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A Case of Inflammatory Hepatocellular adenoma Complicated by Steatohepatitis

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Open Journal of Gastroenterology 2014年第3期4卷 121-129页

作者： Yohei Harima Naoki Urayama Fusako Hisano Yuko Matsuzaki Kazutoshi Sanuki Taichi Kuwahara Tadashi Kaneko Toshio Harada Toru Kawaoka Sakurao Hiraki Shintaro Fukuda Kiwamu Okita Osamu Nakashima Department of Clinical Laboratory Medicine Kurume University Hospital Kurume Japan Department of Gastroenterological Medicine Ube Industries Central Hospital Ube Japan Department of Gastroenterology and Hepatology Social Insurance Shimonoseki Kohsei Hospital Shimonoseki Japan Department of Surgery Ube Industries Central Hospital Ube Japan

A 54-year-old man with hypertension, dyslipidemia, diabetes mellitus and fatty liver was referred to our institution for accurate diagnosis of a 4-cm space-occupying lesion in subsegment 6 of the liver, identified on ultrasonography as an iso-to hypointense lesion with clear margins. Dynamic computed tomography disclosed light accumulation of contrast medium at the margins of the space-occupying lesion from the arterial phase through to the venous phase. Sonazoid-enhanced ultrasonography showed staining of the tumor margins in the vascular phase, disappearing in the post-vascular phase. Hepatic arteriography identified the space-occupying lesion as hypervascular. Since accurate diagnosis by imaging was difficult, tumor resection was performed to exclude hepatocellular carcinoma, after obtaining consent from the patient. Histological examination revealed steatohepatitis and sinusoidal dilatation, representing socalled peliosis hepatis, in the surroundings, while the tumor showed mild hepatocellular atypia. On immunohistochemistry, tumor cells were positive for liver fatty acid-binding protein, glutamine synthetase and serum amyloid A, and negative for β-catenin and glypican 3. Glutamine synthetase, in particular, showed strong diffuse staining. Inflammatory hepatocellular adenoma was thus considered the most likely diagnosis. The pathogenesis and outcome of inflammatory hepatocellular adenoma are not fully understood, and this case with concomitant steatohepatitis was considered worth reporting.

关键词： Inflammatory Hepatocellular adenoma (IHCA) Steatohepatitis Non-Alcoholic Fatty Liver Disease (NAFLD) Glutamine Synthetase (GS) Serum Amyloid A (SAA)

Confounders in adenoma Detection at Initial Screening Colonoscopy: A Factor in the Assessment of Racial Disparities as a Risk for Colon Cancer

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Journal of Cancer Therapy 2019年第4期10卷 269-289页

作者： Yakira David Lorenzo Ottaviano Jihye Park Sadat Iqbal Michelle Likhtshteyn Samir Kumar Helen Lyo Ayanna E. Lewis Brandon E. Lung Jesse T. Frye Li Huang Ellen Li Jie Yang Laura Martello Shivakumar Vignesh Joshua D. Miller Michele Follen Evan B. Grossman Department of Medicine SUNY Downstate Medical Center Brooklyn NY USA Department of Gastroenterology Icahn School of Medicine at Mount Sinai New York City NY USA Department of Medicine Stony Brook University Stony Brook NY USA Department of Applied Mathematics and Statistics Stony Brook University Stony Brook NY USA Department of Family Population and Preventive Medicine Stony Brook University Stony Brook NY USA Department of Obstetrics and Gynecology NYC HNC/Kings County Brooklyn NY USA Department of Medicine Division of Gastroenterology NYC Health and Hospitals/Kings County Brooklyn NY USA

