Surgical resection for accessory spleen torsion: A case report.

INTRODUCTION: Accessory spleen torsion is extremely rare, and surgery is often the emergency or elective treatment of choice. PRESENTATION OF CASE: A 20-year-old female with no specific medical history presented to our outpatient clinic with a chief complaint of abdominal pain. The patient was diagnosed with accessory spleen torsion by computed tomography. However, the abdominal symptoms and inflammatory reaction based on blood tests were mild, so a conservative treatment was selected. Subsequently, blood tests were normalized, and imaging studies showed that the accessory spleen was shrinking. Contrast-enhanced examination showed contrast enhancement in a portion of the infarcted accessory spleen region, indicating that the accessory spleen torsion had been released. Surgical resection was performed to prevent possible future re-torsion and hemorrhage of the accessory spleen. DISCUSSION: The removed specimen seemed to be normal accessory spleen tissue with clear infarcted foci edges. This artery showed evidence of luminal organization and untwisting of the occluded artery. CONCLUSION: This accessory spleen torsion was treated conservatively; however, the patient was referred for surgical treatment.

Portal blood flow via the peribiliary vascular plexus demonstrated by contrast-enhanced ultrasonography with Sonazoid.

PURPOSE: We report two cases in which portal blood flow via the peribiliary vascular plexus (PBP) was clearly demonstrated using contrast-enhanced intra-operative ultrasonography (CE-IOUS). METHODS: Two patients who underwent hemihepatectomies were investigated using CE-IOUS. Before injection of the contrast medium, both the hepatic arterial and portal venous flows of the hemiliver to be resected were interrupted by ligating those corresponding vessels at the hepatic hilum. Subsequently, the perfluorobutane microbubbles were injected intravenously. RESULTS: In the early vascular phase, a remarkable intermittent flow was visualized in the lumen of the portal branches whose inflows were interrupted. The flow of the portal vein then disappeared as a result of ligating the hepatic duct concomitantly with the surrounding connective tissue. We considered that the portal venous flow appearing under the condition of total disruption of original inflow was supplied from the hepatic artery through the PBP. CONCLUSIONS: This is the first report of blood flow via the PBP in human liver visualized by dynamic image study.

A case report of follicular lymphoma arising from the extrahepatic bile duct: interesting contrast-enhanced ultrasonographic findings.

We report a case of follicular lymphoma of the extrahepatic bile duct and the associated characteristic findings of contrast-enhanced ultrasonography (CEUS). A 60-year-old man with jaundice was scheduled to undergo surgical treatment because of a suspected diagnosis of biliary adenocarcinoma. CEUS in the high-resolution power Doppler mode showed early pulsatile enhancement of the inner layer of the thickened bile duct wall. Thereafter, gradual weak enhancement was detected in the outer layer. Extrahepatic bile duct resection was performed, and the resected specimen was diagnosed as a follicular lymphoma. On microscopic examination, the fibromuscular and deeper layers of the specimen were found to be infiltrated by follicle-forming tumor cells. The mucosal epithelium of the bile duct was almost normal. Although this is the fourth report of this condition in the English-language literature, it is the first to discuss the possibility of a preoperative diagnosis by CEUS.

[Two cases of advanced hepatocellular carcinoma (HCC) effectively treated by oral UFT administration].

Case 1 was operated for HCC in September, 2002. After then TAE was performed two times for remnant liver recurrence. A year later, huge recurrence of left liver and tumor thrombus in IVC and PV were detected. After starting oral UFT administration, AFP lever went down within normal limit and tumor thrombus and early enhancement disappeared by CT scan. But after about a year, AFP level went up and TAE was performed two times, the patient died in July, 2007. Case 2 was operated for HCC in August, 2004. Re-operation was performed for recurrence of remnant liver in January, 2006. But recurrence was detected and TAE was performed in November. Ascites and leg edema appeared in June, 2007. Many recurrences of right liver, tumor thrombus in right hepatic vein and hilar hepatic lymph node were detected, UFT administration was started. After then, AFP level went down and tumor size reduced markedly by CT scan. We presents two cases effectively treated by oral UFT administration.

Primary colonic signet ring cell carcinoma presenting carcinocythemia: an autopsy case.

Primary colorectal signet ring cell carcinoma (SRCC) is a rare but distinctive type of mucin-producing adenocarcinoma of the large intestine with still controversial clinicopathological features and prognosis. We encountered primary colonic SRCC in a 51-year-old Japanese man with extensive bone metastasis ultimately leading to carcinocythemia before the initiation of chemotherapy and surgical intervention. Three days before death, besides progressive disseminated intravascular coagulation that had been present on admission, hematological examination showed sudden leukocytosis with nonhematopoietic cells that subsequently turned out to be signet ring cells (SRCs). Carcinocythemia, the presence of circulating cancer cells in peripheral blood, is considered to be a rare but an ominous phenomenon occurring in the advanced stage of certain types of cancers, particularly mammary lobular carcinoma. It can be assumed that carcinoma cells lacking intercellular cohesiveness and polarized cell membrane organization, including SRCs as well as lobular carcinoma cells, can readily get access to the peripheral circulation; however, to our knowledge, this is the first report of primary colorectal SRCC that presented carcinocythemia. Extensive bone metastatic sites, in the present case, may have functioned as a reservoir of circulating SRCs.