ABSTRACT
A 32-year-old Japanese woman was admitted to our hospital for the diagnosis and treatment of multiple liver tumors. She had been receiving 125 mg testosterone enanthate every 2 weeks following female-to-male gender identity disorder (GID) diagnosis at 20 years of age. Ultrasonography, computed tomography, and magnetic resonance imaging showed 11 hepatic nodular tumors with a maximum diameter of 28 mm. Liver tumors with hepatocellular adenoma (HCA) were diagnosed with needle biopsy. Segmentectomy of the left lateral lobe including two lesions, subsegmentectomy of S6 including two lesions, enucleation of each tumor in S5 and S7, and open surgical radiofrequency ablation for each tumor in S4 and S7 were performed. Immunohistochemical specimens showed that the tumor cells were diffusely and strongly positive for glutamine synthetase and that the nuclei were ectopically positive for ß-catenin. Thus, the tumors were diagnosed as ß-catenin-activated HCA (b-HCA). Transcatheter arterial chemoembolization plus subsequent radiofrequency ablation was performed for the 3 residual lesions in S4 and S8. Although testosterone enanthate was being continued for GID, no recurrence was observed until at least 22 months after the intensive treatments. HCA development in such patients receiving testosterone should be closely monitored using image inspection.
Subject(s)
Androgens/adverse effects , Carcinoma, Hepatocellular/chemically induced , Gender Identity , Liver Neoplasms/chemically induced , Neoplasms, Multiple Primary/chemically induced , Testosterone/analogs & derivatives , Adult , Carcinoma, Hepatocellular/classification , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/surgery , Female , Humans , Liver Neoplasms/classification , Liver Neoplasms/diagnosis , Liver Neoplasms/surgery , Neoplasms, Multiple Primary/classification , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/surgery , Testosterone/adverse effectsABSTRACT
OBJECTIVES: Patients with chronic pancreatitis are managed by extracorporeal shock wave lithotripsy (ESWL) for pancreatic stones. Stone density on noncontrast computed tomography (NCCT) is used to predict stone composition and fragility, but no report investigating the pancreatic stone density has been documented. We aimed to assess the usefulness of pancreatic stone density on NCCT in predicting the ESWL outcome. METHODS: We evaluated 128 consecutive patients with pancreatic stones who underwent ESWL. Pancreatic stone density on NCCT was measured in Hounsfield units. Patients with complete stone removal were compared with those with incomplete stone removal. Patient characteristics; imaging findings, including stone density; and interventions were evaluated as potential predictors. The optimal cutoff value of variables to differentiate complete removal from incomplete removal was determined by receiver operating characteristic analysis. RESULTS: Complete stone removal was achieved in 66 patients (51.6%). When the density threshold was set at 820.5 Hounsfield units, complete stone removal was achieved in 52 patients (78.8%) with lower-density stones. In multivariate analysis, single stone (P = 0.007) and lower-density stone (P < 0.001) revealed significant association with complete stone removal. CONCLUSIONS: The measurement of pancreatic stone density before therapy can help predict therapeutic outcomes.
