title: Endoscopic ultrasonography-guided drainage of infected intracystic papillary adenocarcinoma of the liver.
abstract: We describe a case of effective use of endoscopic ultrasonography (EUS)-guided drainage of an infected intracystic papillary adenocarcinoma (ICPA) of the liver. The patient was an 84-year-old woman who was admitted with complaints of continuous epigastric pain and a slight fever. Laboratory data revealed severe inflammation. Computed tomography scanning showed a 110-mm cystic lesion with enhanced papillary tumors in the medial segment of the liver associated with a cyst in the right lobe and subcapsular cyst of the liver. Streptococcus species were detected in the culture of cystic fluid, and a diagnosis of infected ICPA was suspected. Although the patient was medicated by antibiotics, the fever did not resolve. EUS-guided transgastric drainage was performed for the abscess of the medial segment of the liver. Fourteen days after the endoscopic procedure, the plastic drainage tube was replaced with a metal stent. Inserting an endoscope into the liver cyst through the metal stent permitted observation and biopsy of an intracystic tumor, and the diagnosis of ICPA was confirmed. The patient was discharged with the internal metal stent still in place.
authors.affiliation: Department of Gastroenterology, JA Nagano Koseiren Shinonoi General Hospital, 666-1 Ai, Shinonoi, Nagano, Japan. kodryo@grn.janis.or.jp.
authors.forename: Ryo
authors.initials: R
authors.lastname: Kodama
authors.affiliation: Department of Gastroenterology, JA Nagano Koseiren Shinonoi General Hospital, 666-1 Ai, Shinonoi, Nagano, Japan.
authors.forename: Hisanobu
authors.initials: H
authors.lastname: Saegusa
authors.affiliation: Department of Gastroenterology, JA Nagano Koseiren Shinonoi General Hospital, 666-1 Ai, Shinonoi, Nagano, Japan.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ushimaru
authors.affiliation: Department of Surgery, JA Nagano Koseiren Shinonoi General Hospital, 666-1 Ai, Shinonoi, Nagano, Japan.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Ikeno
authors.affiliation: Department of Oncology, JA Nagano Koseiren Shinonoi General Hospital, 666-1 Ai, Shinonoi, Nagano, Japan.
authors.forename: Mutsuki
authors.initials: M
authors.lastname: Makino
authors.affiliation: Department of Oncology, JA Nagano Koseiren Shinonoi General Hospital, 666-1 Ai, Shinonoi, Nagano, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawaguchi
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000628:therapy*; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D019160:Endosonography; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000628:therapy*; D015607:Stents; D013290:Streptococcal Infections / Q000175:diagnosis / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Endoscopic ultrasound; Intrahepatic biliary cystadenocarcinoma; Liver abscess; Mucinous cystic neoplasms; Percutaneous drainage