Background and Aims: The incidence and mortality of colorectal cancer is persistently highest in Black/African-Americans in the United States. While access to care, barriers to screening, and poverty might explain these findings, there in increased interest in examining biological factors that impact the colonic environment. Our group is examining biologic factors that contribute to disparities in development of adenomas prospectively. In preparation for this and to characterize a potential patient population, we conducted a retrospective review of initial screening colonoscopies in a cohort of patients. Methods: A retrospective review was performed on initial average risk screening colonoscopies on patients (age 45 - 75 years) during 2012 at three institutions. Descriptive statistics and multivariable logistic regression models were used to examine the relationship between potential risk factors and the detection of adenomas. Results: Of the 2225 initial screening colonoscopies 1495 (67.2%) were performed on Black/African-Americans and 566 (25.4%) on Caucasians. Multivariable logistic regression revealed that older age, male sex, current smoking and teaching gastroenterologists were associated with higher detection of adenomas and these were less prevalent among Black/African-Americas except for age. Neither race, ethnicity, BMI, diabetes mellitus, HIV nor insurance was associated with adenoma detection. Conclusion: In this sample, there was no association between race and adenoma detection. While this may be due to a lower prevalence of risk factors for adenomas in this sample, our findings were confounded by a lower detection rate by consultant gastroenterologists at one institution. The study allowed us to rectify the problem and characterize patients for future trials.

关键词： Colorectal Cancer Screening adenoma Quality

Postoperative Use of Dopamine Agonist in Controlling the Residual Mass in Non Functioning Pituitary adenoma

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Open Journal of Modern Neurosurgery 2020年第2期10卷 267-274页

作者： Mohamed Mahmoud Ahmad A. Moussa Ahmad Elsayed Abokresha Hazem A. Yousef Department of Neurosurgery Assiut University Hospital Assiut Egypt Department of Neurosurgery Queen Elizabeth Hospital Birmingham UK Department of Radiology Assiut University Hospital Assiut Egypt

Background: Non-functioning pituitary adenoma (NFPA) is a challenging tumor. It is usually reached to a large size before it is clinically manifested. Operative interference is the first option in treatment of large NFPA causing compressive manifestations but with frequent postoperative residual masses that is usually required additional treatment. Postoperative radiotherapy carried frequent side effects which open the door for postoperative medical treatment with dopamine agonist (DA) drugs based on the fact that these tumors have a variable amount of dopamine receptors. Lack of randomized, placebo-controlled trials prevents any conclusion on the efficacy of this drug. Its role in controlling postoperative proliferation and decreasing the rate of recurrence of NFPA is still questionable. Objective: Efficacy of bromocriptine (dopamine agonist (DA) drug) in reducing or preventing the re-growth of non-functioning pituitary adenoma NFPA after surgery. Methods: In this study, we examined the outcome of treating NFPA after surgery, with bromocriptine (dopamine agonists drug). This study was a retrospective review of consecutive patients that were treated by the authors at Assiut University Hospital between 2012-2018. All patients had postoperative Bromocriptine in a dose of 2.5 mg twice daily. Results: Thirty two patients were included in this study after they had surgery for NFPA. All patients had a residual mass documented by the immediate post operative MRI. After 6 months of postoperative bromocriptine treatment, and with comparing to immediate post operative images, eleven patients (34%) had mass reduction, thirteen patients (41%) of their residual masses remained unchanged and eight patients (25%) of the mass showed slight increase in size but not required re-surgery. After two years and throughout the follow up period, seven patients (22%) (all were males) had complete disappearance of the mass;ten patients (31%) had more reduction of the size of the mass (two of

关键词： Dopamine Agonists (DA) Non-Functioning Pituitary adenoma (NFPA)

Diagnosis and management of ampullary adenoma:The expanding role of endoscopy

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World Journal of Gastrointestinal Endoscopy 2011年第12期3卷 241-247页

作者： Payam Chini Peter V Draganov Division of Gastroenterology Hepatology and NutritionUniversity of FloridaGainesvilleFL 32610United States

Ampullary adenoma is a pre-cancerous lesion arising from the duodenal papilla that is often *** is important to distinguish whether the adenoma is sporadic or arises in the setting of familial adenomatous polyposis as this has important implications with respect to management and *** modalities are available for staging of these lesions to help guide the most appropriate *** that are used most commonly include computed tomography,endoscopic ultrasound,and endoscopic retrograde *** recent years,endoscopy has become the primary modality for therapeutic management of the majority of ampullary *** remains the standard curative procedure for confirmed or suspected *** review will provide the framework for the diagnosis and management of ampullary adenomas from the perspective of the practicing gastroenterologist.

