Pelvic inflammatory disease, associated with symptoms of pleuritic and upper abdominal pain, is characteristic of Fitz-Hugh-Curtis syndrome. The upper abdominal pain is due to perihepatitis. Gonococcal infection has previously been implicated almost exclusively as the cause of Fitz-Hugh-Curtis syndrome (Curtis, 1930; Fitz-Hugh, 1934). However, recent publications strongly indicate Chlamydia trachomatis as the causative organism in this syndrome. A case of Fitz-Hugh-Curtis syndrome is presented in which the sonographic demonstration of focal lesions in the liver, together with the presence of a pelvic mass led to an erroneous diagnosis of malignancy. Although Fitz-Hugh-Curtis syndrome was described over 50 years ago, it has not been widely publicized and to our knowledge the sonographic demonstration of focal hepatic lesions in Fitz-Hugh-Curtis syndrome has not previously been documented. A 42-year-old divorced barmaid presented with anorexia, weight loss, upper abdominal pain, menorrhagia and pelvic discomfort. On examination the liver was palpated two fingers below the costal margin. There was tenderness over the right hypochondrium and epigastrium. Haematological investigations revealed a moderate hypochromic microcytic anaemia (haemoglobulin = 9 g/dl), elevated erythrocyte sedimentation rate (ESR) (36 mm/h) and abnormal liver function tests (alkaline phosphate = 184 i.u./l, gamma GT = 80 i.u./l). Ultrasound examination of the abdomen and pelvis revealed multiple small abnormal foci within both lobes of a moderately enlarged liver. The focal lesions were both hypo- and hyperechoic in nature, but several target or “bull's eye” lesions were present (Fig. 1). There was irregular thickening of the liver capsule, particularly anteriorly (Fig. 2).

Epitheloid haemangioendothelioma is a rare neoplasm of vascular origin that may occur in the liver. Although there have been sporadic reports of this tumour in the past, the term “epitheloid haemangioendothelioma” was first suggested by Weiss and Enzinger only recently (Weiss & Enzinger, 1982). The tumour usually affects adults and pursues a relatively benign course intermediate between haemangioma and angiosarcoma; long-term survival with chemotherapy, hepatic resection and hepatic transplant has been documented. Scant reference can be found to its radiographic appearances. We present a case to illustrate the ultrasound appearances of this tumour and emphasize its potential confusion with metastatic disease. A 29-year-old woman presented with persistent right upper quadrant abdominal pain and anorexia over a period of 2 months. She had undergone laparotomy and repair of a liver laceration 16 years earlier, following a riding accident, but had been in good health in the intervening period.

A method combining the DOPA and Warthin-Starry techniques is described in order to positively establish the nature of pleomorphic granules observed in the cytoplasm of cells of putative amelanotic melanoma. The technique identifies these granules as aberrant melanosomes by discretely depositing electron dense silver on suitably prepared sections of DOPA-treated tissue blocks.

During an ultrastructural study of the interface area between tumour and dermis in 23 basal cell carcinoma (BCC), membrane-bound structures were noted in the dermis adjacent to the basal lamina in 12 tumours (52 per cent), but none of the controls. Serial sectioning demonstrated cytoplasmic connections between these structures and tumour cells. Their formation and interaction with adjacent stromal cells is discussed.

Echinococcal disease may affect any part of the body; the liver is the most frequently affected organ (75%) (Saidi, 1976). Although a cyst with internal septation or loculation is the classical ultrasound description of hydatid cyst of the liver, in reality unilocular cysts are more frequently encountered (Sciarrino et al, 1991). On ultrasound unilocular hydatid cysts are usually indistinguishable from innocent simple hepatic cysts, which are common incidental findings during ultrasound examination of the liver. Moreover, in a non-endemic area the index of suspicion is low and the possible diagnosis of hydatid disease may not be entertained when unilocular cysts are detected in the liver.