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Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Focal nodular hyperplasia and adenoma of the liver together represent approximately 2% of all primary hepatic tumors and tumor-like lesions in childhood. This study reports the clinical and pathologic features of focal nodular hyperplasia in three children, all females between 27 months and 15 years of age with asymptomatic hepatomegaly. In contrast, massive hemoperitoneum from a ruptured, hemorrhagic mass was the presentation of the hepatic adenoma in a 14-year-old girl. There was no history of administration of steroids in these four children. Angiography in two cases (one case each of focal nodular hyperplasia and hepatic adenoma) revealed hypervascular lesions with abnormal tortuous vessels suggesting a malignant tumor. Pathologically, the adenoma and focal nodular hyperplasia were readily distinguishable and the necessity for this differentiation was reviewed. All four patients are currently doing well.
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PMID:Focal nodular hyperplasia and adenoma of the liver. A pediatric experience. 23 73

With the advent of whole body computed tomography (CT), an early diagnosis of hepatic tumors may be posible and laparotomy for diagnosis unnecessary. The CT scanner used was the whole body Delta unit. Patients were examined after an iv dose of 100 cc of Renograffin 60. Solid and cystic components of lesions can thus be determined. Case reports are given of 2 patients. The 1st patient had been taking Ovulen-21 for 21 months. Her liver scan revealed a large filling defect in the right lobe of the liver. Abdominal angiography showed an avasuclar mass displacing the right kidney. A CT scan depicted a large mass replacing the right lobe of the liver. The density of the mass indicated a fluid-filled cyst. At laparotomy a cyst involving the entire right lobe of the liver was found. Several nodules were present in the cyst wall. The diagnosis was cyst-adenoma of the liver. The other patient had taken Ovulen-21 for 7 years. An enlarged liver and symptoms of cholecystitis were present. The CT scan revealed a bolbous mass in the right lobe of the liver. The tumor was of the same density as the liver. At laparotomy a large hepatic adenoma was found. A 2nd mass was present in the left lobe. The tumors were not resected; cholecystectomy was done. Because of bleeding, a hepatic artery was ligated. Postoperatively, a repeat CT scan showed a large area of decreased density. At reoperation a large hematoma with necrosis of the hepatic adenoma was found and drained. The CT is an accurate method of performing percutaneous biopsies and aspiration procedures. An exact position of the needle tip can be obtained. CT-guided biopsies have also been done on masses in other areas.
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PMID:Benign hepatic tumors and cysts in women using oral contraceptive agents: computed tomography as a diagnostic aid. 86 89

In 82 patients, a preoperative diagnosis of primary hyperparathyroidism has been established by means of transfemoral neck vein catheterization and measurement of serum immunoreactive parathyroid hormone (iPTH). Twenty-five of these patients have had cancer in other parts of the body but with no evidence of recurrence or metastasis. One patient had carcinoma of the colon with metastases, and four were members of families with multiple endocrine adenomatosis (MEA, Types I and II). In six other hypercalcemic patients, high levels of iPTH were found also in the effluent blood from cancer sites other than the parathyroid gland, secondary to ectopic hormone production or pseudohyperparathyroidism. In addition, a high serum level of iPTH was found in the superior vena cava of a seventh patient who had carcinoma of the breast but no clinical or radiological signs of recurrence or metastasis with the exception of an enlarged liver. This iPTH finding was interpreted as being, probably, the result of parathyroid adenoma in either the neck or the mediastinum. At the time of operation, a transcervical mediastinal search was made. Four normal cervical parathyroid glands were found; three were removed. Hypercalcemia persisted after operation, and the patient died. At postmortem examination, microscopic study revealed that the disease had metastasized to lungs and hilar lymph nodes. There was massive metastasis in the liver; the liver contained a large amount of iPTH. The results of these investigations suggest that (1) venous catheterization of the neck veins and the effluent blood from extraparathyroid tumors aid in identifying and localizing iPTH production; (2) primary benign hyperparathyroidism is not uncommon in patients with cancer, and its co-existence must be recognized; (3) high serum iPTH level in the superior vena cava may be found in patients with metastatic or primary cancer of the thoracic cavity; and (4) hyperparathyroidism may be the first hint of a familial multiple endocrine syndrome.
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PMID:Hypercalcemia in patients with known malignent disease. 96 5

