Tongue abscess induced by embedded remnant fishbone.

The authors reported a 56-year-old man with progressive pain over left bottom of oral cavity involving tongue for 3 days. He had a puncture history of tongue by fishbone, which was immediately removed 3 weeks ago. The subsequent contrast-enhanced computed tomography scan of neck disclosed an abscess formation with a faint linear radiopaque material inside, consisting with remnant fishbone retention. The patient was treated conservatively with intravenous antibiotics, followed by an uneventful course during subsequent follow-up for more than 9 months until now. Tongue abscess is a rare but potentially life threatening clinical entity. Foreign body puncture-related tongue abscess should be listed as a differential diagnosis in cases with acute tongue swelling.

When hepatoma rupture happens in situs inversus totalis: side matters.

The authors reported a 73-year-old alcoholic man with previously-unrecognized situs inversus totalis suffering from left upper quadrant pain. Acute myocardial infarction was diagnosed and coronary angioplasty was performed immediately. However, the massive bleeding from the previously-unfound hepatomas caused hypovolemic shock and fatal outcome. Situs inversus totalis is a rare congenital anomaly with a complete mirror image of the thoracic and abdominal organs. Although being considered a benign entity, it would disturb diagnosis-making of the visceral diseases owing to the altered anatomy. To our knowledge, the coexistence of the coronary artery disease and ruptured hepatomas in situs inversus totalis, as in our patient, is never described. Recognition of any situs anomalies in time is the key to avoid misdiagnosis, inappropriate managements, and unwanted consequences.

Spontaneous regression of a hepatoma with ring calcification.

The authors report a 74-year-old man with chronic hepatitis C-related cirrhosis and end-stage renal disease undergoing maintenance haemodialysis who was diagnosed with hepatoma. The hepatoma spontaneously regressed with significantly decreased serum alpha-fetoprotein level without any treatment during the subsequent 4-year follow-up period. However, recurrent hepatomas over bilateral hepatic lobes were evident thereafter, and the patient died later due to hepatic failure. Hepatoma with ring calcification is extremely rare and considered poor differentiation with high risk for recurrence. Spontaneous regression of hepatoma is also rare, while spontaneous regression occurring in a hepatoma with ring calcification is never reported. The definite mechanisms causing spontaneous regression of hepatomas remain unclear, but an immune response toward hepatoma induced by alpha-fetoprotein might play an important role.