BACKGROUND: Preoperative diagnosis of local vascular invasion is very important to the selection of therapeutic protocols and prediction of the prognosis of pancreatic and periampullary cancers. This meta-analysis was designed to evaluate the accuracy of computed tomography (CT) in diagnosing vascular invasion in patients with pancreatic and periampullary cancers.
DATA SOURCES: English-language articles reporting diagnostic accuracy of CT for vascular invasion in pancreatic and periampullary cancers were searched from the MEDLINE and PubMed databases. A meta-analysis was conducted to estimate pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios.
RESULTS: Data were extracted from 18 studies that met the inclusion criteria. The pooled sensitivity and specificity of CT in diagnosing vascular invasion were 77% and 81%. Since CT technology improved in different periods, in the recent five years (2004-2008) CT has shown a higher diagnostic accuracy, and the pooled sensitivity and specificity increased to 85% and 82%, respectively. Subgroup analysis of CT studies was made to determine the involvement of different vessels, and the pooled sensitivities for the invasion of the venous system, portal vein, and arterial system were 75%, 75%, and 68%, and the pooled specificities were 84%, 91%, and 92%, respectively. For CT imaging with vascular reconstruction, the pooled sensitivity and specificity were 84% and 85%, higher than the estimates in studies without reconstruction.
CONCLUSIONS: Developed CT technology with vascular reconstruction is used as an imaging modality for diagnosing vascular invasion at present. Further combined application of various imaging modalities may improve the accuracy of diagnosis, especially for smaller vessel involvement, such as the superior mesenteric vein or artery, which are difficult to demarcate.

BACKGROUND: Diabetes mellitus (DM) is thought to be associated with an increased risk of hepatocellular carcinoma (HCC) in some published studies. However, can we draw the conclusion that DM is a "true" independent risk factor for HCC based on these references?
DATA SOURCES: MEDLINE and PubMed searches were conducted for published studies (between January 1966 and June 2009) to identify relevant articles using the keywords "diabetes", "insulin resistance" and "hepatocellular carcinoma", including "primary liver cancer". Because of the very limited number of relevant articles most were reviewed.
RESULTS: This systematic review was conducted from 4 aspects: (1) the significant synergy between DM, hepatitis virus infection, and heavy alcohol consumption in HCC; (2) the role of DM independently in HCC cases while other identified risk factors were controlled or excluded; (3) obesity, DM, and nonalcoholic fatty liver disease in HCC patients; and (4) the impact of DM for the prognosis or surgical treatment in HCC patients with DM. No consensus has been reached among these studies and it is too early to draw the conclusion that DM is a "true" independent risk factor for HCC.
CONCLUSIONS: DM can be regarded as a risk factor for HCC. However, whether DM itself directly predisposes to HCC or whether it is a "true" independent risk factor remains unclear. Related issues should be clarified by more research.

BACKGROUND: In liver transplantation, acute cellular rejection (ACR) is still a major complication that can lead to mortality. Bile secretion has been considered as a marker of early graft function.
METHODS: The study included 41 adults who received living donor liver transplantation (LDLT) at Kyoto University Hospital between April 2007 and February 2008. The patients were stratified according to the presence or absence of ACR. Bile samples were collected from donors once and from recipients every other day for the first 2 weeks after transplantation. Total bile acid (BA) and taurine-conjugated bile acid (TCBA) in bile were measured by magnetic resonance spectroscopy. The recipient/donor (R/D) BA ratio and R/D TCBA ratio were calculated.
RESULTS: The ACR group (n=12) showed a greater decrease in BA post-transplantation than the non-ACR group, but this difference was not statistically significant. On both day 7 and day 9 post-transplantation the R/D TCBA was significantly different between the two groups (P=0.038 on day 7 and P=0.036 on day 9). The R/D TCBA ratio ≥0.5 on days 7 and 9, and ≥0.38 on day 11 post-transplantation were associated with better ACR-free survival.
CONCLUSION: The recipient/donor TCBA ratio can be a predictor for ACR after LDLT as early as post-transplantation day 7.

