Measurement of Tissue Stiffness with Virtual Touch Tissue Quantification in Two Cases of Spleen Tumor

We performed non-invasive measurement of tissue stiffness in the spleen for two patients using virtualtouch tissue quantification (VTTQ). Case 1 was an 82-year-old woman with Hodgkin lymphoma. Stiffnessmeasured using VTTQ was lower than normal spleen in tumor areas and higher than normal spleen in nontumorareas. Case 2 was a 66-year-old man with ascites and gastric cancer involving the entire spleen. Stiffnessof the spleen tumor as measured by VTTQ was higher than normal spleen. These cases demonstratedtwo new factors associated with elevated spleen stiffness:compression of healthy spleen tissue by tumorand cancer invasion

A Case of Hemangiosarcoma of the Liver which led to a Diagnosis with Hemoptysis

Angiosarcoma is a vascular endothelium-derived malignant tumor that arises in blood vessel walls, accounting for only 2.3% of soft tissue sarcomas in adults. Primary hepatic angiosarcoma(PHA)is rare, comprising< 5% of all angiosarcomas. We report a case of PHA in a 61-year-old man evaluated by another clinic around our hospital for a chief complaint of hemoptysis in May 2012. Chest computed tomography(CT) showed abnormal shadows in bilateral lung fields, so he was referred to Department of Respiratory Medicine at our hospital in late July. However, no definitive diagnosis was not made, even after bronchoscopy. In mid-August, he presented to the outpatient clinic of the respiratory department with a chief complaint of right-sided abdominal pain. Abdominal CT showed a liver lesion, and he was urgently admitted to our department. Initial physical examination was unremarkable except for palpable liver in the right hypochondrium. Tumor markers for liver and biliary cancers were all within normal limits, and negative results were obtained for hepatitis B and C virus. CT, ultrasonography, and(MRI)identified a large lesion replacing the right hepatic lobe and medial segment of the left hepatic lobe. Hemangioma or hepatic angiosarcoma was suspected, accompanied by intraperitoneal rupture. Transcatheter arterial embolization was attempted, but had to be discontinued, and the patient died from hemorrhagic shock due to tumor rupture after onset of abdominal pain. The PHA which assumes hemoptysis primary symptom is extremely rare, and by reports for the past ten years searched using PubMed, this is the second report in the world

Positioning of novel tumor marker NX-PVKA-R in the diagnosis of hepatocellular carcinoma in comparison with PIVKA-II

Background/Aims:To compare the use of protein induced by vitamin K absence or antagonist II( PIVKA-II) measured conventionally with the ratio between PIVKA-II measured using P-11 and P-16 antibodies(NX-PVKA) and PIVKA-II measured conventionally (NX-PVKA-R) in terms of false-positive resultsfor hepatocellular carcinoma( HCC). Methodology:Subjects comprised 318 patients with chronic liver disease,including 8 patients receiving warfarin treatment, which can result in false-positive results for HCC.HCC was present in 65 patients (HCC group) and absent in 253 (non-HCC group). PIVKA-II was measuredconventionally. NX-PVKA-R was calculated as PIVKA-II/NX-PVKA. Results:Both PIVKA-II andNX-PVKA-R were significantly higher in the HCC group than in the non-HCC group (p<0.0001 each).False-positive results were seen in 9.5% of non-HCC patients with PIVKA-II, and in 10.3% with NX-PVKA-R. False-positive results were seen for all 8 patients (100%) on warfarin with PIVKA-II, but for 0%with NX-PVKA-R. Sensitivity, specificity, and accuracy were all lower for NX-PVKA-R than PIVKA-II.Conclusions:NX-PVKA-R is not more useful than PIVKA-II for diagnosing HCC, but is very useful insubpopulations such as patients on warfarin and patients with jaundice. The characteristics of NX-PVKA-Rcan be best exploited by selecting patients in which these factors are present

