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There are few environmental studies using biomarkers for the species Atherinella brasiliensis in Brazil. In the present work, the presence of hepatic histopathological lesions and nuclear abnormalities in erythrocytes were investigated in A. brasiliensis from Lamberto, a beach under influence of domestic wastes and marine activities. For comparison, fish were also sampled in Puruba, a non-polluted beach, located in the northeastern of São Paulo State. The frequency of lesions found in liver was in higher numbers in individuals from Lamberto than Puruba beach. The most critical injuries observed in A. brasiliensis were the presence of necrotic areas, leucocytes infiltration and piknotic nucleus. A high occurrence of cells with vacuolization was also observed. The hepatic lesion index of the fish from Lamberto beach showed significant high values (Iorg=13) when compared with fish from Puruba beach (Iorg=7) suggesting the influence of the several human activities in the studied site. Notched and blebed nucleous were observed in this study, and significant differences were found between the studied sites. However, these differences did not reflect the total nuclear alterations.Existem poucos estudos no Brasil usando biomarcadores em Atherinella brasiliensis. No presente trabalho foram investigadas a presença de lesões histopatológicas hepáticas e as alterações nucleares em eritrócitos de A. brasiliensis amostrados na praia do Lamberto, local submetido à influência de resíduos domésticos e atividades humanas. Para comparação, indivíduos da espécie foram também amostrados na praia de Puruba, local não impactado, localizado no noroeste do estado de São Paulo. Peixes provenientes da praia do Lamberto apresentaram lesões hepáticas em número maior do que aqueles da praia de Puruba. Áreas necróticas, infiltração de leucócitos e núcleos picnóticos foram os danos de maior importância observados em A. brasiliensis, apesar de uma elevada ocorrência de vacuolização também ter sido verificada. O índice de lesão hepática dos peixes da praia do Lamberto mostrou valores significantemente maiores (Iorg=13) quando comparados com o dos peixes da praia de Puruba (Iorg=7), sugerindo influência das diversas atividades humanas existentes na área avaliada. Em relação aos núcleos "notched" e "blebed", foram observadas diferenças significativas entre as áreas, mas não para as alterações nucleares totais.

To investigate the added diagnostic value of diffusion-weighted imaging (DWI) of the liver and its impact on therapy decisions in patients with hepatic malignancy. Interdisciplinary gastrointestinal tumorboard cases concerning patients with hepatic malignancies discussed between 11/2015 and 06/2016 were included in this retrospective, single-center study. Two radiologists independently reviewed the respective liver MR-examination first without, then with DWI. The readers were blinded regarding number, position and size of hepatic malignancies. Cases in which DWI revealed additional findings concerning the hepatic tumor status as compared to conventional sequences alone were presented to experienced members of the interdisciplinary tumor board. In this retrospective setting changes in treatment decisions based on these additional findings in the DWI sequences were recorded. A total of 87 patients were included. DWI revealed additional findings in 12 patients (13,8%). These new findings had a direct effect on the therapy in 8 patients (9,2%): In 6 patients (6,9%) the surgical/interventional treatment was adapted (n = 5: extended resection, n = 1: with transarterial chemoembolization of a single hepatocellular carcinoma only detectable in DWI); 2 patients (2,3%) received systemic therapy (n = 1: neo-adjuvant, n = 1: palliative) based on the additional findings in DWI. In 4 patients (4.6%) additional DWI findings did not affect the therapeutic decision. DWI is a relevant diagnostic tool in oncologic imaging of the liver. By providing further information regarding tumor load in hepatic malignancies it can lead to a significant change in treatment.

Focal Nodular Hyperplasia (FNH) is a rare benign hepatic lesion believed to generate upon a hyperplastic response of the hepatocyte. Hepatocellular Adenoma (HA) occurs predominantly in young women receiving oral contraceptive medication. These two lesions have drawn significant attention throughout the recent years due to their specific clinical and pathological features as well as their challenging management. Although Focal Nodular Hyperplasia is managed conservatively in the majority of cases, it can albeit pose a difficult diagnostic dilemma. On the other hand, Hepatocellular Adenoma can be complicated with catastrophic hemorrhage or malignant transformation and therefore mandates surgical excision in many cases. The aim of this work is to review the current literature pertaining to these two clinical entities regarding their pathogenesis, diagnostic approach and genetics, as well as to shed light on specific differential diagnostic issues arising in many cases these lesions are encountered.

Tamoxifen is a useful agent in the management of metastatic breast cancer. We describe a patient who was treated sucessfully with Tamoxifen but developed a benign but symptomatic hepatic cyst during treatment. Development of a solitary hepatic lesion during Tamoxifen therapy should be thoroughly investigated before treatment is changed. Cancer 50:1882-1883, 1982.