BACKGROUND: Fulminant hepatic failure manifests a rapid onset, serious complications, and a high mortality, but still there is a possibility of recovery. Once the patient is able to pass a crisis, the liver is able to regenerate completely and regain its normal function. Therefore it is of vital importance to determine the eligible timing for transplantation. Premature surgery might result in a loss of the chance of internal medical treatment and misuse of liver resources, whereas delayed surgery might increase the difficulty of treatment in the preoperative period and the possibility of complications and medical expense, which eventually result in decreased rate of success and survival. This problem remains worldwide how to choose the optional timing of operation.
METHODS: Thirty-six patients with severe hepatitis were treated by orthotopic liver transplantation. The distribution of MELD scores in these patients was: 10-19 in 8 patients, 20-29 in 10, 30-39 in 11, and 40 in 7. They were divided into two groups: MELD score <30 and MELD score ≥30. Parameters (1-year survival rate, complications, preoperative use of artificial liver, operative time, volume of bleeding and blood transfusion, and average hospital costs) were examined as prognostic factors after liver transplantation.
RESULTS: The 1-year survival rate of the MELD score <30 group was higher than that of the ≥30 group (77.8% and 33.3%, P=0.007), and the rate of complications in the <30 group was lower (P=0.012). There were no differences in the timing of artificial liver treatment, operative time, operative hemorrhage, and transfusion between the two groups (P=0.742). But the average daily hospital cost in the MELD score ≥30 group was higher (P=0.008).
CONCLUSION: This study shows that when the MELD score is <30 it may be the optimal time to perform liver transplantation for patients with severe hepatitis.

BACKGROUND: China has the largest potential market for organ transplants in the world, but it has not yet established brain death and organ transplant laws. We aimed to investigate the attitudes and suggestions of doctors, pharmacists, and civil servants concerning brain death, organ transplantation, and their respective legislation.
METHODS: A questionnaire with 10 sections and 44 questions was designed and distributed. The effective questionnaire data were then recorded and checked for descriptive analysis.
RESULTS: In 1400 questionnaires distributed, 1063 were responded and 969 of them were valid and analyzed. The respondents showed an incomplete understanding of brain death and organ transplantation laws. Seventy-four percent of the respondents recognized and accepted the standard of brain death. They agreed that legislation should be involved in the removal of organs for transplantation, the future use of organs, and insurance and compensation for the donor for possible health risks induced by organ removal. Of the 969 respondents, 92% considered it necessary to have legislation in brain death and organ transplantation, and 61% thought that it is time to legislate.
CONCLUSIONS: Legislation for brain death and organ transplantation is urgent and timely in China. The laws must include the respective rights and obligations of patients, close relatives, and medical institutions. Educating the public about brain death and organ transplantation should also be encouraged in a variety of ways.

BACKGROUND: Many diseases can cause obstructive jaundice and then lead to a series of pathologic disorders. Thus preoperative assessment of liver function is of utmost importance. Traditional assessment is to monitor related indicators of liver function, but it is invasive and needs to be performed repeatedly. Color Doppler flow imaging (CDFI) was used to monitor blood flow of the hepatic artery and portal vein, a non-invasive method which can be used repeatedly.
METHODS: Twenty cases of obstructive jaundice were detected by CDFI and changes of liver function were measured after operation. The variables of hemodynamic monitoring included peak flow rate and mean blood flow in the hepatic artery proper at the peak of the contraction period; the inner diameter of blood vessels, the peak flow rate, and the congestion index, the blood flow in the main portal vein.
RESULTS: The average peak flow rate in the hepatic artery of patients with obstructive jaundice was significantly higher than that of normal people; both the inner diameter and congestive index of the portal vein were significantly larger than those of normal people. But the mean blood flow and peak flow rate in the portal vein were lower than those of normal people.
CONCLUSIONS: CDFI is an ideal and non-invasive method for evaluating liver hemodynamics in obstructive jaundice. If the increase of hepatic arterial flow is more significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation is smoother, suggesting a better prognosis. If the increase of the hepatic arterial flow is less significant than the decrease of the blood flow in the portal vein, hepatic functional recovery after operation may not be smooth, suggesting a worse prognosis.

