Primary hepatic gastrointestinal stromal tumor showing remarkable myxoid change and hemangiopericytoma-like pattern

Gastrointestinal stromal tumors (GISTs) in the liver are exceedingly rare. We report a case of hepatic GIST with myxoid changes and hemangiopericytoma-like patterns. A 69-year-old woman presented with epigastric discomfort, and underwent laparotomy for an extruded tumor in the liver. Five years later, recurrent tumor was excised. The primary tumor contained extensive necrotic and myxoid areas. Spindle and epithelioid cells plus a few giant cells with abundant myxoid matrix surrounded the necrotic areas. Immunohistochemically, the spindle cells were distinctly positive for KIT as well as vimentin and smooth muscle actin, leading to a diagnosis of hepatic GIST. The second excised tumor showed increased cellularity and nuclear atypia of epithelioid cells with hemangiopericytoma-like patterns. Although rare, we should consider GIST as a differential diagnosis for a hepatic mesenchymal tumor

Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography

PURPOSE:We aimed to evaluate the outcomes of coil embolization of true visceral artery aneurysms by three-dimensional contrast-enhanced magnetic resonance (MR) angiography. MATERIALS AND METHODS:We used three-dimensional contrast-enhanced MR angiography, which included source images, to evaluate 23 patients (mean age, 60 years; range, 28–83 years) with true visceral artery aneurysms (splenic, n=15; hepatic, n=2; gastroduodenal, n=2; celiac, n=2; pancreaticoduodenal, n=1; gastroepiploic, n=1) who underwent coil embolization. Angiographic aneurysmal occlusion was revealed in all cases. Follow-up MR angiography was conducted with either a 1.5 or 3 Tesla system 3–25 months (mean, 18 months) after embolization. MR angiography was evaluated for aneurysmal occlusion, hemodynamic status, and complications. RESULTS:Complete aneurysmal occlusion was determined in 22 patients (96%) on follow-up MR angiography (mean follow-up period, 18 months). Neck recanalization, which was observed at nine and 20 months after embolization, was confirmed in one of eight patients (13%) using a neck preservation technique. In this patient, a small neck recanalization covered by a coil mass was demonstrated. The complete hemodynamic status after embolization was determined in 21 patients (91%); the visualization of several collateral vessels, such as short gastric arteries, after parent artery occlusion was poor compared with that seen on digital subtraction angiography in the remaining two patients (9%). An asymptomatic localized splenic infarction was confirmed in one patient (4%). CONCLUSION:Our study presents the follow-up results from three-dimensional contrast-enhanced MR angiography, which confirmed neck recanalization, the approximate hemodynamic status, and complications. This effective and less invasive method may be suitable for serial follow-up after coil embolization of true visceral aneurysms

Management of visceral artery embolization using 0.010-inch detachable microcoils

Transcatheter coil embolization is used primarily to treat arterial hemorrhages, tumors, aneurysms, and vascular malformations. However, conventional microcatheter systems cannot always be employed in difficult cases. In this technical note, we describe how small-diameter primary coils and microcatheter tips that are thinner than normal can be used to increase the safety and reliability of coil embolization

A Report of Four Cases of Intestinal Endometriosis

Four cases of intestinal endometriosis seen at our hospital are presented. The patients ranged in age from 35 to 43 years and developed abdominal pain, vomiting, and dyschezia due to stenotic lesions of the intestine. The sites of the lesions were the ileum in 2 cases, and the sigmoid colon and rectum in 1 case each. All cases had no history of bowel disease or laparotomy, and were not diagnosed preoperatively. These results suggested that evaluations of symptoms and clinical examinations are inadequate for an accurate diagnosis of intestinal endometriosis. The patients’ postoperative courses were uneventful, and there have been no recurrences. In conclusion, intestinal endometriosis should be considered in women of childbearing age who present with bowel obstruction, especially in women without a history of laparotomy

Primary hepatic gastrointestinal stromal tumor showing remarkable myxoid change and hemangiopericytoma-like pattern

Gastrointestinal stromal tumors (GISTs) in the liver are exceedingly rare. We report a case of hepatic GIST with myxoid changes and hemangiopericytoma-like patterns. A 69-year-old woman presented with epigastric discomfort, and underwent laparotomy for an extruded tumor in the liver. Five years later, recurrent tumor was excised. The primary tumor contained extensive necrotic and myxoid areas. Spindle and epithelioid cells plus a few giant cells with abundant myxoid matrix surrounded the necrotic areas. Immunohistochemically, the spindle cells were distinctly positive for KIT as well as vimentin and smooth muscle actin, leading to a diagnosis of hepatic GIST. The second excised tumor showed increased cellularity and nuclear atypia of epithelioid cells with hemangiopericytoma-like patterns. Although rare, we should consider GIST as a differential diagnosis for a hepatic mesenchymal tumor