Fulminant hepatic failure caused by diffuse intrasinusoidal metastatic liver disease: a case report.

A 53-year-old woman experienced rapidly progressing liver failure four years after a quadrantectomy for a breast carcinoma. She had received adjuvant chemotherapy and radiotherapy, and second-line chemotherapy for bone metastasis one year earlier. The hepatic failure manifested with ascites, jaundice, elevation of serum bilirubin and hepatic enzyme levels and hypoalbuminemia. Imaging studies showed an enlarged liver without metastatic lesions. The patient died of hepatic decompensation within two weeks. Liver examination at autopsy revealed massive neoplastic infiltration consistent with a primary breast carcinoma. It is important to realize that this unusual pattern of liver metastasis cannot be demonstrated even with the most advanced techniques of instrumental diagnosis (CT scan, ultrasonography and magnetic resonance imaging), and should be taken into account in the differential diagnosis of rapidly progressing liver failure.

Primary non-Hodgkin's lymphoma of the liver.

The clinicopathological features of a rare case of primary non-Hodgkin's hepatic lymphoma (PHL) are described and compared to those of the other 76 cases reported in the world literature. PHL is mainly a disease of Caucasian, middle-aged males and, in approximately half of the reported cases, was associated with other diseases involving depression or chronic stimulation of the immune system. Right upper abdominal and epigastric pain with loss of weight are the most common presenting symptoms. The tumour is usually a single large mass involving both hepatic lobes and is almost invariably composed of lymphocytes reacting with B-cell markers. Most tumours are of intermediate or high grade according to the classification of the Working Formulation for Clinical Usage. No correlation is apparent between gross appearance of PHL (massive or nodular) and grade of severity. Chemotherapy or radiotherapy alone appears to be ineffective, while relatively good results can be obtained with combination modalities.

Inflammatory pseudotumour of the liver--evidence for malignant transformation.

A case of inflammatory pseudotumour of the liver is reported, and evidence is presented for its subsequent evolution into malignant non-Hodgkin's lymphoma. Such postulated malignant transformation challenges the assumption that hepatic inflammatory tumours are entirely benign lesions.

[A case of multifocal inflammatory pseudotumor of the liver]. / Su un caso di pseudotumore infiammatorio multifocale del fegato.

INTRODUCTION: The inflammatory pseudotumor (IPT) of the liver is a tumor-like lesion of unknown etiology and pathogenesis. Non infectious by definition the lesion is considered to be a long-lasting inflammatory process. CASE: In this report we describe a multifocal liver pseudotumor of a 52 year man who underwent a selective hepatectomy for a clinical and radiological suspicion of a liver cell carcinoma. RESULTS: Grossly the masses consisted of rubbery grey-yellowish nodules well-circumscribed from the liver parenchyma. Histologic examination revealed a double shaped cellular population surrounded by a thin rim of collagen fibres. The main population consisted of fibroblasts and histiocytes with no atypias or mitoses, arranged in a storiform or fascicular pattern; the second population consisted of a mixed population of lymphocytes, plasma cells, neutrophils and monocytes. Fibroblasts and histiocytes revealed diffuse positive immunostaining for vimentin and focal immunostaining for cytokeratin and desmin. The histiocytes were also CD68, CD18, CD14 and CD4 positive. CONCLUSIONS: Our case reveals same histological and immunohistochemical features already reported in literature. Primary and metastatic tumors involving the liver need to enter in the differential diagnosis but IPT lacks features of malignancy and the cell population is mixed. Although there is no specific marker for this lesion in cases featuring malignancy immunohistochemistry may be useful for a differential diagnosis: S-100 in cases of neurofibrosarcomas, actin and myosin for rhabdomyosarcomas, cytokeratin for epithelial tumors.

[Terata catydidymus dicephalus: description of a case]. / Terata catydidymus dicephalus: descrizione di un caso.

Conjoined twinning is the result of an abnormal developmental process of "twinning" in which two similar weighted and sized twins are partially conjoined and show a total symmetry independently from the pattern of conjunction. They are classified in three groups: Terata Catydidymus, Terata Anadidyma and Terata Anacatadidyma. Among Terata Catydidymus the dicephalus subtype is a rare abnormality with a severe prognosis compared to other subtypes as: diprosopus, pyophagus and ischiopagus. We report the case of a fetus at the 15th weeks of pregnancy. The external examination revealed severe diffuse somatic malformations consisting of dicephalia with a double neck in conjunction to a single chest, a single abdomen, a double spine conjoined distally near the sacrum, buds of ribs in between the two spines with mid clavicular and scapular fusion following the major axis of the two bones. Arms and legs revealed no abnormalities. Central nervous system structures were normally developed and the two hemispheres seemed completely separated and independent one to the other. We believe that the case described is interesting being Terata Catydidymus a rare phenomenon, being the dicephalus subtype still lesser frequent and its occurrence in males quite exceptional.