A 47 years old male with POEMS syndrome is presented. His illness started seven months before admission. He was in poor general conditions and had malnutrition. He had cutaneous hyperpigmentation, skin changes, hepatomegaly, edema of the limbs, quadriplegia, myotatic reflexes abolished, hypotrophy of muscular masses and bilateral papilledema. Immunoglobulins IgA and IgM were abnormal. Bone scanning showed multiple lytic lesions. The study of bone marrow showed megaloblastic changes. Electromyography revealed severe neuropathy and biopsy from sural nerve showed severe demyelinization. At first, he showed improvement with steroids; nevertheless he died two months afterwards from possible bronchoaspiration. The autopsy revealed changes compatible with the clinical diagnosis and in addition an adenoma of the hypophysis. We emphasize the importance of POEMS syndrome in the differential diagnosis of polyneuropathies.
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PMID:[POEMS syndrome. Report of a case and review of the literature]. 148 88

A case report is presented of a 43-year-old woman with generalized peliosis hepatitis that developed during longterm use of oral contraceptives (OCs). The patient had been in good health until the last 2 years when she began to experience vague epigastric pains and a feeling of abdominal distension. Several months prior to admission, she had started to complain of itching and fatigue. There was no history of dark urine, white stools, or hepatitis. On physical examination, no jaundice or cutaneous stigmata of chronic liver disease were observed. Laboratory studies showed a normal erythrocyte sedimentation rate and hematological blood count. A radionuclide study of the liver showed hepatomegaly; especially the left lobe was enlarged. A computerized tomographic scan of the liver showed multiple areas of decreased density in both of the enlarged lobes. There was no evidence of a tumor. Selective transfemoral angiography of the celiac artery also showed hepatic enlargement but no signs of a space-occupying lesion. At laparoscopy, the liver was grossly enlarged and had a lumpy appearance, but again there were no signs of a tumor. No evidence of veno-occlusive disease or hepatocellular adenoma was found. The diagnosis was peliosis hepatitis. The OCs were withdrawn, and the patient was discharged. Regular follow-up in the outpatient department showed no decrease in the size of the liver. The alkaline phosphatase level rose. The fatigue became worse, and cholestyramine was prescribed for progressive itching. In September 1980, the patient was admitted for reevaluation. A repeated CT scan and angiography of the liver again yielded no evidence of a tumor. Esophagoscopy showed the presence of varices grade 2. The liver at laparoscopy had the same appearance as it had in 1976. Histological examination of a biopsy specimen showed occasional dilated sinusoids and locally marked periportal and intralobular fibrosis. No regeneration nodules were found. The diagnosis was liver fibrosis. The patient's condition deteriorated gradually in the following years. She experienced increasing fatigue. Steatorrhea developed, and the patient lost weight. She needed increasing doses of cholestyramine and oral supplementation of vitamins A, D, and K. She was admitted for a 3rd time in February 1985. Esophagoscopy revealed varices grade 4. A CT scan of the liver showed no change. The patient successfully underwent an orthotopic liver transplantation in January 1987. The diagnosis of peliosis hepatis was well documented in this patient.
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PMID:Generalized peliosis hepatis and cirrhosis after long-term use of oral contraceptives. 312 33

The authors have encountered benign liver masses as frequently as malignant lesions in children with hepatomegaly. Lesions studied included abscesses, cavernous hemangioma/hemangioendothelioma, adenoma of glycogen storage disease, choledochal cysts, focal nodular hyperplasia, cystic hepatoblastoma, and hamartoma. An integrated imaging protocol involving ultrasound, computed tomography, and scintigraphy proved to be more helpful than any one modality in establishing the benign or malignant nature of a hepatic neoplasm and the type of tumor, which is of particular importance when surgical exploration and/or biopsy is contraindicated.
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PMID:Integrated imaging of hepatic tumors in childhood. Part II: Benign lesions (congenital, reparative, and inflammatory). 388 Jun 15

Budd Chiari Syndrome, characterized by massive ascites, hepatomegaly, abdominal pain, and tenderness, nausea, and vomiting, is caused by obstruction of the hepatic venous outflow. Of the known causes of polycythemia rubra vera, hypernephroma, and other tumors invading the inferior vena cava have been most often reported, while pregnancy and oral contraceptives (OCs) have also been held as causes. In this paper the case is presented of a young woman, previously on OCs for 4 months, who developed the syndrome 2 weeks after delivery; she was also found to have multiple hepatic adenomas on laparotomy. The longterm use of OCs has been estimated to be associated with an annual incidence of liver cell adenoma of 3-4/100,000. Evidence suggests that the estrogen components, rather than the progesterone, of OCs seem more likely to cause liver cell adenoma since estrogens are carcinogenic in other organs and promote liver cell regeneration in rats. By interference with the metabolism of oncogenic bile salt derivatives, estrogen may exert its oncogenic effect. The patient is this case was told never to use OCs again since there is also evidence that the tumor may regress on stopping OCs, and she was advised against further pregnancies.
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PMID:Budd-Chiari syndrome and hepatic adenomas associated with oral contraceptives. A case report. 627 27

