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An 86-year-old man was brought in ambulance to our hospital because of sudden hematochezia and abdominal pain during defecation. Intestinal prolapse approximately 80mm from the anus and a type 1 tumor 50mm in size on the mucosal surface were detected. The intestinal prolapse was manually repositioned, and the reduction of the intussusception was confirmed by computed tomography (CT). Following colonoscopy and abdominal-enhanced CT, a sigmoid colon cancer without distant metastases was detected. Elective laparoscopic radical surgery was performed. The present study described a rare case of sigmoid colon cancer with an intussusception prolapsing through the anus and highlighted the treatment strategy by reviewing 48 previous cases. The treatment strategy employed was as follows:first, manual repositioning of the intestinal prolapse was attempted;and second, the presence of intussusception was confirmed by CT. In cases when repositioning of the intussusception was not possible, even with the use of an endoscope or contrast enema, emergency surgery was required.

Liver resection is a widely preferred treatment modality for hepatocellular carcinomas (HCCs). This study aimed to compare the survival impact of anatomical resection with that of limited resection, in patients with single HCCs no larger than 5 cm in diameter.A cohort study was carried out on 209 consecutive patients who underwent hepatic resection for a single HCC no larger than 5 cm in diameter between January 1994 and March 2007 at Osaka City General Hospital.The cumulative 5-year overall survival and disease-free survival rates in the anatomical resection group (n = 111) were 71 and 40%, respectively, both of which were significantly better than the 48 and 25% seen in the limited resection group (n = 98) (P = 0.0043 and P = 0.0232, respectively). Better effects of the anatomical resection on both overall and disease-free survival were seen in patients having HCC larger than 2 cm in diameter and in patients with moderately or poorly differentiated HCC. But no significant difference in either overall or disease-free survival was seen between the groups in patients with a HCC 2 cm or less in diameter or in the patients with well-differentiated HCC. Using Cox's regression model, anatomical resection was confirmed to be an independent favorable factor for both overall and disease-free survival.Anatomical resection is therefore recommended for histologically advanced single HCCs ranging from 2 to 5 cm in diameter.

症例は34歳，慢性B型肝炎患者．25歳時に左葉の径12 cmの巨大肝癌に対して，拡大左葉切除が施行されたが，1年後に再発し，翌年生体肝移植が施行された．移植後44カ月目にグラフト内に肝癌が再発し，経皮的治療が繰り返し施行されたが，制御不能となり，移植肝の後区域切除および前区域部分切除が施行された．術後に再発病変が出現し，経皮的治療および肝動脈内薬剤注入療法が繰り返し施行されたが，次第に制御困難となり，急速に腫瘍が増大し，生体肝移植後から94カ月，移植後の再発からは50カ月目に死亡した．これまで肝癌に対する生体肝移植後3年以上を経過しての再発や，グラフト再発に対する肝切除の報告はなく，大変貴重な症例と考えられた．

症例は49才女性．右背部痛にて当院受診し，腹部超音波，単純CTにて，多発する肝嚢胞を認め，そのうち肝前上区域（S8）の嚢胞内に充実性部分が見られたが，造影効果なく，出血を伴った肝嚢胞と診断され経過観察となった．4カ月後に変化を認めなかったが，10カ月後に嚢胞径ならびに充実性部分の増大と内部性状の変化がみられた．各種造影検査で充実性部分に造影効果を認めたため，肝嚢胞腺癌を疑い肝前区域切除を施行した．組織学的に充実性部分は内部出血を伴った凝血塊と壊死組織で，血管腫様の不規則に拡張した血管腔の増生を伴っていた．

