In 8 cases of hepatocellular carcinoma, hepatectomy was performed after hepatic artery embolization with Gelfoam. Complete necrosis of the tumor was found in 4 of these cases. Compared with the tumors that showed incomplete necrosis, the tumor in the complete necrosis group were small, thickly encapsulated, and located at sites remote from collateral circulation. Angiography and computed tomography after embolization accurately demonstrated tumor necrosis or continued viability, as confirmed by examination of resected specimens.

A 54-year-old man underwent an operation for colon cancer histologically diagnosed as moderately differentiated adenocarcinoma with clinical staging of Dukes C. He was prescribed carmofur for adjuvant chemotherapy. A follow-up computed tomography scan done 6 months later revealed two new low-density areas in the liver. A diagnosis of metastatic adenocarcinoma from the previous colon cancer was presumed, based on the patient's history and radiological findings, and resection of the affected area of liver was performed. Histological examination of these tumors revealed that they were inflammatory pseudotumors (IPT). The patient had an excellent postoperative course and has shown no further signs of recurrence in the 3 years since his last operation. IPT of the liver is a rare disease, for which no methods of diagnosis and treatment have been established, since it is difficult to distinguish IPT from hepatocellular carcinoma or metastatic carcinoma. We describe this case with a review of the 101 cases of IPT documented in the Japanese literature, in the hope that it will contribute to the diagnosis and treatment of this unusual disease entity.

The effectiveness of Lipiodol (iodized oil) in transcatheter arterial embolization (TAE) of hepatocellular carcinoma (HCC) was retrospectively evaluated using statistical analysis. A total of 343 HCC patients who underwent TAE at 5 institutions between 1984 and 1989 were divided into 2 groups: the GS-TAE group underwent TAE with Gelfoam sponge alone, whereas the LP-TAE group was given Lipiodol (LP) immediately before GS-TAE. The statistical T value calculated for the LP-TAE group showed that the administration of LP, the tumor size, intrahepatic metastasis, portal vein infiltration, and serum total bilirubin and alpha-fetoprotein levels significantly (P < 0.01) affected the patients' survival. Both the cumulative survival determined using the Kaplan-Meier model and the cumulative hazard calculated using Cox's proportional hazard model differed significantly (P < 0.01) between the GS-TAE group and the LP-TAE group (log-rank test). These results confirmed the effectiveness of LP used in combination with Gelfoam sponge for TAE of HCC.

Two patients with primary pneumatosis cystoides intestinalis are presented. In both cases, the sigmoid colon was involved and there were no major complications. On computed tomography (CT), at lung window settings, the gas cysts in the colonic wall were clearly delineated. CT was useful in confirming the intramural gas cysts in patients with primary pneumatosis cystoides intestinalis.

To clarify the relationship between percUtaneous transhepatic cholangioscopic findings such as papillogranular surface and vascular dilation, which are reportedly characteristic of carcinoma, and the pattern of spread for bile duct carcinomas, we compared endoscopic photographs with histological features of biopsy specimens in 57 regions of specimens from 35 patients with malignant stenosis of the bile duct. Regions with a papillogranular surface were associated with noninvasive mucosal carcinomas and papillary proliferation of superficial epithelia significantly more often than regions without such a surface (P<0.0001). The sensitivity and specificity of the papillogranular surface to noninvasive mucosal carcinoma was 79 and 95%, respectively, that of papillary proliferation of superficial epithelia was 100 and 98%, respectively. Regions with vascular dilation were associated with invasive carcinoma significantly more often than regions without vascular dilation (P<0.0001). The sensitivity and specificity of vascular dilation to invasive carcinoma were 90 and 86%, respectively. Results indicate that a papillogranular surface is related to noninvasive mucosal carcinomas while vascular dilation is related to invasive carcinomas. However, a papillogranular surface was even more closely related to papillary proliferation of superficial epithelia.