关键词： Ampullary adenoma Ampullectomy Duodenal papilla Familial adenomatous polyposis Papillectomy

Composite intestinal adenoma-microcarcinoid:An update and literature review

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World Journal of Gastrointestinal Endoscopy 2021年第12期13卷 593-606页

作者： Zhi-Yan Fu Michel Kmeid Mahmoud Aldyab Stephen M Lagana Hwajeong Lee Pathology and Laboratory Medicine Albany Medical CenterAlbanyNY 12208United States Department of Pathology and Cell Biology Columbia University Irving Medical CenterNew YorkNY 10032United States

Composite intestinal adenoma-microcarcinoid(CIAM)is a rare intestinal lesion consisting of conventional adenoma and small,well differentiated carcinoid[microcarcinoid(MC)]at its *** incidence of CIAM is 3.8%in surgically resected colorectal *** its pathogenesis is unknown,studies support the role of Wnt/β-catenin pathway in the tumorigenesis of *** have been primarily reported in the colon wherein they present as polyps with well-defined margins,similar to conventional adenomatous *** is usually found in adenomatous polyps with high-risk features such as large size,villous architecture,or high grade ***,the MC component is often multifocal and spans 3.9 to 5.8 millimeters in *** is usually confined within the mucosa but occasional CIAM cases with MC extending to the submucosa have been *** of CIAM demonstrates bland cytology and inconspicuous proliferative *** lesional cells are positive for synaptophysin and 60%to 100%of cases show nuclearβ-catenin *** poses a diagnostic challenge with its morphologic and immunohistochemical resemblance to both benign and malignant lesions,including squamous morules/metaplasia,adenocarcinoma,squamous cell carcinoma,sporadic neuroendocrine tumor and goblet cell *** is an indolent lesion with a favorable *** removal by polypectomy is considered *** and recognition of this rare entity will help arrive at correct diagnosis and improve patient ***,CIAM is not recognized as a subtype of mixed neuroendocrine-nonneuroendocrine neoplasm by WHO.

关键词： Composite adenoma Microcarcinoid Composite intestinal adenomamicrocarcinoid Wnt/β-catenin Mixed neuroendocrine-non-neuroendocrine neoplasm

Mandibular Fibrosarcoma and Bile Duct adenoma in a Pet Rabbit (<i>Oryctolagus cuniculi</i>): A Case Report

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Open Journal of Pathology 2014年第2期4卷 32-40页

作者： Inge Thas Gerry M. Dorrestein Nathalie Ariel Cohen-Solal DAP Thas Gent Belgium Imagerie Medical Veterinaire Brussels Belgium Pathology Laboratory NOIVBD Veldhoven The Netherlands

This report describes the clinical manifestations and pathological findings in a 4-year-old neutered male dwarf rabbit diagnosed with a mandibular fibrosarcoma. The rabbit was evaluated for a unilateral mandibular swelling and an acute onset of oral blood loss. Physical examination confirmed a marked facial asymmetry with a swollen painful left mandible. Radiographic projections of the skull revealed a left mandibular mass extending into the oral cavity. Tissue biopsies demonstrated severe bone destruction and a presumptive pathological diagnosis of a mandibular osteosarcoma were made. A helical CT (computed tomography) study of the skull confirmed the severe mandibular bone destruction and the oral extension of the mass. The patient was treated palliative with oral meloxicam and subcutaneous penicillin injections. Six months later, the rabbit died in a natural way. Postmortem examination led to final diagnosis of severe left facial malformation due to mandibular fibrosarcoma. A bile duct adenoma was found in the liver. To the author’s knowledge, this is the first description of a spontaneous mandibular fibrosarcoma in a pet rabbit.

