A 47-year-old woman was admitted to our hospital with complaints of fever, upper abdominal pain, and back pain. The serum amylase, C-reactive protein (CRP), and IgG (especially IgG4) were elevated, and abdominal computed tomography (CT) revealed diffuse enlargement of the pancreas and pseudocysts. Endoscopic retrograde pancreatography (ERP) revealed diffuse irregular narrowing of the main pancreatic duct. Histopathological examination of the pancreatic tissue showed fibrotic change with lymphocytic infiltration. Based on these findings, we diagnosed this case as a case of autoimmune pancreatitis. This case also fully satisfied the diagnostic criteria for autoimmune pancreatitis established by the Japan Pancreas Society in 2002. Few reports have been published on cases of autoimmune pancreatitis complicated by the formation of pseudocysts in the pancreas. We, therefore, report this case here to emphasize that cases of autoimmune pancreatitis can be complicated by the development of pseudocysts.

Restriction landmark genomic scanning (RLGS) was utilized to identify novel genomic alterations in hepatocellular carcinoma (HCC). Thirty-one HCC samples were examined by RLGS. Two high intensity spots were common to several RLGS pro®les of di erent HCCs. Nucleotide sequencing and homology search analysis showed that these spots represented repetitive sequences, Human tandem repeat sequence (Genbank, L09552) and centromeric NotI cluster (Genbank, Y10752). These intensi®ed signals were attributable to the occurrence of demethylated areas in the recognition sequence of the NotI site of the corresponding fragments. The intensity of these spots in the RLGS pro®le re¯ects their degree of demethylation, which was signi®cantly correlated with postoperative recurrence, even in patients regarded as belonging to the good prognosis group by conventional prognostic factors. Multivariate analysis showed that the intensities of the two spots retained independent prognostic value. This is a new type of predictive factor for HCC based on epigenetic changes in hepatocarcinogenesis, and in the future it is expected to be of great value in making preoperative diagnosis and selecting postoperative therapy.

Pancreatic cancer is the disease of gastrointestinal cancer with the poorest prognosis. At present, in addition to surgery, multimodality treatment combining a variety of therapeutic methods is used. We usually employ the following combination of surgery, radiotherapy and chemotherapy: D2 surgery with pylorus-preserving pancreatoduodenectomy (PPPD), intraoperative radiotherapy (IORT), and portal catheterization (PC) with fluorouracil as the chemotherapy. In this study, we made a historical comparison of PPPD and PD and obtained the following findings: (1) PPPD allows almost the same extent of D2 dissection as conventional PD, and achieves radical treatment without any problems; (2) suppression of local recurrence by IORT cannot be expected from the results of the comparison between the four approaches, i.e. surgery alone, surgery + IORT, surgery + PC and surgery + IORT + PC, and (3) the rate of liver metastasis in patients treated by PC was significantly low.

Squamous cell carcinoma is an extremely rare primary liver tumour. A 42-year-old man presented at our hospital on 19 February 1986, with pain in the right upper quadrant of the abdomen and general fatigue, and reported an 8 year history of this complaint. Ultrasonography showed four cystic masses in the liver with a maximum diameter of 15 cm, one of which contained a solid component. A computed tomography (CT) scan confirmed a huge, predominantly cystic, mass in the liver with a small solid component and irregular wall. Calcifications were seen in the solid components. On 22 April 1986, a laparotomy was performed but the masses were too large to be removed. During 15 years of follow-up after the laparotomy, there had been no change seen in his abdominal CT scan. He subsequently arrived at our hospital again on 10 July 2001 with loss of appetite and of body weight. A CT scan showed a cyst in the liver of 25 cm in diameter with calcification that had a large solid part invading the liver. A post-mortem pathological dissection showed multiple cysts, the largest of which was 25 cm in diameter. They had large solid parts with calcification invading the liver. There were widespread metastatic lesions. Microscopic examination showed the tumour to be a well differentiated squamous cell carcinoma. To the best of our knowledge, this is the first report of a squamous cell carcinoma arising from 15 multiple non-parasitic hepatic cysts after a 15 year follow-up. Furthermore, 23 years had passed since the patient's symptoms appeared for the first time.

Molecular genetic analyses have clari®ed that accumulation of genomic changes provides important steps in carcinogenesis and have identi®ed a number of valuable genetic markers for certain cancers. To date, however, no prognostic markers have been identi®ed for hepatocellular carcinoma (HCC). In this study, we used restriction landmark genomic scanning (RLGS), a new high-speed screening method for multiple genomic changes, to detect unknown genetic alterations in HCC. Thirty-one HCC samples and their normal counterparts were examined by RLGS. Eight spot changes were common in several cases, and all were seen only on the HCC pro®le. Five of these spots were detected in more than 12 of 31 cases (38.7%). Viral infection had no in¯uence on changes in the RLGS spots. The disease-free survival rate for patients with 516 changed RLGS spots was signi®cantly lower than that for patients with fewer changed RLGS spots (415 spots) (P50.001). In multivariate analysis, the number of changed spots was proven to retain an independent prognostic value (relative risk 1.095: P=0.0031). These results suggest that the number of changed RLGS spots may be a useful biological marker for recurrence of HCC.