肝癌切除後の孤立性リンパ節転移を摘除することで, 術後2年6か月の現在, 無再発生存中の症例を経験したので報告する. 症例は58歳の男性で, C型慢性肝炎に伴う肝癌に対して肝切除術を2回施行されていた. 経過観察中のCT像上, 肝尾状葉に約4cm大の腫瘤性病変を認め, AFP, PIVKA-II値の著明な上昇がみられた. 腹部血管造影像では腫瘤は中肝動脈および左胃動脈より栄養される腫瘍濃染像として描出され, 肝癌の尾状葉再発と診断し開腹した. 腫瘍は肝尾状葉に接するように総肝動脈の腹側に存在していたが, 肝臓からは独立しており肝癌の総肝動脈幹リンパ節転移と考え摘除した. 病理組織学的検査では中分化型肝癌のリンパ節転移と診断された. AFP, PIVKA-IIは術後2か月目に標準値範囲内へ低下し, 以来, 再発徴候を認めていない. 原発巣がコントロールされた肝癌の孤立性リンパ節転移は摘除により良好な予後が得られる可能性が示唆された.

症例1：66歳の男性，平成7年9月人間ドックで肝腫瘍を指摘された．精査の結果，C型肝炎およびS2, S6の肝細胞癌，下大静脈腫瘍栓と診断し，平成8年2月手術を施行した．手術所見では，肝腫瘍とは別に肝上部下大静脈壁に孤立性の腫瘍を認め，病理検査の結果，血行性転移によると思われる下大静脈転移と診断した．症例2：73歳の男性，B型肝炎の経過観察中，S4/8に肝細胞癌を認め，平成8年4月手術を施行した．その後肺転移に対して平成10年1月手術を施行した．平成15年10月には右肋骨転移を認め，放射線治療を施行したが奏効せず，残肝再発はみられないが，多発性肺転移と右心房内に腫瘍が認められた．その後肝不全のため死亡され，病理解剖で右心房内の腫瘍は，腫瘍栓の着床，浸潤によると思われる下大静脈転移と診断された．

A spontaneous regression of hepatocellular carcinoma is an extremely rare phenomenon. A 69-year-old Japanese man with hepatitis C virus-related chronic hepatitis presented with a liver tumor. We diagnosed the tumor to be hepatocellular carcinoma in the course of spontaneous regression, by imaging studies and changes in the tumor markers. Because the possible presence of viable cancer cells could not be ruled out, we recommended surgery. He refused all treatments at first, but finally agreed to undergo surgery about 10 months after presentation. A hepatectomy was performed. Histologically, no viable tumor cells were found. In our case, the vascularity of the tumor according to the imaging findings was followed up during the clinical course. The patient is now doing well and without any evidence of recurrence at 37 months after surgery.

膵頭十二指腸切除後の膵腸吻合部縫合不全は,現在もなお発生頻度の高い合併症である.多くは保存的治療にて治癒するが,腸管との交通が消失した完全外膵液瘻は,難治性である.今回われわれは,膵頭十二指腸切除後の難治性膵液瘻に対して,超音波誘導下内瘻術を行い,治癒しえた2例を経験したので報告する.症例は,胆管癌にて膵頭十二指腸切除術を施行した78歳女性と62歳男性.再建はChild変法で,膵空腸吻合は,膵管挿入法にて行った. 2例とも膵管チューブ抜去後より,膵空腸吻合部ドレーンから膵液の漏出がみられ,瘻孔造影にて,完全外膵液瘻と診断した.保存的治療にて軽快せず,超音波誘導下にドレーン瘻孔より挙上腸管を穿刺し,腸管内にチューブを留置,内瘻術を行った.約3カ月後にチューブを抜去,膵液瘻は閉鎖した.膵頭十二指腸切除後の難治性膵液瘻に対して,超音波誘導下内瘻術は,低侵襲であり,有用な治療手段であると考えられた.