关键词： Bile Duct adenoma Facial Swelling Fibrosarcoma Mandible Rabbit

Giant Cystic and Mediastinal Parathyroid adenoma with Non-Uptake in Scintigraphy

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Journal of Cancer Therapy 2018年第11期9卷 850-856页

作者： Raquel Alfonso-Ballester Ana Izquierdo Moreno Rosa Martí Fernández Nicolás Tarigo Norberto Cassinello Fernández Joaquin Ortega Serrano Department of Surgery Clinic University Hospital of Valencia Valencia Spain General Surgery Department Clinic Hospital Faculty of Medicine Republic University Montevideo Uruguay

Introduction: In 85% of patients, the cause of Primary Hyperparathyroidism (PHPT) is an adenoma. Parathyroid adenoma localization is usually simple. 96% of localizations prior to surgery are achieved with ultrasound and scintigraphy combination. Difficulties can appear. If the gland is not located in a cervical position and has no uptake in scintigraphy but there is high suspition of an adenoma causing the PHPT, some extra tests should be considered. Case Report: We present a case of giant cystic mediastinal adenoma, a quite rare condition, which was diagnosed as a thyroid colloid cyst by ultrasound, and was not localized by scintigraphy. We report the CT scan and the magnetic resonance imaging (MRI) images that show the tumour. It was surgically resected by a cervical approach. After the excision, the patient recovered normal levels of Calcium and Parathormone (PTH). Conclusion: We review literature about cystic and mediastinal adenomas and diagnostic methods when the standard ones do not give an accurate localization diagnosis.

关键词： Primary Hyperparathyroidism Cystic Parathyroid adenoma Mediastinal Parathyroid adenoma

Rapidly enlarged inflammatory hepatocellular adenoma: A case report

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Open Journal of Gastroenterology 2013年第4期3卷 227-230页

作者： Kenji Koneri Hidetaka Kurebayashi Katsuji Sawai Yasuo Hirono Mitsuhiro Morikawa Makoto Murakami Takanori Goi Atsushi Iida Kanji Katayama Hiroshi Itoh Motoko Sasaki Yasuni Nakanuma Akio Yamaguchi Department of Gastroenterological Surgery University of Fukui Fukui Japan Department of Human Pathology Kanazawa University Graduate School of Medicine Kanazawa Japan Department of Tumor Pathology University of Fukui Fukui Japan

We present a rare case of rapidly enlarging inflamematory hepatocellular adenoma (IHCA) in a 60-year-old Japanese man. Screening abdominal computed tomography (CT) for the fatty liver patient revealed a 1.7-cm liver mass in the anterior segment of the liver. After 19 months, the lesion had rapidly enlarged to 6 cm in diameter and the patient was referred to our hospital. On perflubutane microbubble contrast-enhanced ultrasonography, the tumor showed a characteristic centripetal filling pattern in the vascular phase. We performed hepatic anterior segment resection because we could not rule out malignant tumor. Histopathological examination showed hyperplasia of mildly atypical hepatocytes and sinusoidal dilatation with marked inflammatory cell infiltration. Immunohistological staining revealed positive staining for serum amyloid A and C-reactive protein;therefore, we diagnosed this tumor as IHCA. The patient remains alive 42 months after operation without evidence of recurrence.

关键词： Inflammatory Hepatocellular adenoma Perflubutane Microbubble Contrast-Enhanced Ultrasonography Surgery Rapid Enlargement

Expression of enterotoxigenic Bacteroides fragilis and polyketide synthase gene-expressing Escherichiacoli in colorectal adenoma patients

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China Medical Abstracts(Internal Medicine) 2016年第2期33卷 40-41页

作者：解玲玲 Dept Gastroenterol Peking Univ People's Hosp

Objective To investigate the distribution of various bacteria in adenoma tissue of colorectal adenoma(T/CRA),normal colonic mucosa tissue adjacent to the adenoma(N/CRA),and healthy colonic mucosa tissue(N/H)by compari... 详细信息

关键词： Bacteroides adenoma colorectal mucosa colonic expressing colonoscopy Peking markedly tumorigenesis