Scirrhous hepatocellular carcinoma displaying atypical findings on imaging studies

We describe a 15-mm scirrhous hepatocellular carcinoma(HCC) in a 60-year-old man with B-type cirrhosis.Ultrasound disclosed a 15-mm hypoechoic nodule in segment 7.Contrast-enhanced US revealed heterogeneous,not diffuse,hypervascularity in the early phase and a defect in the Kupffer phase.Contrast-enhanced computed tomography(CT) revealed a heterogeneous hypervascular nodule in the early phase and a low-density area in the late phase.Magnetic resonance imaging(MRI) revealed iso-to hypointensity at T1 and high intensity at T2-weighted sequences.Contrast-enhanced MRI also revealed a heterogeneous hypervascular nodule in the early phase and washout in the late phase.Super-paramagnetic iron oxide-MRI revealed a hyperintense nodule.CT during hepatic arteriography and CT during arterial portography revealed heterogeneous hyperattenuation and a perfusion defect,respectively.Based on these imaging findings the nodule was diagnosed as a mixed well-differentiated and moderately-differentiated HCC.Histologically,the nodule was moderately-differentiated HCC characterized by typical cytological and structural atypia with dense fibrosis.Immunohistochemically,the nodule was positive for heterochromatin protein 1 and alpha-smooth muscle actin,and negative for cytokeratin 19.From the above findings,the nodule was diagnosed as scirrhous HCC.Clinicians engaged in hepatology should exercise caution with suspected scirrhous HCC when imaging studies reveal atypical findings,as shown in our case on the basis of chronic liver disease.

Parent’s Perceived Provision of Information Regarding Diagnosis to Children with Brain Tumors

Background: The aim of this study was to clarify the degree of information provision to children with brain tumors, factors influencing this provision, and the relationship between this provision and psychosocial consequences. Methods: A total of 157 parents completed a questionnaire on the degree of information provision to their children and sociodemographic and medical characteristics. Parents and their children completed subscales of the Pediatric Quality of Life Inventory (PedsQL) Cancer Module. Relevant factors were investigated using ordinal logistic regression analysis and compared with PedsQL scores by degree of information provision with adjustment for age. Results: The majority of children aged 2 - 4 years received a low level of information only in regard to medical procedure and preparation. The majority of children aged 5 - 11 years were provided information regarding disease symptoms and treatment, but not actual diagnosis. Approximately half of children aged 12 - 18 years were provided detailed information including their actual diagnosis. Older children generally received more information regarding their disease (odds ratio [OR] = 1.3 per 1 year old, P < 0.001), while children with intellectual disability received less (OR = 0.2, P = 0.006). The provision of information did not worsen scores for Procedural Anxiety, Treatment Anxiety, Worry, or Communication. Conclusions: To our knowledge, this is the first report on the degree of information provision to children with brain tumors. Parents of children with brain tumors in Japan provide information dependent on age and intellectual level. The disclosure of information to children regarding their disease might affect their trust of medical and health care professionals.