リュウキ ケイセイ オ テイ シタ ミブンカ ガタ イ ネンマク ナイ ガン ニ タイ シ ナイシキョウ チリョウ オ シコウ シタ 1 レイ

症例は67才男性.上部消化管内視鏡検査で胃前庭部前壁に0-I+IIc型隆起性病変を指摘され,生検結果は低分化型腺癌の診断であった.適応拡大病変と診断して内視鏡的胃粘膜下層剥離術(ESD)施行し適応拡大治癒切除であった.フォローの内視鏡で初回病変の近傍に0-I+IIc型の隆起を主体とした病変を認め,生検結果は印環細胞癌であり,再度ESDを施行した.初回病変のような,隆起を主体とした未分化型粘膜内癌の症例は稀である.二回目の病変の成因は,局所再発・腫瘍移植(implantation)・異時性癌のいずれか確定は困難であったが,貴重な症例と思われたので報告したA 67-year-old man was diagnosed with a small elevated undifferentiated gastric adenocarcinoma in situ and subsequently underwent endoscopic submucosal dissection (ESD). Curative resection was achieved. Fifteen months later, a new lesion was found near the ESD scar of the first lesion. This lesion was similarly elevated, and histopathological examination of the biopsy specimen revealed signet ring cell carcinoma. We performed ESD again for this lesion. Elevated early gastric cancer in which histological examination shows undifferentiated adenocarcinoma and depth M is very rare. We searched for elevated early undifferentiated gastric cancers in the PubMed and Ichushi databases and find only nine cases. The cause of the second lesion was suspected to be either local recurrence, or implantation or metachronous cancer, but it seemed to be very difficult to diagnose exactly. It should be careful observation, even if obtained curative resection of undifferentiated intramucosal gastric cancer by ESD

キュウセイ スイエン オ ケイキ ニ シンダン サレタ タンノウガン ノ 1レイ

80 歳,女性.急性膵炎の診断で入院した際の腹部CT と超音波検査で,胆嚢に3.6 cm 大の腫瘍を認めた.MRCP で膵・胆管合流異常症の合併は否定された.膵炎軽快後に胆嚢腫瘍の診断で腹腔鏡下胆嚢摘出術が施行された.病理診断は胆嚢癌であり,腫瘍表面は脆弱性で一部に脱落と考えられる所見を認めた.本症例は,腫瘍片が総胆管へと脱落することによって惹起された急性膵炎によって診断された稀な胆嚢癌と思われた.An 80-year-old woman was admitted to the emergencydepartment of our hospital complaining of upper abdominalpain. Acute pancreatitis was diagnosed based on increasedserum levels of amylase and lipase. Computed tomographyand abdominal ultrasonography showed a gallbladder tumor3.6 cm in diameter. Pancreaticobiliary maljunction wasexcluded based on Magnetic Resonance cholangiopancreatography.The patient underwent laparoscopic cholecystectomyafter improvement of pancreatitis, and the tumorwas diagnosed as gallbladder cancer. On pathology, the tumorsurface was fragile and defluxion of the tumor was observed.We speculated that the acute pancreatitis wascaused by a small piece of tumor breaking off and passinginto the common bile duct

ショハツ カンサイボウ ガン ノ ビョウイン ト ヨゴ キテイ インシ ニ カン スル リンショウ テキ ケントウ

目的:初発肝細胞癌の病因と予後規定因子について検討し,2000年の我々の獨協医科大学病院症例を対象とした報告と比較することを目的とした.方法:初発肝細胞癌102例を対象とした.病因はB型肝炎 (HBV),C型肝炎 (HCV),NBNC,アルコールの4つに分類した.Kaplan-Meier法を用いて生存率を求め,Coxの比例ハザードモデルを用いて予後因子の検討を行った.得られた結果を2000年の報告と比較した.結果:病因はHBV 12.8%,HCV 60.7%,NBNC 15.7%,アルコール10.8%であり,HCVは減少し,NBNCとアルコールは増加傾向にあった.治療例の生存率は1年87.5%,2年78.0%,3年71.5%であり,近年の診断と治療の進歩による予後改善が確認された.腫瘍ステージがIII以上であること,およびPIVKA-II 40 mAU/ml以上の2つが独立した予後規定因子であった.結論:肝細胞癌の病因ではHCVが減少し,NBNCとアルコールが増加していた.腫瘍ステージ,PIVKA-IIが独立した生命予後規定因子であった.Purpose:The purpose of this study was to investigate the causes of initial hepatocellular carcinoma and the factors determining prognosis, and to compare the findings with those of our year 2000 report.Method:Subjects comprised 102 patients with initial hepatocellular carcinoma. Causes were divided into four categories: hepatitis B virus (HBV);hepatitis C virus (HCV);non-B, non-C hepatitis (NBNC);and alcohol. Survival rates were obtained using the Kaplan-Meier method and prognostic factors were investigated using Cox\u27s proportional hazards model. The results were compared with the findings of the year 2000 report.Results:The cause was HBV in 12.8 % of cases, HCV in 60.7%, NBNC in 15.7%, and alcohol in 10.8%. Frequency of HCV was decreased and frequencies of NBNC and alcohol showed increasing tendencies. The survival rate of treated patients was 87.5 % at 1 year, 78.0 % at 2 years, and 71.5 % at 3 years. Improved prognosis was confirmed with diagnosis in recent years and treatment advances. Two factors were independently associated with poor prognosis:tumor stage III or IV; and PIVKA-II level>40 mAU/ml.Conclusion:HCV decreased and NBNC and alcohol increased as causes of hepatocellular carcinoma. Factors independently associated with life prognosis were tumor stage and PIVKA-II level