BACKGROUND: In the field of gene therapy, viral vectors as delivery tools have a number of disadvantages for medical application. This study aimed to explore a novel nonviral vector as a vehicle for gene therapy.
METHODS: Transvector-rpE-MPP and EGFP (enhanced green fluorescent protein) were used as the gene transfer carrier and the reporter gene, respectively. Polyplexes which integrate transvector-rpE-MPP, the object gene, and EGFP were formed. The optimal charge ratio, stability, and transduction capacity of the polyplexes in mouse hepatocytes in vitro and in mouse liver in vivo were investigated. The polyplexes of transvector-rpE-MPP and pcDNA3-EGFP, with charge ratios of 0, 0.25, 0.5, 0.75, 1 and 1.5 were compared to determine the optimal charge ratio.
RESULTS: Polyplexes with charge ratios of 1:1 were most stable; pcDNA3-EGFP in these complexes resisted digestion by DNaseI and blood plasma. On the other hand, pcDNA3-EGFP alone was digested. Fluorescence analysis indicated that transvector-rpE-MPP successfully delivered the reporter gene EGFP into hepatocytes and that EGFP expression was detected in hepatocyte cultures and in liver tissue.
CONCLUSION: These results have laid a foundation for further study of a novel nonviral gene delivery system.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. We analyzed the expression of nuclear-transcription factor-kappa B (NF-κB) during hepatocarcinogenesis in order to evaluate its dynamic expression and its clinical value in the development and diagnosis of HCC.
METHODS: Hepatoma models were induced by oral administration of 2-acetamidoflurene (2-FAA) to male Sprague-Dawley rats. Morphological changes were observed after hematoxylin and eosin staining. The cellular distribution of NF-κB expression during different stages of cancer development was investigated by immunohistochemistry, and the level of NF-κB expression in liver tissues was quantitatively analyzed by ELISA. The gene fragments of hepatic NF-κB were amplified by nested-polymerase chain reaction assay.
RESULTS: Hepatocytes showed vacuole-like degeneration during the early stages, then had a hyperplastic nodal appearance during the middle stages, and finally progressed to tubercles of cancerous nests with high differentiation. The NF-κB-positive material was buff-colored, fine particles localized in the nucleus, and the incidence of NF-κB-positive cells was 81.8% in degeneration, 83.3% in precancerous lesions, and 100% in cancerous tissues. All of these values were higher than those in controls (P<0.01). Hepatic NF-κB expression and hepatic NF-κB-mRNA were also higher during the course of HCC development (P<0.01).
CONCLUSION: The NF-κB signal transduction pathway is activated during the early stages of HCC development, and its abnormal expression may be associated with the occurrence of HCC.

BACKGROUND: It has been pointed out that only low-dose arsenic trioxide (ATO) presents therapeutic benefits outweighing the toxic side effects. Low-dose ATO can effectively alleviate acute promyelocytic leukemia (APL). However, it is quite challenging in treating solid tumors. The purpose of this study was to investigate the effect of ATO at low concentrations on the metastatic potential of mouse hepatoma H22 cells and the anti-metastatic mechanism of ATO.
METHODS: The metastatic potential of H22 cells was evaluated by adhesion, migration and invasion assays after exposure to a low dose of ATO in vitro. The mouse lung metastatic model induced by injection of H22 cells via the tail vein was adopted for the evaluation of metastatic potential. Different proteins in the lysate of H22 cells exposed to ATO at different concentrations were investigated by surface-enhanced laser desorption and ionization time-of-flight mass spectrometry (SELDI-TOF-MS). Finally, Western blotting analyses were made to detect the expression pattern of MMP-2 and nm23-M1 proteins.
RESULTS: Significant cell death started at ATO concentrations above 2 µmol/L. The growth and adhesion potential of H22 cells was inhibited in a time- and dose-dependent manner, and the migration and invasion potential of H22 cells was inhibited in a dose-dependent manner while ATO concentration was below 2 µmol/L. Mice injected with ATO at a dose of 0.5 mg/kg had fewer lung metastases. However, mice injected with ATO at a dose of 2 mg/kg or 4 mg/kg had a high mortality rate and more liver injuries. A total of 15 different protein peaks were identified between the lysate of H22 cells treated with ATO and controls. Two proteins that peaked at m/z 5302 and 17207 coincided with MMP-2 (fragment) and nm23-M1, respectively. Western blotting analyses demonstrated that MMP-2 and MMP-2 fragments were down-regulated and nm23-M1 was up-regulated in H22 cells treated with 2 µmol/L ATO for 48 hours.
CONCLUSIONS: ATO at a low dose inhibits the metastatic potential of mouse hepatoma H22 cells in vitro and in vivo, and involves down-regulation of MMP-2 and up-regulation of nm23-M1.

