Histologically, hepatocellular carcinoma (HCC) and atypical pituitary adenoma are similar, posing a potential clinical problem. A 76-year-old woman, whose past medical history was significant for hepatitis C virus (HCV), positivity without liver cirrhosis was presented with abducens nerve (CN VI) palsy. Contrast-enhanced magnetic resonance imaging (MRI) showed a clival tumor with infiltration of the right cavernous sinus. Subtotal resection was performed using a right anterior petrosal approach. Histological diagnosis was pituitary adenoma. Thirty-four days after the operation, MRI imaging showed residual tumor growth without any liver masses on computed tomography (CT). The patient underwent a second operation using an endoscopic transnasal transsphenoidal approach. Histological examination of the specimen gave a positive reaction for α-fetoprotein. Repeat whole-body CT showed an enhanced liver mass. Based on these findings, the lesion was diagnosed as metastatic HCC. The patient died of liver failure 6 months later. In this case, tumor diagnosis was difficult because of the histological similarity of HCC and pituitary adenoma, and the fact that the clival tumor grew prior to presentation of the liver mass on CT. This case emphasizes the importance of comparing the pathological diagnosis with the patient's clinical course.
Focusing on the effect of oily contrast medium as an embolic agent, we performed embolization of meningioma. Its usefulness is reported. Case Presentations: A flow guide catheter was advanced through the feeding blood vessel to the tumor as close as possible, and 1.0 mL-2.0 mL of undiluted oily contrast medium was injected. The contrast medium did not flow out, and it was retained in the tumor. The proximal portion was then embolized with 33%-40% N-butyl cyanoacrylate (NBCA). On pathological examination of the excised specimen, the embolized blood vessel and tumor necrosis were noted, showing time-course progression of necrosis and softening. Conclusion: This method is superior in visibility and injection control because of the use of oily contrast medium. The flow guide microcatheter is easy to guide close to a tumor and insert into thin and tortuous blood vessels. So this is applicable for skull base tumors, showing its usefulness.
An 84-year-old man suffered severe low-back pain after falling on a cruise ship. He got ashore in Chile and was admitted to a local hospital 7 days after injury. His diagnosis was L3 vertebral burst fracture. Bone fragment extruded in to the spinal canal about 50%. Posterior spinal fixation surgery was performed 4 days after admission, when he found it difficult to walk due to severe low-back pain. He had an episode of high fever 8 days after surgery, and antibiotic therapy was initiated using ciprofloxacin. Magnetic resonance image (MRI) revealed iliopsoas muscle empyema and pyogenic spondylitis. A drainage tube was inserted into the empyema cavity 17 days after surgery. Salmonella was detected in the culture specimen of the iliopsoas muscle empyema. He departed from Chile 20 days after the surgery and, 5 days later, he was admitted to our hospital via a hospital in Mexico. On admission to our hospital, his operative wound was dehisced and his abdominal computed tomography (CT) images revealed increased abscess on both sides of iliopsoas muscles. Removal of the instrument and debridement was performed on the third day at our hospital. Salmonella enteritidis growth was detected in a specimen of the wound. Drip infusion of ciprofloxacin was continued until the 42nd day in our hospital. Ceftriaxone and minocycline were administrated from the 42nd day to the 91st day. The exact route of salmonella infection was not determined because he had no abdominal symptoms such as diarrhea during the entire course and salmonella was not cultured from fecal specimen. Two possible routes of infection were considered. The first was infection through the blood stream. A Salmonella colony may have caused bacteremia, which led to the development of pyogenic spondylitis. Second, the surgical site infection may have spread. Here, the authors reported the case of a patient who developed surgical site Salmonella enteritidis infection at a foreign hospital.
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