[A bone metastasis of hepatocellular carcinoma].

Reported is a case of a bone metastasis of a hepatocellular carcinoma (HCC). A 61-year-old man with an unresectable HCC, which had been detected on spontaneous rupture, complained of a severe neck pain and numbness of both arms. A roentgenogram of the cervix showed destruction in the spinous process of the third cervical vertebra, and an MRI revealed a vertebral tumor compressing the spinal cord. Thus, the tumor was surgically removed. A pathological examination of the tumor revealed it to have the characteristic features on an HCC. One month after its removal, however, an iliac bone metastasis that was causing pain was found, and, again, an excision of the new tumor was performed. Pain symptoms disappeared after these operations. Treatment of an HCC bone metastasis is palliative, however, it is beneficial in maintaining the quality of the patient's remaining life.

[A case of plasmacytoma (IgD lambda) of the breast associated with multiple myeloma].

A case of secondary plasmacytoma (Ig. D. lambda) of the breast, associated with multiple myeloma, is reported, involving a 60-year-old woman in whom multiple tumors of the right breast appeared during the course of her treatment for multiple myeloma. These breast tumors were firm, non-tender, clear-margined, smooth-surfaced, and showed good mobility. An ultrasonogram revealed that the tumors had the shape of a clear-margined anechoic mass like a cyst. A histological diagnosis of a biopsied specimen determined plasmacytoma (Ig. D, lambda) and the patient was treated with chemotherapy which caused the tumors to greatly reduce.

[A case of a carcinoid of the duodenum (somatostatin-, serotonin- and ACTH-producing) with carcinoma of the stomach].

A case of a duodenal carcinoid which was producing somatostatin, serotonin and ACTH in a 65-year-old man is reported. The patient was found to have a submucosal protruded mass of the duodenal bulb and a tumor mass-like IIa + IIc in the antral portion of the stomach. Subtotal gastrectomy was performed and the histological diagnosis of the tumors were found to be a classical carcinoid of the duodenum and a well-differentiated tubular adenocarcinoma of the stomach. The carcinoid cells of the duodenum had numerous cyto-plasmic granules which were positive by Grimelius staining and negative by Hellerström-Hellmann staining, and 200-300 nm in size, electronmicroscopically. These cells were shown to contain somatostatin, serotonin or ACTH-positive cells by means of monoclonal immunohistochemistry, however, results were negative for gastrin, insulin, glucagon, calcitonin, VIP or PP.

[A case of amebic liver abscess rupturing into the stomach].

A forty-eight year-old man complained of upper abdominal pain and diarrhea with mucinous bloody stool. He had not been abroad. Except high fever, anemia, leukocytosis and elevated rate of erythrocyte sedimentation, laboratory findings were not abnormal. Gastrofiberscopy showed the protrusion of gastric mucosa with a hollow on its surface in the angle. Abdominal CT scan and echogram revealed an abscess in the right hepatic lobe and an abscess in the left lobe. Ulceration and small protrusion of the rectal mucosa were found by romanoscopy. Stool examinations could not reveal amebas, but serological test for amebiasis by the Ouchterlony method showed positive. Under the diagnosis of the perforation into the stomach of amebic liver abscess, he was treated with Metronidazole and tetracycline. But, as a diffuse shadow appeared in the right thoracic cavity on the chest x-ray films with bloody sputa, perforation of amebic liver abscess to the right thoracic cavity was suspected. Laparotomy showed the communication of the abscess to gastric lumen. The post operative course was uneventful. We reported a case with the rare complication of amebic liver abscess.

Nonfunctioning islet cell carcinoma presenting bleeding gastric varices and splenomegaly.

This is a report of a 63-year-old Japanese woman with a nonfunctioning islet cell carcinoma of the pancreas presenting bleeding gastric varices and splenomegaly. These manifestations are extremely rare in patients with nonfunctioning islet cell tumor. The tumor originated in the tail of the pancreas and grew mainly within the spleen. The gastric varices due to increased blood flow to the tumor and arteriovenous fistulas within the tumor were confirmed by angiography and operation. The tumor was resected and she is in a good health for 14-months after the operation.

Pancreatic somatostatinoma.

A 66 year old woman was admitted for right hypochondriac pain and an abdominal tumor. A tumor of the pancreatic head with duodenal infiltration and liver metastases was found by laparotomy, and pancreaticoduodenectomy was performed. In addition, there was associated cholelithiasis and a goiter. Histopathologically, a tumor of the islets of Langerhans was suspected. The tumor tissue was positive by the Hellman-Hellerström silver impregnation method, and electron microscopy confirmed the presence of secretory granules similar to D cells. The tumor tissue contained a large quantity of somatostatin (1.3 micrograms/g). Finally, the diagnosis of somatostatin-producing tumor originating in the pancreas was made.