survived successfully in 14 cases and partial necrosis developed in 2 cases. However, the latter were healed by conservative treatment.

Epitheloid Sarcoma in the Hand: A Case Report

Epitheloid sarcoma is rare malignant tumor of the skin, connective tissue, subcutaneous tissue and tendon sheath, which was first described by Enzinger in 1970. It is usually located in the extremities. We treated a 30-years-old man who developed an epitheloid sarcoma in the radial side of the left palm. The tumor was 2x1.6x1 cm sized, arose from the thenar muscle, and histologically the mass was composed of epitheloid cells. It was treated by wide local excision. However, after 2 months of initial operation, second operation and radiotheraphy was performed because of local recurrence. Because of its harmless appearance and similarity to an inflammatory response, it is often mistaken for a benign lesion.Even though it is a rare tumor, clinicians and pathologists should be aware of this malignant nature. Metastasis can be local or may involve draining lymph node and other distant organs, mostly the lung. Diagnosis is made on pathologic evaluation. Aggressive surgical approach is required in order to prevent recurrence, and radiotherapy and chemotherapy should be considered in all cases.