We report a new case of solitary fibrous tumor (SFT) of the liver, an extremely rare neoplasm. Including the present case no more than ten cases are reported in the English-language literature. To date there is no definite proof of the origin of this tumor. Both mesothelial and fibroblas-tic genesis has been postulated. The monoclonal antibody CD 34 has recently been used for the characterization of SFT. SFT would appear to be histogenetically related to a CD 34 - positive fibroblastic stem cell. A 61-year-old woman was admitted to our department with epigastric and right hypochondriac pain, weight loss, and hypoglycemia. Ultrasonography and computed tomography demonstrated a large heterogeneous mass in the right hepatic lobe. A right hepatectomy was performed. The tumor weighed 2850 g and microscopic section revealed a peculiar random pattern, the so-called patternless pattern of spindle tumor cells separated by abundant thick collagen bands. The tumor presented a number of highly cellular areas composed of plump spindle cell with hyperchromatic nuclei and rare mitotic figures. Ninety percent of the neoplastic cells displayed strong immunoreactivity for CD 34/My 10. The postoperative course was uneventful and the patient is alive and well without recurrence 6 years after surgery.

Summary:Determination of the functional hepatic reserve is still controversial. Many tests have been proposed, but the assay based on formation of the lidocaine metabolite, monoethylglycine xylidide, seems to offer a promising approach to this problem. In this study we evaluated the effectiveness of the monoethylglycine xylidide test in the clinical evaluation of 31 cirrhotic patients submitted to three different therapeutic options (sclerotherapy, transjugular intrahepatic portosystemic shunt and surgical procedures) and in 1 patient submitted to right hepatectomy for giant hepatic angioma. We found a statistically significant difference between Child A and C patients and between Child B and C patients. The test did not differentiate Child A from Child B patients. We found no correlation between the Child-Pugh score, serum bilirubin, albumin and prothrombin time. There were no differences among the three groups of patients that could be statistically related to their therapy. The monoethylglycine xylidide test seems to be an attractive alternative to previous methods for the evaluation of the functional hepatic reserve, but further studies are necessary to assess the prognostic value of the test in cirrhotics, to separate the independent contribution of portosystemic shunting and hepatocyte dysfunction to monoethylglycine xylidide formation, and to evaluate the test as a prognostic index in cirrhotic patients submitted to general surgery.

This report describes the use of a transjugular intrahepatic portosystemic shunt (TIPS) in a cirrhotic patient with early gastric cancer, presenting with gastroesophageal varices and severe hypertensive gastropathy, in order to perform an endoscopic mucosal resection. The patient first underwent a TIPS to reduce the hypertensive gastropathy and thereafter was successfully treated by an endoscopic mucosal resection. Owing to the high operative risk, the treatment of gastric cancer in cirrhotic patients needs to be individualized. New procedures such as TIPS and an endoscopic mucosal resection may be useful in selected high-risk patients.

No abstract

This report describes the use of a transjugular intrahepatic portosystemic shunt (TIPS) in a cirrhotic patient with early gastric cancer, presenting with gastroesophageal varices and severe hypertensive gastropathy, in order to perform an endoscopic mucosal resection. The patient first underwent a TIPS to reduce the hypertensive gastropathy and thereafter was successfully treated by an endoscopic mucosal resection. Owing to the high operative risk, the treatment of gastric cancer in cirrhotic patients needs to be individualized. New procedures such as TIPS and an endoscopic mucosal resection may be useful in selected high-risk patients.