This study suggests that a disease entity which can be named follicular cholangitis and pancreatitis exists and may be under-recognized. The disease mainly affects the hilar bile ducts and pancreatic head in adults.

Liver metastases from colorectal cancer easily invade the Glisson's triad and sometimes have intrabiliary tumor growth. This behavior is by no means rare, and causes the cut end of the Glisson's triad to be positive for cancer. We report here a 72-year-old Japanese man with a medical history of ascending colon cancer in whom enhanced computed tomography (CT) showed a low-density mass in the caudate lobe of the liver and dilatation of the peripheral intrahepatic bile duct. He underwent right hemihepatectomy and caudate lobectomy. The resected specimen showed a polypoid tumor in the bile duct lumen, with minimal invasion of the liver parenchyma; the tumor was similar to cholangio-carcinoma. Histological findings proved it to be well-differentiated adenocarcinoma. Immunochemically, the tumor cells were positive for cytokeratin (CK) 20, but negative for CK7, and we finally diagnosed him with intrabiliary polypoid growth of liver metastasis from colonic cancer. For complete surgical resection, it is very important to diagnose intrabiliary tumor growth. However, we could not diagnose it preoperatively in spite of the CT detecting an intrabiliary polypoid tumor, because the CT revealed no extrabiliary tumors in the liver parenchyma. We have to pay attention to the fact that CT rarely demonstrates only intrabiliary growth without extrabiliary tumors.

Granular cell tumors (GCTs) are uncommon soft tissue tumors that mostly occur in patients between 40 and 60 years of age and can occur at various body sites. Malignant granular cell tumors (MGCTs) comprise less than 2 % of GCTs and are mostly found on the lower extremities, especially the thighs. These tumors grow more rapidly than benign GCTs, and most importantly, they can metastasize. We describe an MGCT that presented as a right breast mass in a 79-year-old Japanese woman. Local excision was performed for the primary tumor, which was diagnosed as an atypical GCT, but 15 months later, the tumor recurred at the same site. Thereafter, right mastectomy with axillary lymph node dissection was performed. Metastatic disease was identified in 2 of 12 lymph nodes. The pathological examination revealed that the tumor had progressed to an MGCT after recurrence. Multiple liver, lung and bone metastases were revealed 4 months after the second surgery, and the patient died 34 months after the primary surgery. Our findings highlighted the difficulty in diagnosing MGCTs using histological features alone and suggested the usefulness of Ki67 values. A tumor with a high level of Ki67 should be treated as malignant, even if the tumor has few pathological features of malignancy.

Recent autopsy studies have clarified the frequency of lymph node (LN) metastases from hepatocellular carcinoma (HCC). However, LN metastases commonly occur in advanced and poorly differentiated HCC and are very rare in small HCC. We encountered a patient with skip LN metastases from a small HCC, 10 mm in diameter. An intra-abdominal tumor adjoining the duodenum was detected by follow-up ultrasonography for viral hepatitis C. Computed tomography showed, in addition to the tumor bordering the duodenum, a small low-density area of the liver (S6), 2 cm in diameter, and a swelling of LN adjacent to the common hepatic artery. Upper gastrointestinal rentogenography revealed a compression of the duodenal second portion without irregularity of the mucosa. Our pre-operative diagnosis was duodenal gastrointestinal stromal tumor with LN metastasis and HCC or liver metastasis. However, laparotomy proved them to be LN metastases from a small HCC and partial hepatectomy and LN dissection were performed. The patient is doing well 22 months after surgery with no signs of recurrence. In the cases of HCC with LN metastases, the prognosis is generally very poor. However, in small HCC, the clinical characteristics are not fully evaluated. In treatment, we have to keep LN metastases, particularly skip LN metastases, in mind, even in cases of small HCC.

A total of 175 rats were divided into: (1) a sham operation group, in which the liver was slightly mobilized after laparotomy; (2) a control group in which 68% of the liver was resected without the blockade of blood flow; (3) an ischemia + hepatectomy group, in which the vessels entering the right and caudate lobes were clamped for 30 min, and the nonischemic lobes were resected; (4) a DFMO + ischemia + hepatectomy group, in which the same procedure as for the ischemia + hepatectomy group was performed, but the animals received alpha-difluoromethylornithine (DFMO); (5) a DFMO + Put + ischemia + hepatectomy group, in which the animals underwent the same procedure, but were given putrescine (Put) in addition to DFMO. There were 6 to 7 rats in each of the five groups. The putrescine level and ornithine decarboxylase (ODC) activity were significantly higher in the ischemia + hepatectomy group than in the control group, but were markedly decreased in the DFMO + ischemia + hepatectomy group. However, the lipid peroxide level was significantly higher in the DFMO + ischemia + hepatectomy group than in the ischemia + hepatectomy group. The incorporation of [3H]thymidine in the DFMO + ischemia + hepatectomy group was significantly lower than that in the control group. The increase in the lipid peroxide level and the decrease in [3H]thymidine found in the DFMO + ischemia + hepatectomy group tended to be reversed by the administration of putrescine. These results suggest that putrescine suppressed the production of lipid peroxides and promoted DNA synthesis in regenerating the liver after ischemia-reperfusion injury.