CT evaluation of small polypoid lesions of the gallbladder

BACKGROUND/AIMS: The ability of CT to differentiate small polypoid lesions of the gallbladder was evaluated. MATERIAL AND METHODS: CT followed by cholecystectomy was performed in 20 patients with small polypoid lesions (< or = 20mm) of the gallbladder measured by preoperative ultrasonography. Detectability of the lesions on both unenhanced and enhanced CT, and the configuration and density of the polypoid lesions on enhanced CT were evaluated in comparison with histopathology. RESULTS: Unenhanced CT detected 8 of 20 polypoid lesions (40%), whereas enhanced CT detected all lesions. All the cholesterol polyp (n = 9) and hyperplastic polyp (n = 2) were not detected on unenhanced CT. Configurations of the polypoid lesions were classified into three types; pedunculated, sessile, and mass forming type. All of cholesterol polyp and hyperplastic polyp were demonstrated as pedunculated type, and adenomyomatosis (n = 2) as mass forming type in all lesions, respectively. Two of adenoma were seen as pedunculated type in one and as mass forming type in the other. Adenocarcinoma (n = 5) was depicted as sessile type in four lesions and as pedunculated type in one. The density of the lesions compared with the liver parenchyma on enhanced CT was not specific. CONCLUSIONS: The configuration of polypoid lesions depicted on enhanced CT and visualization of them on unenhanced CT are helpful in differentiating neoplastic lesions which should be resected from other benign lesions.     

Small polypoid lesions of the gallbladder: differential diagnosis and surgical indications by helical computed tomography

We report the case of a 16-year-old girl who experienced sudden cardiac arrest from ventricular fibrillation, complicating an arrhythmogenic right ventricular dysplasia, a rare heart muscle disorder, occurring typically in young adults, characterized by a fibrofatty replacement of the right ventricular myocardium. Symptomatic ventricular arrhythmias are frequent, and sudden death has been reported. In our case, diagnosis of arrhythmogenic dysplasia was based on the association of one major criterion and two minor criteria as suggested by the relevant task force. In contrast with most other reports, the chest ECG did not display the typical features. An automatic transvenous pectoral cardioverter-defibrillator was implanted. The authors emphasise that juvenile forms are more exposed to ventricular fibrillation and sudden cardiac death, and consequently require the early detection of the disease. Family cases have been described and the occurrence in one individual must lead to investigations in the relatives.     

Early cancer of the sigmoid colon with multiple atypical polypoid lesions

Three types of morphologic abnormalities of megaloblasts in the bone marrows of eight patients with severe untreated pernicious anemia and two patients with folate deficiency are described. A fourth type of abnormality, probably indicating disturbances in hemoglobin synthesis, was also observed in megaloblasts from patients with these conditons. In addition to the phenomenon of erythrophagocytosis in these disorders, the degenerating megaloblasts and those showing disturbances of hemoglobinization may constitute additional cytologic evidence for intramedullary destruction of erythroid precursors contributing to ineffective erythropoiesis in these disorders.     

小切口胆囊切除术22例体会

目的:探讨小切口胆囊切除术的优点.方法:对26例小切口胆囊切除术进行临床分析总结.结果:切口长度4～6cm,平均手术时间50min.平均术后住院5天,22例全部治愈,无术中胆道损伤、术后出血、胆漏、切口感染发生.结论:小切口胆囊切除术是安全可行的.其创伤小、恢复快、痛苦轻、住院费用低等优点,故有良好的应用价值.     

Histogenetic types and size of polypoid lesions in the stomach, with special reference to cancerous change

The personality correlates of study difficulty and academic performance in university students have been measured in terms of psychiatric symptomatology and premorbid characteristics. The UCLSQ, MHQ and DPI were administered to two groups of male and female students presenting at an health centre: one (n = 72) of patients seeking psychological help, the other (n = 73) a control group. Significant differences between the two groups were formed on the MHQ, confirming previous results; and these were supplemented by differences on the DPI. Motivational and psychoneurotic components of study difficulty were significantly related to MHQ scores in both groups. DPI scores were more closely related to study difficulty in the patients than controls; and served particularly to characterize their sylbism and work satisfaction. The DPI added to the picture of a subgroup of students observed both in an earlier and the present study: academically successful patients scoring high on phobic anxiety.     