肝細胞癌(hepatocellular carcinoma;以下HCCと略記)に対してTAEを施行後, bilomaを形成し,その後bilomaを含めて肝切除した2症例を報告する.症例1は67歳,男性.アルコール性慢性肝疾患を背景としたHCCに対してTAEを施行後, bilomaの診断をうけた.その後,当院での精査にて肝S8にHCCの再発が疑われた.症例2は65歳,女性. C型肝炎を背景としたHCCに対し, TAE施行約1.5カ月後に,多発するbilomaを認めた.その後,腫瘍マーカーが再上昇し,再発が疑われたが, HCCとbilomaの鑑別は画像上困難であった.Bilomaが保存的治療で軽快しない場合や,自験例の様にbilomaの遺残によりその後の癌治療に制約が大きい場合は,癌病巣も含めた外科的切除も考慮されるべきと考えた.

Although curative surgical resection provides the best chance of long-term survival for patients with intrahepatic cholangiocarcinoma, the presence of bile duct invasion decreases postoperative survival rates in patients with mass-forming intrahepatic cholangiocarcinoma. We carried out this study to determine a surgical strategy for patients with bile duct invasion of these tumors. Forty-one patients with mass-forming intrahepatic cholangiocarcinoma were classified as either having bile duct invasion (n= 26) or not having bile duct invasion (n= 15). Clinicopathologic findings, including postoperative outcomes, were compared between these two groups. Perineural invasion, lymphatic invasion, and a positive resection margin were more frequent in patients with ductal invasion. Patients with ductal invasion had lower survival rates than those without ductal invasion. Intraoperative frozen section examination of the bile duct stump to confirm a clear resection margin is required in patients with mass-forming tumors. Resection of the extrahepatic bile duct should be considered when tumor cells are identified at the surgical margin of the resected bile duct.

The effects of H atoms on the hydrogenated amorphous silicon and poly-Si film-growth in catalytic CVD processes were examined. The following results were obtained: (1) The H atom concentration in the gas phase can be as high as 1014 cm−3. This density is more than one order of magnitude higher than those in conventional plasma-enhanced CVD processes. (2) When SiH4 is introduced, the H atom density decreases sharply. This decrease is mainly caused by the loss processes on chamber walls, but gas phase reactions with SiH4 to produce SiH3 are also important. SiH3 thus produced should be one of the dominant deposition precursors for Si film-growth. (3) Atomic H etches not only amorphous but also crystalline Si, including single-crystalline one. (4) The main etching product is SiH4, but Si2H6 is also produced. Si2H6 derived from previously deposited Si compounds deteriorates the film properties. However, this deterioration can be avoided by regular chamber cleaning using H atoms.

We investigated the rates of the treatments and their prognoses in 450 patients with hepatocellular carcinoma (HCC), in order to determine the usefulness of percutaneous microwave coagulation therapy (PMCT) given the present situation of treatment for HCC. Rates of initial treatments were hepatectomy in 31%, percutaneous ethanol injection therapy (PEIT) in 19%, transarterial embolization (TAE) and PEIT in 16%, TAE in 14%, hepatic arterial chemotherapy (HAC) in 7%, PMCT in 7% and others in 6% of cases. The prognosis of PMCT in patients with a single tumor 3 cm in size or less was comparable to that with hepatectomy. Recurrence was found in about 59% of 387 patients who underwent radical treatment initially, and about 96% of these were intrahepatic recurrences. Rates of treatment for intrahepatic recurrence were TAE in 59%, PEIT in 33%, HAC in 31%, PMCT in 24% and hepatectomy in 4% of cases. Indications for use of PMCT were more restricted than for PEIT for reasons of safety. Therefore, the rate of use of PMCT as initial treatment was lower than that of PEIT. On the other hand, the rate of use of PMCT in treatment of recurrence was similar to that of PEIT. PMCT should be used not only as initial treatment but also in the treatment of recurrence, in which HCC is often found at a size 3 cm or less, considering the high incidence of intrahepatic recurrence of HCC as well as reliability of the therapeutic effect and low invasiveness attached to PMCT.