Primary tumors of the liver infrequently develop in patients with a normal liver or in those who have not been exposed to one of several tumor-producing compounds. Hepatocellular adenoma was one of the rarest liver tumors prior to the use of oral contraceptives (OCs). Now the annual incidence in longterm users is estimated at 3-4/100,000. An adenoma that follows OC use is one that often regresses with discontinuation. Focal nodular hyperplasia is a nonencapsulated solitary lesion that has a fibrotic stellate center in which large thick-walled arteries are the source of the blood supply, and occurs most often in women during the menstrual age, and there is no evidence that OCs have increased their frequency. Adenomatous hyperplasia occurs occasionally in patients with submassive necrosis and also in those with cirrhosis. Liver cysts present most often in middle aged women and the ratio of females to males is 4:1. In the US, metastatic carcinoma of the liver is some 18-20 times more frequent and about 85% of these arise in a cirrhotic or precirrhotic liver. Malignant mesenchymal tumors have been associated with exposure to vinyl chloride of injection of Thorotrast. Signs and symptoms of liver disease occur in about 50% of patients with hepatic metastases with hepatomegaly being the most common physical sign. Metastatic carcinoma most often produces multiple umbilicated nodules that involve the liver uniformly. Portal hypertension may be associated with a hepatic neoplasm.
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PMID:Tumors of the liver: pathologic features. 630 41

A case is described wherein a 29 year old woman was admitted to the hospital because of the possibility of a hepatic tumor; symptoms included abdominal pain, diffuse hepatic enlargement and absence of uptake in an area of the right hepatic lobe. After a normal pregnancy and delivery 11 years earlier the patient used oral contraceptives (OCs) composed of norethindrone with mestranol until 8 years before entry; 5 years before admission she resumed use of an OC containing norethindrone and ethinyl estradiol. She smoked 1.5 packages of cigarettes and drank 1 glass of wine daily, and there was no history of nausea, vomiting, melena, jaundice, dark urine, light stools, hepatitis, or blood transfusions. Benign lesions which are known to be caused by OCs fall into 2 groups: designated focal nodular hyperplasia and liver-cell adenoma. The evidence linking the latter with OCs is more convincing since in case-controlled studies the risk of development of adenomas has been shown to increase with the estrogen strength of the OCs and duration of use; in women who have been taking OCs over 7 years the relative risk is 500 times that for matched control nonusers. The vascular complications of OC therapy include Budd-Chiari syndrome, peliosis hepatis, and periportal sinusoidal dilatation. The patient in this case was diagnosed to have periportal and midzonal hepatic sinusoidal dilatation association with OC medication. She underwent an operation on her liver which proved to be successful combined with cessation of OC use. The mechanism by which OCs cause these lesions is not known. In 5 of 13 cases similar to the one described here clinical and biochemical abnormalities resolved and 1 patient had a follow-up liver biopsy that revealed normal findings 10 months after cessation of OC therapy; there is no evidence to suggest that sinusoidal dilatation is irreversible.
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PMID:Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 40-1982. Tender hepatomegaly in a 29-year-old woman. 711 Feb 74

Seventy-six cases of surgical hepatomegaly were subjected to fine needle aspiration cytology (FNAC) for initial diagnosis. Primary malignancies, as suspected clinically with adjunction of other investigative procedures, were 29 cases of whom 25 were confirmed by biopsy or therapy. Secondary deposits in liver were 27 of whom 15 were confirmed by therapy. Inflammatory lesions were 9 of whom 6 were confirmed by therapeutic response with specific therapy. Benign lesions were 10 of whom 5 were confirmed by surgery. Diagnosis of malignancies of liver is rather easier than that of benign lesions like hydatid cysts of liver which were Casoni's test negative; and hepatocellular adenoma, as the aspirate in the former is clear fluid and that of the latter is only normal looking liver cells. Thus, in respect of benign lesions of liver, FNAC diagnosis may be clinched after due consideration to the clinical findings, radiological and ultrasonographic findings and ultimately confirmed by exploration. Thus the fallacy lies in aspiration of normal looking liver cells whereby the histology may prove it to be hepatocellular adenoma, well differentiated hepatocellular carcinoma and secondary deposits where the exact site has not been hit. Ultrasonogram (USG) guidance helps in these cases where the same facility is available. This fallacy can again be avoided, where USG guidance is not available, by imparting due importance to clinical findings, USG findings and also by repeat smear.
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PMID:Fallacies of the fine needle aspiration cytology of surgical lesions of liver. 781 99


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