Clinical data and morphological materials from 70 cases of liver‐cell carcinoma in infants and children in Japan were collected and studied. The cases were classified into 4 types according to the histopathologic appearance of the epithelial components: 1. adult type; 2. anaplastic type; 3. embryonal type; and 4. fetal type. The study confirmed the existence of a distinct correlation beween the histologic type of the tumor, its gross appearance, and the clinical course of the disease. Twenty‐seven of the 70 cases underwent radical surgery. Postoperative prognosis was studied in these cases according to histologic types of tumor. Of 9 long‐term survivors (i.e., surviving more than 2 years), 7 were found to belong to the fetal type. No difference was found in prognosis between the cases with and without osteoid tissue in tumor. The benign character of the fetal type, as compared with other types of hepatoblastoma, was demonstrated even in infants under 12 months of age.
Intrahepatic bile ducts are patent in the liver of patients with biliary atresia in early infancy. Small bile ducts at the porta hepatis continuing to the intrahepatic ducts usually terminate in fibrous tissue replacing the hepatic radicles, which does not extend to the common hepatic duct. Therefore, the level of transection of the fibrous tissue at the porta hepatis is of prime importance for successful hepatic portoenterostomy. Transection should be done at the level of the posterior surface of the portal vein. The overall cure rate of surgery for biliary atresia was 30%. In our recent series, however, the results have markedly improved and the cure rate has been increased to 55%. There are 47 patients living without jaundice, 22 of them for more than 5 years. The longest survivors are 23 years old. All the longterm survivors are leading a normal life for their age, although 6 of them have some physical or mental handicap. Early operation, adequate surgical technique, and prevention of postoperative cholangitis are requisites for successful hepatic portoenterostomy.
Surgical specimens from 25 patients with intraductal papilloma were subjected to 3‐dimensional (3‐D) reconstruction studies of their mammary ducts. Papillomas of the multiple type (15 cases) always originated in the terminal duct lobular units (TDLU), whereas all papillomas of the solitary type (10 cases) originated in the large ducts except for one. In 6 of the 25 (24%) patients ductal carcinomas were accidentally found during specimen reconstruction. Two of the six patients harbored microscopic carcinoma as small as 3 mm or less. Three‐D reconstructions revealed that carcinomas with multifocal origins in the TDLUs were connected with peripheral papilloma. Papilloma preceding carcinoma was of the multiple type in five patients, and of the solitary type in one. This study also showed that 6 of the 16 (37.5%) patients with papilloma originating in the periphery had carcinomas, whereas none of the nine patients originating in the center did. This observation strongly suggests that the peripheral papilloma is highly susceptible to cancerous change.
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