Primary lung adenocarcinoma with gross calcification and suspected bone formation.

Calcification in a lung tumor suggests that it is a benign tumor such as a hamartoma or a sclerosing lung cell tumor. In contrast, carcinoid, lung cancer, carcinosarcoma, and sarcoma rarely harbor calcification. Primary lung adenocarcinomas with gross calcification that is suggestive of bone formation are very rare. It is difficult to distinguish between calcification and bone formation purely on the basis of image definitive diagnosis of bone formation being difficult in the absence of a large surgical specimen. Lung cancers with bone formation are exceedingly rare: to the best of our knowledge, only 13 cases have been reported. Careful attention is needed when differentiating between benign and malignant tumors. Here, we report a case of primary lung adenocarcinoma with gross calcification that was suggestive of bone formation.

One hundred seven consecutive surgical resections for hilar cholangiocarcinoma of Bismuth types II, III, IV between 2001 and 2008.

Many authors at high-volume centers all over the world have reported improved outcomes of hilar cholangiocarcinoma by several aggressive surgical approaches such as extended hepatic resection, combined vascular resection, and hepatopancreaticoduodenectomy in recent years. There has been great progress in the surgical treatment of hilar cholangiocarcinoma with these previous efforts by aggressive hepatobiliary surgeons. In particular, surgical techniques, diagnostic modalities, and perioperative management have been remarkably improved as compared with before. Herein we report the surgical outcome for both hilar cholangiocarcinoma of Bismuth types II, III, and IV and intrahepatic cholangiocarcinoma involving the hepatic duct confluence during the recent 8-year period between 2001 and 2008 at our institution, the Department of General Surgery at Chiba University. From our recent experienced results, it can be concluded that the surgical strategy for hilar cholangiocarcinoma has been improved remarkably, and major surgical hepatectomy can be done with relative safety, and these aggressive surgical approaches, including combined vascular resection, may be warranted for the surgical treatment of hilar cholangiocarcinoma. However, the adoption of new innovative therapeutic approaches might be required for further improvement of surgical outcome of hilar cholangiocarcinoma.

[Gaucher disease type I diagnosed at 63 years old presenting with thrombocytopenia].

A 63-year-old man who was incidentally found to have thrombocytopenia at a periodic physical examination visited our hospital. The spleen was palpable 3 finger-breadths below the navel level, and the liver was palpable 1 finger-breadth below the right costal margin. Peripheral blood examination showed WBC 2,900/microl, Hb 13.4 g/dl, and platelets 54 X 10(3)/ microl. Gaucher cells were recognized in the bone marrow by aspiration, and serum levels of total acid phosphatase and angiotensin converting enzyme were increased. Glucocerebrosidase activity was lower than the control level in bone marrow stroma cells, and modification of glucocerebrosidase genotype N188S was shown, which had been identified in the past. Furthermore, neurological examination was normal. Based on these results, we diagnosed the patient with Gaucher disease type I, and started enzyme replacement therapy. Gaucher disease is rare in Japanese, approximately 100 cases having been reported; diagnosis at older age is also relatively rare and, as far as we know, the oldest age reported in Japanese was 57 years old. Gaucher disease should be considered a differential diagnosis when thrombocytopenia and splenomegaly are found in elderly patients, although it is relatively rare.

Surgical treatment for liver cancer. Current issues.

Surgical treatment of hepatocellular carcinoma (HCC) has developed remarkable for several reasons. The surgical mortality rates of patients with HCC after hepatectomy have decreased due to appropriate criteria for surgery, refined surgical techniques and improvement in the pre- and postoperative management. In preoperative management, refinements in liver function tests and strategies for esophageal varices, and the induction of preoperative portal vein embolization have contributed favorably to the outcome after hepatectomy for HCC. Furthermore, hepatectomy has been technically refined by various vascular control methods and liver transection devices based on the realization that surgical anatomical information also plays a major role in improving surgical outcome. Also concomitant splenectomy with hepatectomy might extend the criteria for surgery in HCC patients with hypersplenism. Therefore, hepatectomy is a safe therapeutic approach that could bring about a favorable outcome in patients with HCC. Nowadays transplantation is one of the therapeutic options for HCC patients, even in Japan. Herein the surgical treatment of HCC in Japan is reviewed and current issues in the surgical treatment of HCC are discussed.