Clinical Evaluation of Liver Cirrhosis Patients Using Liver Scintigraphy / 한국간담췌외과학회지

BACKGROUND/AIMS: Liver scintigraphy is a useful tool in evaluating the chronic liver disease, even though it is less sensitive to detect a mass lesion in the liver than ultrasonography, computed tomography (CT), or magnetic resonance imaging (MRI). We evaluate the clinical usefulness of liver scintigraphy in patients with liver cirrhosis by comparing with the clinical and biochemical indices. METHODS: Liver scintigraphy was taken beginning 20 minutes after the intravenous injection of 370 MBq of Tc-99m phytate. Images were obtained in multiple views with a gamma camera (Basicam(R), Siemens). The size of the liver, left lobe enlargement, inhomogeneity of radioactivity, the size of the spleen, the extrahepatic uptake were evaluated on liver scintigraphy. The compared clinical indices were serum albumin level, serum bilirubin level, INR (international normalized ratio) for prothrombin time, the presence of hepatic coma, and esophageal varix. RESULTS: Forty four patients (M:F=24:20) were included. The extrahepatic uptake such as bone marrow and splenic uptake was positively correlated with the level of serum bilirubin and negatively correlated with the level of serum albumin. The size of the spleen, inhomogenous liver uptake, hypertrophy of left lobe was positively correlated with the degree of esophageal varix. The size of the liver was negatively correlated with that of esophageal varix. CONCLUSION: We suggest that scintigraphic findings in liver scintigraphy could be used in the evaluation of patients with liver cirrhosis not only to diagnose cirrhosis but also to know the severity of cirrhosis.

Hepatocellular Carcinoma of the Liver with Sarcomatous Feature / 한국간담췌외과학회지

One case of hepatocellular carcinoma with sarcomatous changes is presented. Histologically, the tumor was composed of hepatocellular-carcinomatous and sarcomatous components, including trabecular, pseudoglandular, and spindle-shaped varieties. There was a transitional cell form between the carcinoma and sarcomatous cells. Immunohistochemical examination for alpha-feto protein reveals positive staining in hepatocellular carcinoma component, and vimentin had positive result in most spindle-shaped sarcomatous cells and some epithelial tumor cells, whereas cytokeratin and EMA(epithelial membrane antigen) revealed negative staining in tumor cells, On the basis of this findings, the possibility of sarcomatous transformation of hepatocellular carcinoma was discussed.

Primary Malignant Fibrous Histiocytoma of the Jejunum

Malignant fibrous histiocytoma (MFH) occurs primarily in the extremities and trunk, however primary malignant fibrous histiocytoma of the alimentary tract, particularly of the jejunum, is uncommon. This case report presents a case of malignant fibrous histiocytoma as the primary lesion of the jejunum in a 42-year-old male patient with a 10-day history of melena. A small bowel tumor was resected without complication. The final diagnosis was based on the pathological report of the surgical specimen.

Expression of p53, bcl-2 Proteins and Estrogen Receptors in Human Breast Cancer

In 56 breast cancer tissues (infiltrating ductal carcinoma) with a clinical follow-up period of more than 5 years, positivity of estrogen receptor(ER) by enzyme immunoassay and expressions of bcl-2 and p53 oncoproteins by immunohistochemistry were evaluated. The purposes of this study were to determine prevalence of bcl-2 and p53 in breast cancer, the interrelationship between expression of the proteins and estrogen receptor, correlation between histologic grade and the expression of the tumor-related oncogenes, and to explore the biologic bahavior of breast cancer (lymph node metastasis, recurrence rate, and survival) via expression of bcl-2 and p53. Twelve of 56 (21.4%) carcinomas were bcl-2 positive, and seventeen (30.4%) were p53- positive. Eleven of 12 bcl-2 positive tumors (91.7%) were ER-positive, and bcl-2 expression was significantly associated with ER-positivity(P=0.043). Seven of 36 ER-positive tumors (12.5%) were p53 positive, and p53 expression was inversely associated with ER-positivity(P=0.006) significantly. The bcl-2 protein expression showed a significant relationship to low histologic grade of tumor (P=0.0002), and an almost significant relationship to lower recurrence rate (P=0.09). The p53 protein expression showed a significant relationship to high histologic grade of tumor (P=0.002) and an almost significant relationship to lymph node metastasis (P=0.09). Also an almost inverse relationship between bcl-2 and p53 was demonstrated (P=0.057). The bcl-2 expression had a tendency to be associated with longer patient survival(P= 0.09), but p53 immunoreaction was found not to be associated with shorter patient survival(P=0.16). These results provide further evidence that higher incidence of bcl-2 expression is correlated with higher incidence of ER and lower grade of tumor, while p53 expression is correlated with lower incidence of ER and higher grade of tumor. In conclusion, although the biologic function of bcl-2 protein is not yet well understood in breast cancer, our results suggest that bcl-2 and p53 oncoproteins might play significant roles in estrogen receptor and development of breast cancer. But their prognostic significance could not be determined; our results are 'not significant' but 'almost significant'. Thus, contribution of bcl-2 and p53 immunohistochemical phenotyping of breast cancer with ER to the clinical management need verification in larger series.

Papillary cystic neoplasm of pancreas, report of four cases and review of the literature / 대한암학회지

No abstract available.