Mikulicz ビョウ ノ チリョウ チュウ ニ カン ショウガイ デ ハッショウ シタ ジコ メンエキセイ スイエン ノ 1レイ

69 歳,女性.2004 年に他院耳鼻科にてシェーグレン症候群と診断され治療中であった.2010 年5月に肝機能障害を指摘されたために当科を受診した.初診時に両側上眼瞼の腫脹と両側耳下腺の腫大(約1 cm)を認めた.血液生化学検査では胆道系酵素の上昇を認め,またIgG は2308 mg/dl,IgG4 は498 mg/dl と高値を呈した.造影CT では膵はびまん性に腫大していた.内視鏡的逆行性膵胆管造影で膵管に特徴的な狭細像を認めたため自己免疫性膵炎と診断した.本症例の眼瞼腫脹と顎下腺腫脹は現在の診断基準ではMikulicz 病と診断が可能である.Mikulicz 病と自己免疫性膵炎の合併は少なくないものの,本邦における文献報告例は本例で11 例目である.A 69-year-old woman presented with a chief complaintof liver dysfunction in May 2010. Both palpebrae superiorand the parotid gland had been swollen for six years. Bloodtests showed increased levels of biliary system enzymesand serum IgG and IgG4. Enhanced computed tomographyrevealed a diffusely enlarged pancreas. A narrowed pancreaticduct revealed by endoscopic retrograde cholangio-pancreatographywas diagnosed as autoimmune pancreatitis.The swollen eyelid and enlarged submandibular gland indicateda diagnosis of Mikulicz\u27s disease. Case reports of Mikulicz\u27sdisease complicated with autoimmune pancreatitisare very rare

ドッキョウ イカ ダイガク コシガヤ ビョウイン ニオケル, フクブ チョウ オンパ ケンサ ニヨル タンノウ リュウキセイ ビョウヘン ノ ケントウ

腹部超音波検査が施行された3572 例を対象として胆嚢隆起性病変の検討を行った.胆嚢隆起性病変は3572例中791例( 22.1%) に認められ,重複検査例を除いた773例の平均年齢は59.6±13.6歳であり,男性370 例,女性403 例であった.胆嚢隆起性病変の最大径の平均は4.7±5.8 mm で,単発が256 例 (33.1%),多発が517例( 66.9%) であった.773例中,10 mm 以上の病変を有する症例は44 例( 5.6%) であった.これら44例の最終診断は,胆嚢良性ポリープ19例( 43.2%),胆嚢腺筋症2 例( 4.6%),胆泥貯留2 例( 4.6%),胆嚢結石2例( 4.6%) 切除可能胆嚢癌6例( 13.6%),切除不能胆嚢癌6 例( 13.6%),その他の癌2 例( 4.6%),不明5例( 11.3%) であり,胆嚢癌の半数が切除不能であった.今後,超音波検査を用いて切除可能な胆嚢癌をより多く拾い上げるためには,人間ドック等による,より幅広いスクリーニングが必要であると考えられた.The present study investigated the presence and characteristicsof elevated gallbladder lesions in 3572 patients whounderwent abdominal ultrasonography in our hospital betweenApril 2011 and March 2012. Elevated gallbladder lesionswere present in 791 patients (22.1 %). After excludingpatients who underwent repeat examination, 44 of theremaining 773 patients (5.6 %) had lesions &#8805; 10 mm. Finaldiagnoses in these 44 patients were as follows:benign gallbladderpolyp, n=19 (43.2 %);gallbladder adenomyosis,n=2 (4.6 %);biliary sludge accumulation, n=2 (4.6 %);gallbladder stone, n=2( 4.6%);resectable gallbladder cancer,n=6( 13.6%);non-resectable gallbladder cancer, n=6(13.6%);other cancers, n=2( 4.6%);and unknown, n=5(11.3 %). Wider screening during routine medical examinationssuch as annual health checks is required to enable increasedidentification of gallbladder cancer at an early stagewhen resection is still possible