|
Table 37-3. Colorectal Cancer (CRC) Screening and Surveillance Recommendations |
Congenital hypertrophy of the retinal pigment epithelium is an early benign manifestation of both FAP and
سندرم های پارانئوپلاستیک در آدنوکارسینومای معده:
A variety of paraneoplastic syndromes have been associated with gastric adenocarcinoma and warrant an investigation for a gastrointestinal malignancy. They include:
Trousseau's syndrome (thrombosis),
acanthosis nigricans (pigmented dermal lesions),
membranous nephropathy,
microangiopathic hemolytic anemia,
Leser-Trélat sign (seborrheic keratosis), and
dermatomyositis.
نئوپلاسمهای کبدی:
آدنوم های کبدی
Hepatic Adenomas:
found predominantly in women of childbearing age, are associated with estrogen and oral contraceptive use, and may enlarge during pregnancy. in Men use of anabolic steroids -- usually incidentally identified -- can spontaneously hemorrhage during menstruation or pregnancy or postpartum, causing shock and requiring surgical resection-- Consist of normal hepatocytes without portal tracts and Kupffer cells.
The diagnosis is suggested by the appearance of a cold spot on technetium-99m-sulfur colloid scans (resulting from absence of Kupffer cells) and of vascular lesions on angiography.
The appearance on ultrasonography, computed tomography, and magnetic resonance imaging is nonspecific, but a characteristic feature is the presence of a well-defined capsule.
همانژیوم های کبدی:
Hemangiomas
are the most common mesenchymal hepatic neoplasms -- prevalence in the general population of 2 to 5%-- usually discovered incidentally--most often solitary and located in the right lobe of the liver.
Right upper quadrant abdominal pain may occur in patients with large lesions (typically > 5 cm) owing to the development of intratumoral hemorrhage and thrombosis.
Diagnosisà readily made when a hyperechoic lesion on ultrasound evaluation corresponds to a peripheral enhancing lesion that eventually completely fills during dynamic computed tomography, when MRI reveals a high-intensity signal on T2-weighted images (most sensitive test), or when a technetium-99m red blood cell scan (most specific test) shows retention of the isotope in the tumor.
Treatment is usually not necessary in lesions less than 5 cm. In larger lesions, close monitoring and/or elective resection has been advocated. Symptomatic lesions may be treated with embolization, enucleation, resection, and, in extreme cases, transplantation (large unresectable lesions or multiple lesions).
|
Table 44-1. Hepatocellular Carcinoma |
Indeed, in 10 to 20% of patients, no cause for granulomas is found despite extensive investigation. A subset of these patients have a syndrome consisting of fever, hepatomegaly, and hepatic granulomas that responds to corticosteroids, described as hepatic granulomatous disease or "granulomatous hepatitis." These patients may possibly have a variant of sarcoidosis.
Liver biopsy (and culture, particularly for acid-fast bacteria) is of considerable value in the diagnosis of sarcoidosis, miliary tuberculosis, and disseminated histoplasmosis, because virtually all patients with these disorders have hepatic granulomas.
Characteristic granulomas are seen in many patients with primary biliary cirrhosis, and granulomas may be the first clue to Hodgkin's disease.