Intrahepatic cholangiocarcinoma with a long-term survival of 12 years after surgical resection: report of a case and review of the literature.

The prognosis of primary liver cancer, especially cholangiocarcinoma, is extremely poor. A long term, 12 years survivor of intrahepatic cholangiocarcinoma arising in a local dilatation of the intrahepatic bile duct is presented. A 40-year-old male patient was presented with recurrent upper abdominal pain, fever, and jaundice. Computed tomography revealed a localized duct dilatation, and ultrasound clearly demonstrated a tumor mass arising within the bile duct. At surgery in March, 1982, the tumor mass was resected and histologically confirmed as a well differentiated papillary adenocarcinoma arising. In March, 1994, the patient is alive and cancer-free, 12 years after surgical resection. To our knowledge, there has been no report on a patient surviving more than 10 years after initial treatment. This case suggests that a localized cystic dilatation of the intrahepatic-bile duct on imaging modalities may harbor a bile duct carcinoma, and this in turn may contribute to early diagnosis of carcinomas and improved long term survival.

Tumorigenicity study of sodium erythorbate administered orally to mice.

Sodium erythorbate (SE) was administered at concentrations of 0, 1.25, or 2.5% (maximum tolerated dose, MTD) in the drinking-water to groups of 50 male B6C3F1 mice respectively. Female groups, each consisting of 50 mice, received SE in the drinking-water at concentrations of 0, 2.5 or 5% (MTD). Treatment continued for 96 wks and the experiment was terminated during wk 110. Tumors were observed at various sites including the liver, hematopoietic system, lung and soft tissue. However, at any of the sites, the tumor incidence, the time to death with tumors or the histological distribution of tumors did not differ significantly from those in the untreated control group. Thus, the present study did not demonstrate a tumorigenic effect of SE on B6C3F1 mice by means of oral administration.

Early cancer and related lesions in the bronchial epithelium in former workers of mustard gas factory.

The bronchial epithelium in stepwise transverse sections was examined histologically in 66 male autopsy cases, composed of the groups of 19 mustard gas (MG) ex-workers with lung cancer, 17 MG ex-workers with non-lung cancer, 10 non-MG lung cancer cases, and 20 non-MG non-lung cancer cases. Foci of moderate or severe atypical cellular lesion or dysplasia, or of carcinoma in situ (CIS) in total slides of each group, were counted as 146 in 3,485, 72 in 2,226, 70 in 3,797, and 18 in 4,611, respectively. The relative frequency of moderate or severe dysplasia and CIS in MG exposed non-lung cancer cases resembled that found in lung cancer cases of both MG and non-MG exposed. Seven CIS lesions were detected from among all MG-exposed cases and one CIS was found in a non-MG lung cancer case. Six out of eight CIS examples were adjoined by dysplasia. A multi-variate analysis revealed a significant correlation between the incidence of atypical lesions and MG exposure, though the incidence of atypical lesions was also influenced significantly by age, smoking, and chronic bronchitis. The incidence of atypical lesions was significantly higher in cases of squamous cell lung cancer than those of other histological types, particularly small cell cancer.

Tumorigenicity study of butyl and isobutyl p-hydroxybenzoates administered orally to mice.

Butyl p-hydroxybenzoate (n-BHB) and isobutyl p-hydroxybenzoate (i-BHB) were administered orally to ICR/Jcl mice at concentrations of 0.6 (maximum tolerated dose), 0.3 or 0.15% in the diet for up to 102 wk. Tumours were observed at various sites including the haematopoietic system, the lung and the soft tissue. However, at none of the sites did the tumour incidence or the time to death with tumours differ significantly from that in the untreated control group.

Hepatic resection in the treatment of hepatocellular carcinoma: report of 60 cases.

During the last 3 years and 9 months, hepatic resections were carried out on 60 patients with hepatocellular carcinoma (HCC). The resections were radical in 44 and palliative in 16 cases. Simultaneous operations were performed for oesophageal varices in 11 (9 prophylactic and 2 therapeutic) and for cholelithiasis in 9 patients. Fifty-nine patients had underlying hepatic disease; 52 had cirrhosis and 7 chronic hepatitis. Operative mortality rate within 1 month was 10 per cent and overall hospital mortality rate was 16.7 per cent. Excluding operative and hospital deaths, 76.8 per cent of patients who had radical excision and 18.8 per cent with palliative resections are alive. The result indicates that HCCs are frequently resectable even in the presence of liver cirrhosis provided that they are discovered at a relatively early stage.

Hepatocellular pseudotumor in the cirrhotic liver. Report of three cases.

Three cases of regenerating hyperplastic nodule in the cirrhotic liver are reported in detail. The patients were all men, ranging in age from 41 to 57 years. They were all heavy drinkers and had chronic liver disease for 6 to 10 years. All patients had slightly elevated alpha-fetoprotein levels and were positive for HBs and HBc antibodies. Radiologic findings were not uniform except for ultrasonography, which demonstrated the lesion in all cases. Preoperative diagnosis was hepatocellular carcinoma (HCC) or highly suspicious of HCC in all of them. At laparotomy, all lesions were embedded in the liver parenchyma and invisible from the hepatic surface. With the aid of intraoperative sonography, partial hepatic resections were performed. Pseudocapsule was seen in two cases. Definitive differential diagnosis of regenerating nodules from HCC in the cirrhotic liver was extremely difficult. The authors propose the name "hepatocellular pseudotumor in the cirrhotic liver" to describe such lesions.

[A case of ovarian carcinoma preceded by intracranial metastasis].

A 28-year-old woman with primary ovarian carcinoma which was found with intracranial metastasis is reported. The patient was operated on because of metastatic brain tumor with unknown primary lesion. Subsequently, left ovarian tumor was found, and left salpingo-oophorectomy was performed. The histological diagnosis was endometrioid carcinoma. A review of the literature shows that intracranial metastasis by ovarian carcinoma is very rare. The incidence is lower than 2.1%. The present case in which intracranial metastasis manifested itself before primary ovarian carcinoma seems to be extremely rare.

Malignant lymphoma presenting with neoplastic angioendotheliosis of the central nervous system.

In this paper we report a case of malignant lymphoma with neoplastic angioendotheliosis in the brain. A 44-year-old man with transient episodes of deafness, hypersomnia, and anorexia over a 5-month period acutely deteriorated. He presented with low grade fever, dementia, frontal lobe signs, general hyperreflexia, muscle weakness of the extremities, and ataxia. He did not have hepatosplenomegaly, lymph node swelling, or skin eruptions. On the 15th day after admission to the hospital he developed convulsions and died. Post-mortem examination revealed multiple infarcts in the central nervous system, especially in the bilateral cerebral white matter and basal ganglia, where mononuclear tumor cells were widespread within the lumens of small blood vessels, accompanied by lymphocytic infiltration and degenerative and occulsive changes of the vessels. Intravascularly in many visceral organs and in the adrenal glands, both intra- and extravascularly, proliferation of tumor cells was observed. Furthermore, a small nest of malignant lymphoma of diffuse mixed cell type was found in a para-aortic lymph node, and the lymphoma cells were identical to tumor cells observed in the brain and other organs.