Radical species produced in catalytic chemical vapor deposition (CVD), often called hot-wire CVD, processes were identified by using a laser induced fluorescence technique. Ground state Si atoms could be detected at low pressures where collisional processes in the gas phase could be ignored. The electronic temperature of Si atoms just after the formation on the catalyzer (tungsten) surfaces was 1320±490 K, when the catalyzer temperature was 2300 K. By the addition of 0.5 Pa of Ar, the electronic temperature was lowered down to 450±30 K. The absolute density of Si atoms was 3±1×10^9 cm^ at 10 cm below the catalyzer when the flow rate and the pressure of SiH_4 were 0.5 sccm and 4 mPa, respectively. This density is just 0.3% of that of the parent SiH_4 molecules. However, since the decay rate of Si atoms is fast, it can be concluded that atomic silicon is one of the major products on the heated catalyzer surfaces. SiH radicals could also be detected, but the production rate of this species is two orders of magnitude less than that of Si atoms. It was also discovered that volatile SiH_4 molecules are produced by the atomic hydrogen attack on the amorphous silicon deposited on the chamber walls.

We have performed percutaneous microwave coagulation therapy (PMCT) for hepatocellular carcinoma (HCC) of the size below 3 cm since 1994. In the present study, we examined the complication of 117 patients with HCC (including recurrent cases) having undergone PMCT. There was no severe complication with PMCT requiring a treatment except one patient with hemothorax (0.9%). Clinical results of the patients with single occurrence of HCC below 3 cm in size were examined by comparing the cumulative survival rate and cumulative nonrecurrent survival rate among the group of 16 patients having undergone PMCT as initial treatment, that of 38 patients given hepatectomy and that of 34 patients treated percutaneous ethanol injection therapy (PEIT) in the same period using Kaplan-Meier method. The 5-year cumulative survival rate was 93% in the group given PMCT, 72% in that given hepatectomy and 68% in that given PEIT, respectively. Similarly, the 4-year cumulative nonrecurrent survival rate was 29% in the group given PMCT, 38% in that given hepatectomy and 15% in that given PEIT, respectively. In conclusion, PMCT was a safe and less-invasive therapy similarly to PEIT. A therapeutic effect comparable to hepatectomy could be expected for PMCT in the patients with HCC below 3 cm in size.

今回われわれは, 胸部食道癌に対する高位胸腔内胃管吻合術後に, 右気管支動脈と奇静脈弓により胃管の絞扼壊死をきたした症例を経験したので報告した, 症例は59歳の男性, IuImの1pl+0-IIb型の高分化型扁平上皮癌に対して, 低容量しすぷらちんと5FUによる術前化学療法を2週間行った後, 胸部食道全摘・3領域りんぱ節郭清・全胃管高位胸腔内吻合術を施行した, 第4病日にショックとなりドレーンより消化液の流出を認めたため, 縫合不全による縦隔炎と診断した, 再開胸すると, 右気管支動脈と再縫合した奇静脈弓に挟まれた挙上胃管がその口側で壊死穿孔していたため, 壊死部胃管切除・頸部食道外瘻術を施行した, 術後はMOFに陥ったが集中治療にて回復し, 4か月後に左結腸による消化管再建術を施行し軽快退院した, 高位胸腔内での胃管再建は, 安全性が高く近年注目されているが, 右気管支動脈と奇静脈弓による絞扼壊死の報告は今回が初めてである, 右気管支動脈をその分枝近くの大動脈弓付近まで剥離する, あるいは奇静脈弓の再縫合をしない, またはゆるくするなどの工夫が必要と思われた.