A case is reported of a well differentiated hepatoma that occurred 4.5 years after the institution of diethylstilbestrol therapy for prostatic carcinoma. A review of the literature indicates that this apparently represents the third case of hepatic malignancy and the first instance that hepatoma has been reported in this setting. Oncologists treating breast or prostate cancer patients with diethylstilbestrol are urged to be alert to the possible emergence of hepatic, renal or endometrial cancer.

The etiology of idiopathic portal hypertension (IPH) is not known. To obtain clues to the pathogenesis, an attempt was made to produce a hepatic lesion similar to that in IPH by repeated injections of aggregated killed non-pathogenic E. coli directly into the portal vein. In the treated dogs, histology of the liver showed dense fibrosis in the portal tract and an aberrant vasculature around the portal area after 1 month. Portal pressure was elevated and middle-to-small-sized portal branches were decreased in number as studied by portography. These changes closely mimic those seen in human IPH. The possibility is discussed that chronic entrance of an antigen such as bacteria from the intestine to the portal venous system plays an etiologic role in IPH.

The accuracy of diagnosis of hepatic malignancy by percutaneous aspiration biopsy was compared using heparinized and nonheparinized 22-gauge needles. When a heparinized instrument was used, it was able to accurately diagnose malignancy and cytologic types of exfoliative cells. Heparinization also made it possible to recover small tissue fragments and make ultrathin sections for histologic examination. In this way, material suitable for cytologic and histologic examination was obtained from 100% and 95%, respectively, of 59 patients suspected of having hepatic malignancy. A correct diagnosis was made cytologically in 92.5% of patients with hepatic malignancy and in 89.5% of those from whom histologic material was obtained. From a combination of histologic and cytologic results, the overall diagnostic rate for hepatic malignancy was increased to 95%. This procedure proved to be a reliable method for diagnosis of hepatic malignancy.

The case of a 20-year-old Laotian student with cholangitis, Gram-negative speticemia, and a large common duct stone associated with heavy infection by Opisthorchis viverrini is presented. Opisthorchis infection has been previously related to chronic cholangitis and an increased risk of hepatic malignancy. The formation of biliary stones as a result of infection with this parasite also appears to be possible.

Frontiers in Gastrointestinal Cancer is the first in a series of books that will review in detail some of the latest information in the field of oncology. Levine and Riddell have edited the present volume and have done an outstanding job of choosing chapters, headings, and authors. The material presented represents both the results and many of the latest trials of therapy for gastrointestinal and hepatic malignancy and such topics as ideas of general pathogenesis, the role of food, nutrients in cancer, the effect and action of hepatitis virus type b in liver cell cancer, and the concepts of regional and infusion chemotherapy. There are chapters on experimental cancer models, including pancreatic cancer in the hamster and the effect of indomethacin in rats with intestinal tumors, immunotherapy, radiation therapy, and mechanisms of adenoma formation. In this era of cost consciousness, there is even an analysis of the cost-effectiveness of colorectal

To the Editor.— The detection of cytoplasmic microtubules in the glomerular endothelium of patients with systemic lupus erythematosus (SLE) aroused considerable interest recently. These structures are recognizable very frequently in the kidneys of patients with SLE, and although they are not specific or pathognomonic for this disease, their demonstration has some diagnostic value in suspected cases. 1-3 The exact nature of the cytoplasmic microtubules is not known. They were believed to represent myxovirus-like particles suggesting viral cause of the disease. 1 Other authors, however, assume that they are ultrastructural manifestations of endothelial cell injury, due either to viral infection or to some other deleterious mechanism. 2,4 We found cytoplasmic microtubules in the endothelial cells of the liver sinusoids of a 20-year-old woman patient. Her illness, based on the characteristic history, and clinical and laboratory findings, was diagnosed as SLE with hepatic involvement. Liver biopsy was performed with the Menghini needle.

The surgeon is frequently called on to perform operations on the extrahepatic bile passages without adequate knowledge of the extent of the hepatic lesion. Too often emphasis is placed on the disease of the gallbladder or common duct only, without estimating the associated hepatic damage. It has seemed to us that the extent of hepatic damage in all surgical lesions of the biliary apparatus should be determined, previous to operation, in the hope that some light might be thrown on the operative prognosis and the end-result. An accurate estimation of hepatic damage is complicated and complex because of the manifold functions of the liver. We have, therefore, confined ourselves in this study to an investigation of the pigment metabolism of the liver. We realize that this presents only one aspect of the subject, but we believe that if this function shows any alteration, in the absence of gross obstruction, it