Treatment of hepatocellular carcinoma occurring after distal splenorenal shunt for esophagogastric varices.

BACKGROUND/AIMS: Whereas endoscopic therapy is hardly effective, distal splenorenal shunt is expected to have permanent hemostatic effects on the esophagogastric varices complicated with hepatocellular carcinoma and to sustain favorable general condition of the patient. In this study, we examined the effects of the shunt in the patients who developed hepatocellular carcinoma during the follow-up of the shunt operation. METHODOLOGY: Among the patients who had undergone distal splenorenal shunt operation for portal hypertension caused by cirrhosis, we selected only those who developed hepatocellular carcinoma during the follow-up, and then we reviewed our treatment of hepatocellular carcinoma. RESULTS: Hepatocellular carcinomas developed postoperatively in 12 out of 59 patients with the shunt operation. At onset of the carcinomas, the varices were well controlled with no risk of bleeding; and the liver function was reasonably maintained and pancytopenia was alleviated, compared to those at shunt operation. We performed hepatectomy in 4 cases and nonoperative therapies in 8 cases. After the therapies, no variceal bleeding occurred. Those therapies caused minor complications but no death. CONCLUSIONS: Distal splenorenal shunt is a useful therapy for postcirrhotic esophagogastric varices as it enables us to safely perform therapies for the hepatocellular carcinomas that develop during the follow-up period.

Endocrine cell carcinoma of the gallbladder with anomalous pancreaticobiliary ductal junction.

We experienced a case of endocrine cell carcinoma of the gallbladder with anomalous pancreaticobiliary ductal junction. It is well known that anomalous pancreaticobiliary ductal junction has potentiality to cause gallbladder cancer and that most of the cases are papillary adenocarcinoma or well-differentiated adenocarcinoma. The direct relationship between endocrine cell carcinoma of the gallbladder and anomalous pancreaticobiliary ductal junction has not been elucidated.

Changes in the mouse exocrine pancreas after pancreatic duct ligation: a qualitative and quantitative histological study.

The pancreatic duct from the splenic lobe, the largest lobe of the pancreas in the mouse, was ligated at 6 weeks of age, with histological and cytological changes in the organ examined 1 day to 16 weeks after the ligation. Changes in the volumes of the pancreatic lobe, exocrine tissue, and interstitial tissue as well as relative total numbers of each cellular element in the organ after duct ligation were stereologically obtained using serial sections of the whole pancreas. Cell sizes, degenerated cell and mitotic cell indices, and nuclear densities of the acinar and ductal cells were also obtained. After duct ligation, the volume of the pancreas increased by interstitial edema in the first 2 days but rapidly decreased thereafter due to atrophy of the exocrine tissue, amounting to 10% or less of normal volume by 7 days. The acinar cells showed an accumulation of the zymogen granules, cytoplasmic condensation and a pyknotic figure of the nucleus; they then were thoroughly deleted with appearance of numerous macrophages. This cell death was suggested to be due to apoptosis. On the other hand, the ductal cells remained in the atrophic pancreas and proliferated with mitotic figures to two times the normal frequency at 3 days, and then formed duct-like structures lacking in the acinar cells. After 2 week, the ductal cells slowly decreased in number also due to cell death, but the pancreas became gradually enlarged by intralobular fatty replacement, to reach a volume approximating that of normal 8 weeks after duct ligation. The stereological method serves for the correct evaluation of cell dynamics including the deletion and proliferation of the cells in the whole organ.

[Changes in the mouse pancreas after reopening the closed pancreatic duct: a qualitative and quantitative histologic study].

To understand histologic regeneration of deteriorated pancreas, pancreatic duct was clipped at 6 weeks of age in mice, the clip was removed 1 week after clipping, and the pancreas was histologically examined 1,2,3,5,7 and 14 days after removing the clip. For quantitative evaluation of the histologic changes, volume of the pancreatic parenchyma and volume densities, numerical densities, and relative total numbers of acinar cells and ductular cells in the pancreas were obtained by a stereological method using serial sections. In addition, the size and mitotic index was estimated for each cellular components. The pancreas was reduced to 18% of the normal after 1 week clipping. Exocrine acinar cells had degenerated and disappeared and the atrophied lobules were occupied by duct-like structures composed of cells like intercalated duct cells. The cells of duct-like structures showed occasional mitotic figures. Dilation of the ducts was noted. The histologic changes in the pancreas after removing the clip were classified with the two different groups (Group A and Group B). Group A pancreas showed regeneration of acinar cells, Group B pancreas showed no evidence of the regeneration. On the 2nd to 3rd days after removing the clip, in Group A pancreas, the lumen of the duct has been shrunken and acinar cells reappeared. Acinar cells were occasionally grouped at the terminal of the ducts. On the 7th day, the duct-like structures had almost disappeared, and exocrine acini were developed to show almost normal appearance of the lobules. The stereometry indicates that, after removing the clip from the duct, the total number of duct cells was decreased, while acinar cells rapidly increased until the 7th day when the increase became gradual, but eventually the recovery of the cell numbers was below the half of the normal range. The findings suggest that 1) duct-like structures in the atrophied pancreas proliferate from ductular cells in the pancreas, 2) reopening of the obstructed pancreatic duct induce regeneration of the acinar cells from the ductular cells, 3) regeneration of acinar cells complete of normal histology but does not recover the normal size of this organ, and 4) the stereological method is appreciated to evaluate correctly a quantitative cell dynamics in the whole organ.