Erythrocyte deformability is an important factor in the microcirculation. The deformability in patients with chronic liver disease is less than normal. We studied changes in erythrocyte deformability in 32 patients undergoing liver resection for hepatocellular carcinoma with underlying chronic liver disease to investigate whether the measurement of deformability gives information useful for postoperative management. We measured erythrocyte deformability as erythrocyte transit time (ETT) before and after resection, as well as the erythrocyte adenosine triphosphate level, mean corpuscular volume, mean corpuscular hemoglobin concentration, and indices of liver function. The 15-minute indocyanine green retention rate (ICGR15) was measured before resection. Correlations between the change in deformability and these values were evaluated, as was correlation with the scale of the operation and with the occurrence of postoperative complications. Mean ETT was higher in the patients before resection than in healthy volunteers. ETT was correlated with serum high density lipoprotein-cholesterol (p0.05). The incidence of postoperative complications was higher (p = 0.001) in the patients (group A) with ETT increased during the first 3 postoperative days by/=1 SD of the mean of the preoperative value than in patients (group B) with less change. Of the 12 patients whose ICGR15 value was/=20%, all 9 patients in group A had postoperative complications. The increase in ETT (decrease in erythrocyte deformability) is associated with the development of postoperative complications. The measurement of erythrocyte deformability gives information useful for postoperative management, and special monitoring for postoperative complications is necessary in patients with the increase soon after liver resection.

肝細胞癌切除後, 肝尾状葉下大静脈部に再発した2例に尾状葉単独全切除を行い, 2年以上の無再発生存を得ている.手術は上腹部逆T字型切開による開腹のみのapproachで行い, 尾状葉下大静脈部右縁の同定は肝門approachによるグリソン一括処理法でグリソン後区域枝をclampして生じるdemarcation lineから同定した.短肝静脈を切離し肝を下大静脈から完全に剥離した後, 尾状葉右縁から肝切離を開始した.頭側は右肝静脈背側面, 中肝静脈背側面に沿って切離し, 尾側は肝門板から分枝する尾状葉グリソン枝をグリソン騰部背側端まで逐一切離し, 最後にArantius管を根部で切離した.いったん, 左側に術野を転じArantius管を中肝静脈流入部で切離した後, 中肝静脈背側縁に沿って肝切離を進め, 最後に両肝切離面を連続させて尾状葉単独全切除を完了した.最も切除困難といわれる尾状葉下大静脈部に再発した肝細胞癌といえども早期に発見すれば尾状葉単独全切除によって根治的切除も可能である.

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. In severe cases, inflammation extends to adjacent structures, and XGC is sometimes confused with a malignant neoplasm. We recently diagnosed XGC as the preoperative cause of Mirizzi syndrome in a patient based on the clinical course. The patient was admitted because of obstructive jaundice, with gallbladder carcinoma as the suspected cause. The gallbladder was swollen with gallstones and the serum level of carbohydrate antigen 19-9 (CA19-9) was 3070 U/ml at admission. A percutaneous transhepatic cholangiodrainage (PTCD) was done, and the common hepatic duct as well as the right and left hepatic ducts were found to be obstructed. Later, the CA19-9 level and swelling of the gallbladder decreased and the obstruction of the bile ducts disappeared. A cholecystectomy was performed and the intraoperative pathohistological diagnosis of chronic cholecystitis was made from frozen sections. The pathohistological diagnosis of XGC was made from paraffin-embedded sections. Mirizzi syndrome such as that seen in our patient is a rare complication of XGC. XGC occasionally causes extensive inflammation; thus, performing a conventional cholecystectomy can be unsafe. However, in our opinion, a total, not subtotal, cholecystectomy should be done whenever possible because the incidence of gallbladder carcinoma accompanied with XGC is higher than that with ordinary cholecystitis or gallstones.

The prognosis for patients with unresectable intrahepatic cholangiocarcinoma(ICC) is extremely poor. Case 1 was a 65- year-old woman who had an ICC of 9 cm in diameter (mass-forming type) in the right lobe with portal trunk invasion. She was treated with hepatic arterial infusion chemotherapy[cisplatin(CDDP)/5-fluorouracil(5-FU)/l-leucovorin(l-LV)] and radiation therapy (total dose, 50 Gy). After 6 months, abdominal computed tomography (CT) revealed that the tumor had regressed. She survived for 7 years without recurrence of the ICC; subsequently, she died of peritoneal cancer. Case 2 was a 59-year-old woman who had an ICC of 8 cm in diameter (mass-forming type) in the left lobe with lymph node metastasis in the hepatoduodenal ligament; the right hepatic artery was involved by the metastatic lymph nodes. She was treated with hepatic arterial infusion chemotherapy(CDDP/5-FU/l-LV) and radiation therapy(total dose, 30 Gy). After 10 months, abdominal CT revealed that the tumor had disappeared, but paraaortic and mediastinal lymph node metastases were detected. She was therefore treated with systemic chemotherapy. Treatment with systematic chemotherapy enabled her to survive for over 5 years with a good performance status.

