Introduction: Successful treatment of a patient with acute pyogenic spondylitis and an iliopsoas abscess arising as complications of a bacterialliver abscess was reported. Case Report: A 69ぅTear-oldman who underwent pylorus-preserving pancreatoduodenectomy (Child's reconstruction) for duodenal papillary carcinoma 6 years previously was referred for emergency hospitalization to our institution due to pyrexia and chils. On admission, a high inflammatory response was noted (white blood cels, 21,960/μL; C-reactive protein, 24.74 mg/ dL), a liver abscess was observed on computed tomography (CT), and Gram-negative bacili were detected on blood cultures, leading to a diagnosis of disseminated intravascular coagulation and septicemia due to a bacterialliver abscess. Conservative treatment with antibiotics was started; however, the patient then developed septic shock and acute respiratory distress syndrome. Percutaneous transhepatic drainage surgery was thus performed under artificial ventilation. The patient subsequently developed pyogenic spondylitis and an iliopsoas abscess. Longterm antibiotic administration for multiple internal organ infections achieved a gradual decrease in the inflammatory response and shrinkage of the liver abscess, as confirmed on CT. Discussion: Only six cases of acute pyogenic spondylitis caused by hematogenous spread of a liver abscess into the spine have been reported in J apan; therefore, this case is extremely valuable. A brief review of the related literature was also presented.
A case of adenoid cystic carcinoma with a primary breast lesion is reported together with a brief discussion of the literature. The patient was a 71.・year-oldwoman. On examination she was found to have a mass beneath and somewhat lateral and inferior to the left breast, and she was referred to our hospital for detailed examination. Adenoid cystic carcinoma was diagnosed on needle biopsy, and mastectomy and sentinellymph node biopsy were performed. On histopathology, nests of various sizes were present as百surroundingthe interstitium, and cribriform and solid structures were seen. In the nests, true glandular lumina and pseudocysts were seen, presenting a so-called adenoid cystic pattern. The tumor cels were small , the nucIear grade was low, and no vascular invasion was seen. Adenoid cystic carcinoma is generally thought to have a fairly good prognosis, but many are triple-negative breast cancers, for which the prognosis is poor, and the course needs to be monitored appropriately.