BACKGROUND: Gadolinium chloride (GdCl3) is a specific inhibitor of Kupffer cells (KCs), which are important promoters of various liver injuries. It is therefore of interest to explore the role of KCs in liver ischemia-reperfusion injury and their relations with apoptosis caused by ischemia-reperfusion injury.
METHODS: One hundred male Wistar rats (190-210 g, 6-7 weeks old) were divided into two groups at random, GdCl3 group and control group. Samples were collected at 0.5, 1, 6, 12, and 24 hours from each group after reperfusion. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured by an automatic biochemical analyzer. TNF-α in serum was measured by enzyme-linked immunosorbent assay (ELISA). Malondialdehyde (MDA) in the liver mitochondria was measured by a colorimetric method. Pathological changes in the liver and immunohistochemical staining for caspase-3 were observed under an optical microscope. The ratio of apoptotic cells was measured by TdT-mediated dUTP nick-end labeling (TUNEL), and ultrastructural features of apoptosis were observed with a transmission electron microscope (TEM).
RESULTS: The levels of ALT in the GdCl3 group were lower than those in the control group after reperfusion for 0.5, 1, 6 and 12 hours (P<0.05); and the levels of AST in the GdCl3 group were lower than those in the control group after reperfusion for 6 and 12 hours (P<0.05). The levels of TNF-α in the GdCl3 group were lower than those in the control group after reperfusion for each time (P<0.05). The concentrations of MDA after reperfusion in the GdCl3 group were lower than those in the control group after reperfusion for 6, 12 and 24 hours (P<0.05). After reperfusion for 0.5, 1, 6 and 12 hours, the integral optical density (IOD) of caspase-3-positive cells was lower in the GdCl3 group than in the control group (P<0.05). After reperfusion for 1, 6, and 12 hours, the IOD of cells stained by TUNEL in the GdCl3 group was lower than that in the control group (P<0.05).
CONCLUSIONS: GdCl3 inhibits the activity of ALT, AST and TNF-α, decreases the accumulation of MDA in mitochondria, and depresses the expression of caspase-3 in liver after ischemia-reperfusion. This may be an important protective mechanism by depressing KCs and indirectly inhibiting liver cell apoptosis.

BACKGROUND: Mechanical lithotripsy and/or stent insertion is the alternative therapeutic approach in difficult endoscopic retrograde cholangiopancreatography (ERCP) case. This study was designed to investigate the appropriate treatment for extraction of bile duct stones in difficult cases of ERCP.
METHODS: Between 2000 and 2008, 744 ERCP procedures were performed in 592 patients with choledocholithiasis in our endoscopy unit. The demographic features, and clinical and laboratory findings were collected from a prospectively held database. Bile duct calculi were extracted by basket and/or balloon catheter following ERCP and sphincterotomy. Patients with retained stones were regarded as difficult cases. These patients were treated with mechanical lithotripsy and those with incomplete clearance of stones underwent stent placement.
RESULTS: Two hundred and forty-five patients (41%) were male and 347 (59%) were female with a mean age of 58 years (range 19-95 years). Stones were impacted in 27 patients (5%). Stone extraction was performed by basket and/or balloon catheter in 610 ERCP procedures, and lithotripsy was performed in 70 ERCP procedures. Forty-four patients underwent stent insertion, and 20 underwent stent replacement. Morbidity occurred in 39 patients (5%), with no mortality associated with the procedure. Hemorrhage occurred in 9 patients and basket impaction in 4. Mild pancreatitis and cholangitis developed in 12 and 11 patients, respectively.
CONCLUSION: Difficult cases of bile duct stones can be treated successfully with lithotripsy, and a stent should be applied when the common bile duct cannot be cleared completely.

BACKGROUND: Dendritic cells (DCs) are the most important antigen-presenting cells in the human body, and DCs with different mature status possess different or even opposite functions. This study was designed to explore the influence of insulin on the functional status of cord blood-derived DCs and on DC-induced cytotoxic T lymphocyte (CTL) activity against pancreatic cancer cell lines.
METHODS: Mononuclear cells were isolated from fresh cord blood. Interleukin-4 (IL-4) and granulocyte-macrophage colony-stimulating factor (GM-CSF) were used to induce or stimulate the mononuclear cells. Insulin at different concentrations served to modify DCs, and then DC morphology, number, and growth status were assessed. The DC immunophenotype was detected with a flow cytometer. The IL-12 in DC supernatant was determined by ELISA. DC functional status was evaluated by the autologous mixed lymphocyte reaction. T lymphocytes were induced by insulin-modified DCs to become CTLs. The CTL cytotoxicity against pancreatic cancer cell lines was determined.
RESULTS: Mononuclear cells from cord blood can be differentiated into DCs by cytokine induction and insulin modification. With the increase in insulin concentration (2.5-25 mg/L), the expression of DC HLA-DR, CD1α, CD80, and CD83 was significantly increased, the DC ability to secrete IL-12 was significantly improved, DC function to activate autologous lymphocytes was significantly enhanced, and the cytotoxicity of CTLs induced by insulin-modified DCs against pancreatic cancer cell lines was significantly strengthened.
CONCLUSIONS: Insulin may facilitate DC induction and maturation, and improve the reproductive activity of autologous lymphocytes. The cytotoxicity of CTLs induced by insulin-modified DCs against pancreatic cancer cell lines was significantly enhanced. Insulin may serve as a factor modifying DCs and inducing CTLs in vitro in insulin biotherapy.

