Intra-abdominal cystic lymphangiomas are rare lesions that can be difficult to diagnose. We present a report of a patient with a giant multilocular cystic lesion in the abdomen. Ultrasonography and computed tomography scans of the abdomen revealed that the cyst had originated in the gall-bladder fossa. There was some calcification and thickening of the cyst wall. Endoscopic retrograde cholangiopancreatography demonstrated a medially deviated common bile duct, an elongated cystic duct and an inferior compressed gallbladder. There was no apparent communication between the cyst and the biliary tract; however, an abdominal angiogram revealed that the lesion was supplied by a branch of the cystic artery. Histological findings obtained intra-operatively were consistent with a cystic lymphangioma. Its characteristic histology was observed in the subserous layer of the gall-bladder. This case is a rare instance of a cystic lymphangioma originating in the gall-bladder.

To document the transmission of hepatitis C virus (HCV) through needlestick accidents, 3 health workers who acquired HCV through such accidents and their HCV donor patients were studied using molecular evolutionary analysis based on the HCV E2 region. At least six clones were sequenced from each subject. Nucleotide substitutions were estimated by the six-parameter method, and a phylogenetic tree was constructed by the neighbor-joining method. HCV isolates from the donor patient and the recipient were nested in one monophyletic cluster; this clustering was confirmed to be statistically significant by bootstrap analysis. The nucleotide divergence among the isolates from the recipient was always smaller than that from the donor, supporting the notion that the direction of transmission was from the donor to the recipient. These findings provide evidence, at a molecular evolutionary level, that HCV was transmitted through needlestick accidents.

VRD) with neurogenic malignancies, including neuroendocrine tumors, is well established, whereas its association with nonneurogenic malignancies is considered to be coincidental. We describe a rare case of periampullary somatostatinoma (neurogenic malignancy) and multiple gastrointestinal stromal tumors (GISTs, non-neurogenic malignancy) associated with VRD.A 62-year-old man with VRD was admitted to our hospital with a poor appetite and weight loss. Gastroduodenoscopy revealed a protuberant tumor with an irregular surface occupying half of the lumen in the second part of the duodenum. Contrast-enhanced computed tomography showed a tumor, 5 cm in diameter, extending from the second part of the duodenum to the head of the pancreas. Angiography showed a tumor stain with an increase in vascularity. Histological examination of a tumor biopsy specimen revealed that atypical small cells with low-grade growth had invaded the connective tissue of the duodenal mucosa, forming trabecular and tubular arrangements, suggesting a diagnosis of carcinoid. The tumor was positive for keratin, somatostatin ( Fig. 1b), synaptophysin (Fig. 1c), and chromogranin A (Fig. 1d) on immunohistochemical examination. The plasma somatostatin level was markedly elevated, but the plasma levels of glucagon, gastrin, serotonin, vasoactive intestinal peptide, and calcitonin were in the normal ranges. Under the diagnosis of somatostatinsecreting periampullary carcinoid, pancreatoduodenectomy was considered to be indicated for this patient with VRD.At the operation, the tumor was palpable from the inner and dorsal aspects of the duodenum to the head of the pancreas. There were four miliary white nodules on the surface of the liver. Histopathological examination of a frozen section taken from the nodule for rapid diagnosis during the operation showed atypical cells that formed a glandular structure, with stromal cell proliferation in normal hepatic tissues, indicating metastasis.As the tumor was considered to be unresectable because of the liver metastases, a gastrojejunal bypass was created. Immunohistochemical staining showed that atypical cells in the white nodules on the surface of the liver were positive for somatostatin, indicating that the nodules were metastases from a somatostatinoma (malignant endocrine tumor). A psammoma body was present in biopsy samples of liver (Fig. 1a). Several subserosal white nodules, 1 cm in diameter, were also found at operation, on the anterior wall of the stomach and small intestine. On histological examination, the nodules in the stomach and small intestine consisted of atypical cells of spindle shape showing a bundle pattern, and the cells were immunohistochemically positive for CD34 and C-KIT (Fig. 2a), but not for S-100 protein (Fig. 2b). Thus, we diagnosed these lesions as multiple GISTs.The neural tissues of patients with VRD contain high levels of a neuronotropic factor that stimulates DNA synthesis by neurofibroblasts. As a result, VRD is associated with neurogenic malignancies. Thus, in our current patien...

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