Hepatocellular carcinoma in pregnancy with unusual presentations

Hepatocellular carcinoma [HCC] is very rare during pregnancy and has a worse prognosis in pregnant women compared to those who are not pregnant. We present a case of HCC in a 41- year-old pregnant patient who was referred to our academic hospital. The patient presented with chief complaints of abdominal pain, jaundice, ede-ma and hypertension. Laboratory results were notable for elevated liver enzymes and features of microangiopathic hemolytic anemia with normal alpha fetoprotein [AFP] and elevated cancer antigen 125 [CA125]. At laparotomy for termination of pregnancy, multiple massive lesions were detected in the liver. Histologic evaluation showed features of HCC. HCC must be included in the differential diagnosis of any pregnant patient who presents with elevated liver enzymes and hemolysis.

Repair of head and face defects with the use of pericranial flap

The pericranial flaps' benefits have been described in many otolaryngologic, maxillofacial and plastic surgery literature. The benefits are due to the pericranial flaps unique characteristics including good flexibility and mobility, very rich blood supply from several arterial sources and access to sufficient bulk of the flap without any need for distant surgical sites. Using pericranial flaps to repair the local defects of the head and face region in several cases has been reported in this study. A follow up study was carried out on 12 patients who had undergone frontal sinus obliteration; auriculoplasty and repair of the orbital walls and scalp's defects. Pericranial flap had been used for all these patients. Demographic specifications, surgical indications, imaging evaluations and early and late complications were recorded as well. The functional and cosmetic results and also the satisfaction level of patients were also assessed. According to the average follow up period which lasted about 4 years, none of the patients suffered early or late significant complications. No disease relapse or need for revision surgery was reported. Almost all patients were completely satisfied with the procedure and its cosmetic results. The use of a pericranial flap is a simple, quick, cost-effective and safe method for repair of head and face defects. Although, a longer follow up time is required, but this uncomplicated method has been considered as an ideal method to repair sinonasal, ear and scalp defects

Differential diagnosis of cervical malignant lymphadenopathy among Iranian patients

To investigate the differential diagnosis in cases referred with neck lumps suspicious to malignant nodal masses and its relation to demographic variants. Individuals who entered in this cross-sectional study conducted at the Department of Otolaryngology, Ghaem Medical Center, Mashdad, Iran from May 1995 to April 2005 were re-evaluated by history taking, physical examination and imaging studies. Fine needle aspiration was applied to obtain tissue sampling. Among the patients, 232 cases had malignant disease confirmed by pathology reports. Cases with unknown primary tumor underwent investigations including pan-endoscopy, and further imaging studies were carried out to determine the primary tumor site. Demographic data as gender, age, location, size, and pathology of tumor were considered. The results of this study showed that 50% of patients which were referred with neck masses had malignant neoplasm. The most common pathology in patients younger than 40 years were lymphoma [55%] and thyroid cancer [26%], whereas, in patients older than 40 years squamous cell carcinoma [67%] was more common. The most involved lymph nodes were jugulodigastric chain. Larynx and hypopharynx are the most common sources of aerodigestive tract metastatic. According to high incidence malignancy [50%] among neck lesions, an asymmetrical neck mass in adults should be considered malignant until proven otherwise. It seems that age is an important predictor of tumor pathology, and determination of further diagnostic investigations would be helpful