Varioliform mucosal polypoid lesions in intestinal tract in a patient with adult T-cell leukemia

We have investigated the significance of local recurrence on survival in 173 patients with localised soft-tissue sarcomas of the limbs and of the trunk. The overall survival rates at five and ten years were 75.2% and 68.0%, respectively. After definitive surgery at our hospitals, there was local recurrence in 25 patients (14.5%). After inadequate operations elsewhere, there was a higher incidence of late local recurrence (28.3%), in comparison with those with primary tumours treated by us (9.0%), or patients referred to us immediately after inadequate surgery elsewhere (10.2%). Because of small numbers these differences in the survival rates were not statistically significantly different. Univariate survival analysis showed that local recurrence after definitive surgery (p = 0.006) together with the histological grade (p = 0.0002), the size of the tumour (p = 0.002), its depth in relation to deep fascia (p = 0.003), and the surgical margin (p = 0.0001) were the significant prognostic factors. Local recurrence at the initial presentation did not affect survival. Multivariate analysis showed that local recurrence after definitive surgery also lost its apparent prognostic significance.     

Small cell carcinoma of gallbladder: report of two cases

Extrapulmonary small cell carcinoma has been reported from multiple sites, including the gallbladder. Small cell carcinoma of the gallbladder is a very rare tumor, found usually in elderly women and associated with cholelithiasis. It carries a grave prognosis, metastasizing early and causing death shortly after diagnosis. Treatment of metastatic disease with two different chemotherapeutic regimens has been shown to improve survival. To the best of our knowledge, this tumor has not been previously reported in a black individual, or in any subject less than 49 yr or more than 79 yr old. We report two cases: one is the first black and youngest reported case. The second is the oldest person reported with this rare malignancy. Radiological studies such as ultrasound and CT scan were useful in evaluating tumor spread and follow-up.     

Expression of vascular endothelial growth factor in human gallbladder lesions

Pregnancy-induced hypertension has been suggested to be mediated by several mechanisms, including reduced nitric oxide (NO) synthesis. In this study, the effects of chronic treatment with the NO synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME) on blood pressure and the underlying changes in vascular reactivity were investigated in virgin and late-pregnancy Sprague-Dawley rats. The systolic blood pressure was 120+/-2, 124+/-5, 116+/-4, and 171+/-5 mm Hg in untreated virgin, virgin treated with L-NAME, untreated pregnant, and pregnant treated with L-NAME rats, respectively. The rats were killed, and the thoracic aorta was cut into strips for measurement of active stress in response to alpha1-adrenergic stimulation with phenylephrine and membrane depolarization by high KCl. In pregnant rats, the maximal active stress to phenylephrine (0.31+/-0.03 x 10(4) N/m2) and the high-KCl-induced active stress (0.55+/-0.09 x 10(4) N/m2) were smaller than those in virgin rats. By contrast, in the L-NAME-treated pregnant rats, the maximal phenylephrine-induced active stress (0.76+/-0.1 x 10(4) N/m2) was greater than that in virgin rats (0.52+/-0.1 x 10(4) N/m2), whereas the high-KCl-induced active stress (1.08+/-0.14 x 10(4) N/m2) was indistinguishable from that in virgin rats (1.03+/-0.14 x 10(4) N/m2). Treatment with L-NAME did not affect the phenylephrine-releasable Ca2+ stores in pregnant rats and had minimal effect on active stress in virgin rats. Thus, reduction of NO synthesis during late pregnancy is associated with a significant increase in blood pressure and vascular responsiveness to alpha-adrenergic stimulation, which can possibly be explained in part by enhanced Ca2+ entry from extracellular space. However, other mechanisms such as increased myofilament force sensitivity to Ca2+ and/or activation of a completely Ca2+-independent mechanism cannot be excluded.     