早期の微小肝細胞癌(肝癌)ならびにその境界病変における門脈血流の関与を検討するため,肝切除の術中あるいは術後に担癌門脈枝より色素を注入し,術後の病理標本上での結節内色素の有無を観察し,被膜形成ならびに分化度との関係を検索した.対象とした14例17結節を病理組織学的に検討したところ被膜形成のない高分化型肝癌は6結節(腫瘍径:10±7mm)であり,全例結節内に門脈域がみられたが,結節内に色素がみられたものは2結節に過ぎなかった.他の11結節のうち中分化型肝癌(29±26mm)は7結節で,被膜を有さない1結節にのみ色素がみられた.なお残りの4結節(34±10mm)は術前治療のため完全壊死に陥っていた.結節内色素の有無は各結節の組織学的分化度より被膜の有無とよりよく相関しており,肝癌の発育過程で被膜が形成されるに伴い腫瘍内門脈血流が低下することが示唆された.

大腸癌と肝細胞癌 (肝癌) の同時性および異時性重複癌 (本症) おのおの1例を経験した.症例1は体重減少を主訴とする67歳, 女性.Carcinoembryonic antigenとα-fetoprotein値の上昇, 超音波検査, computed tomography, 血管造影により肝癌が, 注腸と大腸内視鏡により上行結腸癌が認められ, 同時性重複癌と診断された.肝硬変症併存のため右半結腸切除と肝外側区域切除が1期的に行われたが, 術1年8か月後に肝癌再発のため死亡した.症例2はS状結腸癌切除後の54歳, 男性.超音波検査により肝腫瘍が発見され, 血管造影, 吸引細胞診により肝癌と診断, 右2区域切除が行われた. 本症の発見には腫瘍マーカーの測定や超音波検査が, その診断には生検や細胞診と血管造影が有用である.本症の予後は肝癌の進行度や併存する肝疾患の重症度に規定されることから, それらを中心に手術適応と術式を決めれば1期的切除でも安全に施行できると考えられた.

A 45-year-old woman complained of a painless breast mass, sized 2.5cm in diameter. It was diagnosed as fibroadenoma of intracanalicular type or benign phyllodes tumor. About one month later, breast mass appeared again, which could not be disappeared by aspiration, and was diagnosed as late onset hematoma. Its wall was coagulated under general anesthesia. Microscopic findings of the hematoma wall showed fibrosarcoma partially including the proliferation of cartilage, and it was proved that the hematoma was malignant phyllodes tumor. She died elevent months later after mastectomy. Inappropriate high levels of serum ALP and RI accumulation (99mTcMDP) in the breast mass were present. This case suggests that ALP (isozyme 3) may be an useful marker of malignant phyllodes tumor with proliferation of cartilage.

To control the CD precisely, inorganic "Hard-Mask" which we expect one of the candidates for 45nm-node and beyond technology was evaluated. Hard-Mask which is inserted between resist and Cr layer of a photomask blank enable us to use high anisotropic etch condition. Also it enhances the resist resolution because it can avoid the interaction between resist and Cr. This time, we confirmed the benefit of Hard-Mask which could reduce the etch bias and proximity process error. Especially proximity process error was reduced down to 1/4. And resolution enhancement effect was observed. We also confirmed the blank quality such as defects, film stress, sheet resistance, optical properties and so on, and found that Hard-Mask blank would not be a showstopper for this development.

