Incidentally detected liver metastasis of well-differentiated follicular carcinoma of the thyroid, mimicking ectopic thyroid.

A case of incidentally detected liver metastasis of follicular carcinoma of the thyroid, histologically mimicking ectopic thyroid, is described. The patient was a 48-year-old woman. A 2-cm mass was incidentally detected in the left lobe of the liver by abdominal computed tomography (CT) scan. Partial liver resection was performed for diagnosis and treatment. Histologically, the liver nodule was composed of small-to-large follicles containing colloid material. The lining epithelium was flat or cuboidal and showed no cellular or nuclear atypia. Immunohistochemical studies for thyroid-specific proteins, thyroglobulin (Tg), triiodothyronine (T3) and thyroxine (T4), suggested that the nodule was of thyroid origin. Therefore, a differential diagnosis of metastasis of well-differentiated thyroid cancer, ectopic thyroid tissue and teratoma was made. The patient had a history of subtotal thyroidectomy performed 8 years ago due to a thyroid tumor. The original surgical specimens of the thyroid tumor were diagnosed as follicular adenoma. Additional sections of the specimen were reviewed and an area of convincing vascular invasion was found that was suggestive of follicular carcinoma. Subsequent whole-body examination failed to find other metastases. It was determined that the liver tumor was metastasized from well-differentiated follicular carcinoma of the thyroid.

Well-differentiated hepatocellular carcinoma: findings of US, CT, and MR imaging.

BACKGROUND: To elucidate the imaging characteristics of well-differentiated hepatocellular carcinomas (HCCs) on ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging. METHODS: Ultrasonograms, CTs, and MR images of 18 histopathologically proven well-differentiated HCCs in 15 patients were reviewed. The findings of these images were correlated with histopathologic findings. RESULTS: On US, seven tumors were depicted as a hyperechoic area and eight as a hypoechoic area. Three tumors were not visualized. On precontrast CT, four tumors were depicted as a low-density area, but 14 were not visualized. On conventional contrast-enhanced CT, 12 tumors were depicted as a low-density area but six were not visualized. On T1-weighted MR images, 10 tumors had high signal intensity and two had low signal intensity. Six tumors were not visualized. On T2-weighted MR images, five tumors had high signal intensity and two had low signal intensity. Eleven tumors were not visualized. Tumors with fatty change and/or clear cell formation were frequently hyperechoic on US and hyperintense on T1-weighted MR images. CONCLUSIONS: Well-differentiated HCCs show different findings on US, CT, and MR imaging. Therefore, reliable diagnosis of well-differentiated HCCs by these imaging techniques may be difficult.

Use of Tc-99m DTPA galactosyl human serum albumin to predict postoperative residual liver function.

PURPOSE: Residual liver uptake at 15 minutes (RLU15), a new index for predicting residual liver function after excision of hepatocellular carcinoma, was evaluated using dynamic liver images and SPECT by Tc-99m DTPA galactosyl human serum albumin. MATERIALS AND METHODS: In 13 cases of hepatectomy, RLU15 was compared with postoperative serum prothrombin levels, serum bilirubin levels, and ascites. RESULTS: RLU15 showed good correlation with both the prothrombin activity and the serum bilirubin, with correlation coefficients of r = 0.829 and r = -0.757. CONCLUSION: This new index appears useful for predicting residual liver function after hepatectomy.

[An evaluation of perioperative and continuous infusion of tegafur as surgical adjuvant chemotherapy of resected gastric cancer].

Perioperative continuous intravenous infusion of Tegafur (FT) seems theoretically an effective adjuvant chemotherapy for patients with gastric carcinoma. Then we estimated the clinical effect of this therapy on the survival of patients who had undergone curative (Stage I, II, III) and non-curative (Stage IV) resection of a primary gastric carcinoma. One hundred fifty patients received chemotherapy and two hundred thirty-seven were observed. Results showed a significant difference in survival curves of Stage I (p less than 0.01) and Stage III (p less than 0.01). The 5-year survival rate was 100% for the adjuvant therapy arm and 82% for the observation arm in Stage I. In stage III, the survival curve of both arms was similar from the beginning to the 5th year, but the 7-year survival rate was 53% and 39%, respectively. There was no serious side effect of chemotherapy. These results demonstrate that this chemotherapy regimen is beneficial and recommendable as a perioperative adjuvant chemotherapy for resected gastric cancer in which the cancer cells were almost removed.

[Cancer cells in the portal and hepatic veins of resected specimens of hepatocellular carcinomas].

After injecting 100 ml of a saline solution into the hepatic artery of 27 livers evidencing a hepatocellular carcinoma, samples from the resected livers were collected through the portal and the hepatic vein. Cancer cells were detected in 4 out of 27 samples from the portal vein and in 1 out of 19 samples from the hepatic vein, and the total number of positive cases were 4. Further, tumors over 5 cm in diameter showed a tendency of flowing cancer cells into the portal vein. Four positive cases had an intrahepatic and a distant metastasis within one year of their operation and two of these patients died.

[Histopathological studies on antitumor effect of tegafur administered by continuous intravenous infusion].

The effects of preoperative treatment by continuous intravenous infusion of Tegafur, the antagonist of DNA synthesis, were histopathologically studied in 34 patients with gastric cancer. Histologically the treatment was found to be effective in 41.2% of patients with cancer invasion in the mucosa, 58.8% in the submucosa, 61.3% in the muscularis propria, 59.3% in the subserosa and 86.9% of those with metastatic lymph nodes. The treatment was effective, when assessed in terms of the histological type of cancer, in 90.9% of cancers of the differentiated type (papillary adenocarcinoma, well differentiated tubular adenocarcinoma and moderately differentiated tubular adenocarcinoma) and 47.8% of those of the poorly differentiated type (poorly differentiated adenocarcinoma, mucinous adenocarcinoma and signet-ring cell carcinoma), showing a higher rate of efficacy in the differentiated type cancers. Meanwhile, even among patients with cancer of poorly differentiated type, a high efficacy rate (90.0%) was found in those with metastatic cancer of the lymph nodes. No relationship was found between the total doses of Tegafur and histological effects. There was a tendency, however, for a higher frequency of a good response in patients administered more than 4,000 mg of Tegafur. In the patients with a histologically positive effect, 5-FU concentration in the tumor tissue was higher than 0.071 microgram/g. However, some patients showed no response despite a high concentration. This finding suggested that sensitivity to 5-FU and 5-FU metabolism vary depending on the tumor. The inhibitory effect of Tegafur on DNA synthesis is produced through inhibition of thymidylate synthase (TS) by the Tegafur metabolite FdUMP.(ABSTRACT TRUNCATED AT 250 WORDS)