Preneoplastic lesions and gallbladder cancer: an estimate of the period required for progression

BACKGROUND & AIMS: Scarce biological information exists about the importance of preneoplastic lesions in gallbladder cancer. The aim of this study was to estimate the time required for the sequence of dysplasia (DY) to carcinoma of the gallbladder. METHODS: Eighty-four cases of DY, 60 cases of early carcinomas (ECs), 181 cases of advanced carcinomas (ACs), and 121 cases of metastatic (ME) gallbladder cancer were analyzed. Age was used as the main parameter. Statistical analysis was performed using analysis of variance and multiple regression analysis. RESULTS: Among all cases, the mean age of female patients was lower than the mean age of male patients (P = 0.001). A significant difference in mean age between sexes by specific type of lesion was also observed (P < 0.001). The mean age was 46.3 years (SD, 16) in the DY group, 57.5 years (SD, 16.7) in the EC group, 59 (SD, 13.7) in the AC group, and 61.1 (SD, 12.1) in the ME group. Multiple regression analysis showed statistically significant differences (r = 0.386; P < 0.001) in the mean age of patients with dysplastic lesions compared with the carcinoma group. CONCLUSIONS: According to these observations, the period required to progress from dysplasia to advanced gallbladder carcinoma would be around 15 years, observing a continuum in the progression of the lesions.     

Benign polypoid vaginal rhabdomyoma

A case of benign polypoid rhabdomyoma of the vagina in a 57 years old multipara is reported. The diagnosis confirmed by light and electron microscopy,allowed to estimate the tumour as a benign analogen of sarcoma botryoides.     

Small solid renal lesions: usefulness of power Doppler US

PURPOSE: To evaluate whether the vascular pattern at power Doppler ultrasonography (US) improves diagnostic accuracy in small solid renal lesions over that at gray-scale US. MATERIALS AND METHODS: Gray-scale and power Doppler US were performed prospectively in 64 small (1.5-3.0-cm-diameter) solid renal lesions (26 renal cell carcinomas [RCCs], 34 angiomyolipomas, two oncocytomas, two pseudotumors). At gray-scale US, echogenicity and homogeneity of the lesion, an anechoic rim, intratumoral cysts, shadowing, or a central scar were sought. At power Doppler US, the vascular distribution was divided into four patterns. RESULTS: Findings at gray-scale US included an anechoic rim or intratumoral cysts in 20 of 26 RCCs (77%) and the two oncocytomas. Shadowing was seen in seven of 34 angiomyolipomas (21%). Echogenicity, homogeneity, and a central scar were not pathognomonic. At power Doppler US, pattern 3 (peripheral) or 4 (mixed penetrating and peripheral) was seen in all RCCs, seven of 34 angiomyolipomas, and the two oncocytomas. Pattern 1 (intratumoral focal) or 2 (penetrating) was seen in 27 angiomyolipomas. Pattern 1 or 2 was characteristic of angiomyolipoma. The rate of correct diagnosis was significantly increased with combined US (78%) as compared to that with gray-scale (42%) or power Doppler (45%) US alone. CONCLUSION: The vascular distribution at power Doppler US could add important information to gray-scale US findings for differential diagnosis of small solid renal lesions.     

A case of polypoid solitary colonic plasmocytoma

One case of polypoid solitary plasmacytoma in the sigmoid colon of a 60 year-old woman is presented. Plasmacytomas are rarely observed in the gastrointestinal tract and are especially uncommon in the c?lon. Eight cases were published since 1972. They show a mean age of 46.3 years, a sex-ratio of 1/1, varying revealing symptoms, and no preferential colonic location. Two differential diagnosis must be discussed: an inflammatory pseudotumor, and a multiple myeloma related tumor. Multiple myeloma must be ruled out by a complete radiographic and biological research. Surgery is the only therapy described and seems to be efficient.     

Endometrioid adenoma (polypoid endometriosis) of the omentum maius

Endometrioid adenoma (polypoid endometriosis) of the omentum maius in an 89-year old female is reported. The tumor measured 1 cm in diameter and consisted of resting or weakly proliferating, partially macrocystic endometrial glands, encapsulated by delicate fibrous connective tissue. Immunohistochemically, glandular and stromal cells expressed estrogen receptor strongly, progesterone receptor weakly and CA 125 only weakly in a few glands. This is another, but rare example of the capacity of the omentum maius to develop tumors of the Müllerian variety.     

Volvulus of the gallbladder

We report a patient with cirrhosis and hepatopulmonary syndrome. This syndrome is an entity characterized by anomalies in the arterial oxygenation in patients with chronic hepatic disease and/or portal hypertension and demonstration of pulmonary vasodilatation (PV) in absence of primary cardiac or pulmonary disease. We show that the finding of PV with transthoracic contrast enhanced echocardiography (TCEE) in the diagnosis of PV is real and corresponds to direct measurement of capillary diameter by morphometry.