We examineded the clinical effects of serum hepatitis B e antigen (HBeAg) positivity on clinicopathologic findings and prognosis after liver resection for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. A series of 56 patients who underwent curative resection were divided into two groups: 25 HBeAg-positive patients (group 1) and 31 HBeAg-negative patients (group 2). The mean age was significantly lower in group 1 than in group 2 (p = 0.0021), and the proportion of patients with symptoms was significantly higher in group 1 than in group 2 (p = 0.037). There were no significant differences in other clinical findings between the two groups, including laboratory test results, coexisting medical conditions, and operative methods. Although tumor size, degree of differentiation of the main tumor, and the prevalence of vascular invasion did not differ between the groups, the prevalence of intrahepatic metastasis and the proportion of patients with active hepatitis were significantly higher in group 1 than in group 2 (p = 0.009 and p = 0.043, respectively). Tumor-free and cumulative survival rates were significantly lower in group 1 than in group 2 (p = 0.022 and p = 0.0001, respectively). Multivariate analysis of various possible risk factors demonstrated serum HBeAg positivity to be an independent risk factor for recurrence [risk ratio (RR) 2.49; 95% confidence interval (CI) 1.12-5.49; p = 0.032] and an independent unfavorable factor for the survival time (RR 7.58; 95% CI 2.10-27.8; p = 0.0020). We concluded that the prognosis after liver resection for HCC is worse for HBeAg-positive patients than for HBeAg-negative patients.

A case of erythrocytosis caused by a hepatocellular carcinoma (HCC) that produced erythropoietin (Epo) is described. A 64-year-old man, with a huge HCC tumor in the right lobe of the liver, showed a high concentration of hemoglobin and increased levels of serum Epo, alpha-fetoprotein (AFP), and protein induced by vitamin K absence II (PIVKA-II). Right lobectomy of the liver was performed. Histological findings of the specimen showed a moderately differentiated HCC. The existence of Epo was confirmed immunohistochemically only in the tumor tissue and not in the normal liver tissue. Erythrocytosis disappeared and the serum levels of Epo, AFP, and PIVKA-II returned to the normal range after the operation. Within 2 months after the operation, recurrent tumors appeared in the remnant liver, and the patient died 13 months after the operation.

We describe herein the case of a hepatic abscess that developed secondary to fish bone penetration which was successfully treated without laparotomy. A 61-year-old man was admitted to our hospital with a high fever that had persisted for 2 weeks in spite of medication. Abdominal ultrasonography (AUS) and computed tomography (CT) of the abdomen revealed a hepatic abscess with a linear calcified foreign body and gas. Percutaneous abscess drainage was performed under ultrasonographic guidance. After drainage, the patient became afebrile, and AUS and CT findings demonstrated that the abscess cavity had decreased in size, but still contained the foreign body. Under ultrasonographic guidance and fluoroscopy, we inserted endoscopic forceps into the sinus tract and succeeded in removing the foreign body from the liver. It was found to be a fish bone that was 2.8 cm long and 0.3 cm wide.

of hepatic tumors was minimal over 7 years (see Fig. 1), very unlikely as metastatic tumors. Additionally, we failed to find any possible primary site for somatostatinoma, even though extensive searches for the primary sites were performed using upper and lower GI endoscopy, CT scan of the head, neck, and trunk, and 67Ga scintigraphy of the whole body. Therefore, it is reasonable to assume that the tumor originated from the liver. Hepatic tumors observed in patients with VRD, although very rare, include plexiform neurofibromas, angiosarcoma, and malignant schwannoma.2 Primary hepatic somatostatinoma, with or even without VRD, is very rare and has been reported only by Ohwada et al.3 It is known that somatostatin-containing cells are present in the intrahepatic biliary tree.4 Thus, intrahepatic tumors have arisen from these endocrine cells, possible affected by a genetic disorder present in patients with VRD.