BACKGROUND: Since respiratory dysfunction is the main cause of death in patients with severe acute pancreatitis (SAP), elucidating the critical period of acute pancreatitis-associated lung injury (APALI) is of important clinical value. This study aimed to define the risk period of APALI by a series of studies including a dynamic analysis of total water content, ultrastructure and number of type Ⅱ alveolar epithelial cells, and reactive oxygen metabolites (ROMs) of lung tissue in a mouse model of SAP, and a clinical analysis of APALI patients.
METHODS: ICR mice were selected to establish a SAP model. They were given 7 intraperitoneal injections of cerulein (50 µg/kg body weight) at hourly intervals, followed by an intraperitoneal injection of lipopolysaccharide (15 mg/kg body weight). The total water content, ultrastructure, and number of type Ⅱ alveolar epithelial cells, and ROMs of lung tissue were assessed before (0 hour) and after the establishment of SAP model (6 hours, 12 hours, 1 day, 4 days, and 7 days). In addition, we analyzed the data from 215 patients with APALI (PaO2 <60 mmHg) treated at our hospital between January 1998 and December 2006. Statistical analyses were made using the F test. P values less than 0.05 were regarded as statistically significant.
RESULTS: The total water content and ultrastructure of type Ⅱ alveolar epithelial cells (mitochondria and lamellar bodies) of the lung in the SAP mice were significantly altered at 12 hours after the establishment of SAP model, and reached a maximum at 1 to 4 days. The number of type Ⅱ alveolar epithelial cells and ROMs increased maximally at 1 day after the establishment of the model. Furthermore, clinical results showed that lung injury occurred at a mean of 3.1435±1.0199 days in patients with SAP. These clinical data were almost consistent with the results of the SAP model.
CONCLUSION: The risk period for APALI is between the first and fourth day during the course of SAP.

BACKGROUND: A malignant fibrous histiocytoma, recently referred to as an undifferentiated pleomorphic sarcoma (UPS), is very rare in the liver, and only 34 cases of primary hepatic malignant fibrous histiocytoma have been reported in the English literature.
METHODS: We report a rare case of a hepatic UPS presenting as a unilocular cystic lesion with respect to histopathologic features, the newly revised diagnostic criteria, and the differential diagnosis.
RESULTS: A 60-year-old man presented for evaluation of epigastric pain of 7 months duration. Abdominal computed tomography revealed a hypodense, unilocular cystic mass in the right lobe of the liver, measuring 14.0×11.1 cm. A right lobectomy was performed. Grossly, the cut surface showed a single, well-circumscribed unilocular cystic tumor mass containing dark red-brown necrotic debris and blood clots, which occupied most of the mass. Microscopically, the tumor consisted of haphazardly arranged mononuclear pleomorphic tumor cells, admixed with abundant osteoclast-like multinucleated giant cells. Immunohistochemically, the tumor cells expressed vimentin only. The histopathologic and immunohistochemical findings were compatible with a UPS. The patient is alive and well 41 months after surgery without recurrence.
CONCLUSIONS: Clinically, most of the hepatic UPSs are solid masses. Only two cases have presented as multilocular cystic masses. A primary hepatic UPS presenting as a unilocular cyst has never been reported. A UPS should be included in the differential diagnosis of unilocular cystic lesions in the liver.

