ABSTRACT
Spontaneous regression of a malignant tumor is an exceptional phenomenon. A 56-year-old woman with liver cirrhosis related to chronic hepatitis C presented with a liver tumor. Partial regression of a hepatocellular carcinoma was diagnosed by imaging studies that showed progressive diminution of the size of the tumor and changes in the tumor markers. However, because of the persistence of the tumor and uncertainty in the diagnosis we recommended surgery. A hepatectomy was performed and a hepatocellular carcinoma moderately differentiated was found. The patient is now doing well and without any evidence of recurrence at 25 months after surgery. We found 61 case reports that have been published from 1982 to September 2006, with apparently spontaneous regression of hepatocellular carcinoma. The precise mechanism regarding the spontaneous regression of this tumor is not fully understood, either ischemia due to rapid growth of the neoplasia or particular inflammatory and immunologic mechanisms may be involved in the regression of the hepatocellular carcinoma.
Subject(s)
Carcinoma, Hepatocellular/complications , Liver Cirrhosis/complications , Liver Neoplasms/complications , Carcinoma, Hepatocellular/diagnosis , Female , Follow-Up Studies , Humans , Liver Cirrhosis/diagnosis , Liver Neoplasms/diagnosis , Magnetic Resonance Imaging , Middle Aged , Remission, Spontaneous , Tomography, X-Ray ComputedABSTRACT
The Budd-Chiari syndrome is a heterogeneous group of disorders characterized by obstruction of hepatic venous outflow at any level from the small hepatic veins to the junction of the inferior vena cava with the right atrium. We present two cases of Budd- Chiari syndrome with severe ascites associated with polycythemia vera in first case and protein C deficiency in the second, in both cases transjugular intrahepatic portosystemic shunt were placed, with excellent control of symptoms, no mortality were observed, and just one episode of pulmonary venous thrombosis was observed. To our knowledge this is the first time that transjugular intrahepatic portosystemic shunt are used and reported in Budd-Chiari syndrome in Mexico.
Subject(s)
Budd-Chiari Syndrome/surgery , Portasystemic Shunt, Transjugular Intrahepatic , Adolescent , Budd-Chiari Syndrome/pathology , Budd-Chiari Syndrome/physiopathology , Female , Hepatic Veins/diagnostic imaging , Hepatic Veins/surgery , Humans , Male , Mexico , Middle Aged , Polycythemia Vera/physiopathology , Protein C Deficiency/physiopathology , UltrasonographyABSTRACT
Objetivo: describir las características clínicas, radiológicas, morfológicas e inmunohistoquímicas de tres casos de neumatosis intestinal. Método: de 1982 a 1999 se revisaron los casos de neumatosis intestinal diagnosticados en el Departamento de Patología del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Se analizaron los datos clínicos, estudios de laboratorio, gabinete, evolución y tratamiento. Del archivo de patología quirúrgica se obtuvieron las preparaciones histológicas, fotografías macroscópicas, y de los bloques de parafina se obtuvieron cortes en blanco para estudios de inmunohistoquímica para identificar revestimiento endotelial (anti-CD31) y células macrofágicas (anti-CD 68). Resultados: se realizaron 936 resecciones de intestino delgado en el periodo de estudio y en tres pacientes con antecedente de cirugía abdominal se identificó neumatosis intestinal (0.3 por ciento). Clínicamente iniciaron con obstrucción intestinal. Los estudios morfológicos y de inmunohistoquímica revelaron la presencia de pseudoquistes sin revestimiento epitelial y espacios revestidos por células gigantes multinucleadas de origen fagocítico mononuclear positivas para CD68 y, algunas estructuras revestidas por células endoteliales positivas para CD31. Conclusión: los casos de neumatosis se asociaron a obstrucción intestinal y cirugías abdominales previas. La mayoría de las lesiones fueron pseudoquistes sin revestimiento epitelial o endotelial.
