Volume 71 - 2008 - Fasc.4 - Letters
Giant hepatic paraganglioma succesfuly treated with embolisation
Extra-adrenal pheochromocytoma may occur at any location where paraganglionic tissue is present and primary hepatic paraganglioma is a very rare entity (1). Internal cyst formation is frequently seen in large para- gangliomas with intramural hemorrhage and it can mimic cystic diseases of the liver.
A 71 year old man admitted to our clinic with the complaint of dull pain on right upper quadrant for 3 months. In his past medical history he had diabetes and hypertension for 20 years, which were under control with fosinopril sodium and gliclaside. Four years before admission, a cystic lesion observed on ultrasonography was diagnosed as hydatid disease. Physical examination revealed hepatomegaly and an epigastric mass. On labo- ratory analysis, counter blood count, sedimentation rate, INR was normal, but creatinin was 1.3 mg/dl, AST 67 IU/ml, ALT 64 IU/ml, albumin 3.6 g/dl, total bilirubin was 2 mg/dl.
Papillon-Lefèvre syndrome with pyogenic liver abscess : case report focusing on radiological findings and review of the literature
We present the results of CT and US in the rare case of Papillon-Lefèvre syndrome (PLS) with multiple pyogenic liver abscesses.
A 26-year-old woman presented with fever and right hypochondrial pain. At 3 years of age, she had been diagnosed as having PLS at another hospital. She had a history of abdominal, liver, and renal abscess. Again, a liver abscess was suspected, and Staphylococcus aureus was found in the drainage fluid specimen. She was trans- ferred to our hospital. Upon admission, her temperature was 37.2 °C and her pulse was 94 per minute. She had mild keratosis of the soles. Although she had a history of periodontosis, her permanent teeth were still in place probably because of continual treatment for periodon- tosis. The laboratory results showed a total white blood cell count of 12,500/µL and a C-reactive protein of 6.13 mg/dL. The nitroblue tetrazolium (NBT) reduction test showed a reduced response to latex stimulation (12%). Contrast-enhanced CT and US of the abdomen revealed multiple ill-defined hypodense and inhomoge- neous masses with peripheral enhancement in the liver (Fig. 1). Our diagnosis was pyogenic liver abscess asso- ciated with PLS, as no other causes of liver abscess could be demonstrated. After treatment, the patient recovered and was discharged four months after admission. Further CTs performed 16 months later showed that the lesions were well defined and reduced, suggesting absorption of the liver abscess (Fig. 2). The patient is now symptom- free, and periodic observation in the outpatient depart- ment is maintained.