BACKGROUND: The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as a dilutional hyponatremia is due to a pathological increase of antidiuretic hormone (ADH). It is characterized by hyponatremia and decreased serum osmolarity as well as an increase in urinary osmolarity. The most common etiological factors of this syndrome include diseases or trauma of the central nervous system and malignant tumor or inflammation of the lung. SIADH following abdominal surgery is rare.
METHODS: We report the case of a 68-year-old woman who developed, 24 hours after common bile duct exploration and stone removal, continuous hyponatremia for 20 days and clinical manifestations of nausea, vomiting, and lethargy without focal neurological signs.
RESULT: Laboratory examinations supported the diagnosis of SIADH. After therapy with fluid restriction, the patient recovered.
CONCLUSION: There are diverse causes for SIADH. It is important to have kept this clinical possibility in mind in the differential diagnosis of refractory hyponatremia under any circumstances.

BACKGROUND: Pyogenic liver abscess (PLA) is commonly seen in patients in the Far East. Similarly, hepatobiliary neoplasms are also common. PLA as the initial manifestation of hepatobiliary neoplasms is extremely rare.
METHOD: Three patients with PLA were identified from the ward registion files and were retrospectively reviewed.
RESULTS: These patients (two men aged 74 and 80 years, and one woman aged 35 years) were treated (in the right lobe in two patients and in the left lobe in one) and subsequently followed up for 11-22 months. Two patients were diagnosed with hepatocellular carcinoma and one with metastatic cholangiocarcinoma. Two patients were subjected to biopsies showing features of inflammatory pseudotumor before a diagnosis of hepatocellular carcinoma. One patient underwent hepatic resection with good results. In the other two patients who declined any further interventions, one died a few weeks after diagnosis and the other is still alive on conservative treatment.
CONCLUSIONS: This series of cases highlights the importance of considering underlying hepatobiliary malignancies in patients with PLA and a close follow-up necessary for non-resolving hepatic lesions.

BACKGROUND: Retroperitoneal abscess is a dangerous complication of the inflammatory process in organs. The pancreas reacts by enzymatic autodigestion and inflammation to external and internal factors: alcohol abuse, trauma, biliary stones, and viral infections. Chronic pancreatitis and formation of pseudocysts are late complications. The diffuse spread of pancreatic inflammation may form a retroperitoneal phlegmon. A better outcome is the limitation of the process by capsule formation-retroperitoneal abscess.
METHODS: A 62-year-old man, with a history of alcohol abuse, was admitted for intermittent abdominal pain, fever, and significant weight loss. Previous medical consultations (laboratory tests, US, CT) confirmed chronic pancreatitis with pseudocyst formation. A new CT depicted a giant retroperitoneal abscess.
RESULTS: After preoperative preparation with antibiotics, laparotomy and internal drainage-longitudinal cystoje-junostomy with Roux-en-Y loop were performed. At the 8th postoperative day the patient was in good condition.
CONCLUSIONS: Giant retroperitoneal abscess is a dangerous pathology with significant mortality and morbidity. Diagnosis strongly necessitates operative intervention in order to evacuate and drain the space. These conditions include one internal drainage (in the GI tract) with the stomach, duodenum, or jejunum, which does not cause early and late GI discomfort and will gradually liquidate the cavity. We propose internal drainage with Roux-en-Y jejunal loop as the only method for accomplishing these conditions in cases of giant retroperitoneal abscesses.

BACKGROUND: Castleman's disease is a rare lymphopro-liferative disease of unknown cause. Most multicentric cases described have been of the plasma-cell variety. This article presents a case of multicentric hyaline-vascular Castleman's disease in the retroperitoneum with the ultrasonographic and computed tomography (CT) imaging manifestations.
METHODS: During routine physical examination, a mass was detected in the left abdomen of a 53-year-old man with no signs or symptoms. The patient underwent ultrasound-guided aspiration biopsy and operative excision after laboratory examination, ultrasonography, and CT.
RESULTS: Ultrasonography demonstrated a dominant hypoechogenic mass with hypervascularity in the retroperitoneum. CT detected a relatively homogenous enhanced lesion and several satellite nodules. After the mass and several lymph nodes were resected, histopathologic examination demonstrated a lymphocyte-predominant infiltrate surrounding the germinal centres and extensive capillary proliferation, consistent with the hyaline-vascular type of Castleman's disease. The patient received postoperative chemotherapy and remained free of recurrence 3 months later.
CONCLUSION: Ultrasonography and contrast-enhanced CT can provide a positive differential diagnosis of hyaline-vascular Castleman's disease which is a kind of giant lymph node hyperplasia with hypervascularity.