We treated a 51 year-old man following admission to our hospital for investigation of liver tumors. The patient had previously taken Lamivudine orally for liver cirrhosis type B. Dynamic computed tomography (CT) performed in October 2005 demonstrated 2 liver tumors, 6 and 3cm in diameter, in the 6th segment. However, tumor staining was not shown by angiography, while portal vein flow was detected in the liver tumors by CT-arterial portography. We diagnosed the tumors as well-differentiated hepatocellular carcinomas (HCCs) from the results of a biopsy and performed surgical resection. Since it is reported that most well-differentiated HCCs are detected as small tumors under 2cm in size and rarely become greater than 3cm, the present case is unusual.

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A 73 years old woman with liver cirrhosis was admitted to our hospital for the purpose of radiofrequency ablation (RFA) for her hepatocellular carcinoma (HCC) . However, as waiting for the RFA therapy for HCC, she developed rupture of esophageal varices and underwent endoscopic variceal ligation (EVL) . Then, 38 hours after the EVL of esophageal varices, melena occurred. Since colonoscopy and abdominal CT revealed that the melena was caused by a rupture of giant rectal varices, we thought that an endoscopic treatment of the variceal rupture was not suitable. Abdominal angiography indicated a portosystemic shunt from inferior mesenteric vein to middle rectal vein. We then treated for the rectal varices with the percutaneous transhepatic obliteration (PTO) with coil and sclerosant. After PTO, the long-awaited RFA was performed for HCC finally. Now, at 6 months after these therapies, the patient remains free from relapses of melena and HCC.

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Congenital absence of the portal vein (CAPV) is a rare malformation that is often accompanied by hepatic tumors such as focal nodular hyperplasia (FNH). We describe here a case of CAPV, complicated with multiple hepatic tumors in a 14-year-old girl. Imaging techniques revealed a typical FNH lesion and multiple FNH-like lesions in the liver, and abdominal angiography confirmed that the portal vein drains directly into the inferior vena cava with the absence of the left portal vein. These findings led to a diagnosis of CAPV complicated with multiple hepatic tumors with different imaging characters. Although we could not finally identify with certainty whether these FNH-like lesions are indeed FNH or hepatocellular adenoma (HA), our case shows features that suggest a close relationship between FNH and HA, helping speculate how FNH forms.

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A 65-year-old man was admitted to one of our hospitals for acute hepatitis B. He had not been abroad in the past 12 months. The viral genome was subjected to full-genome nucleotide sequencing. A phylogenetic analysis revealed that the strain belongs to genotype H, which is extremely rare in Japan. Being one and only case of domestic infection with HBV genotype H so far reported from Japan, however, this case may represent a tiny tip of the iceberg, since the recent booming of globalization and commercial sex industry in Japan has accelerated importation of a wide variety of foreign strains of HBV.

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We prospectively monitored the serum levels of HCV core protein every 3 months for a year in 13 hemodialysis patients who were positive for HCV RNA. HCV core protein levels in these patients were significantly lower than in those chronically infected with HCV but not receiving hemodialysis (average 1632 vs 7932 fmol/l, p=0.0009. )A significant reduction in the HCV core protein levels, from 1822 to 1444 fmol/l in average (p<0.002), was observed by a single hemodialysis procedure. Similar reduction (about 20%) was also observed at the end of the follow-up period, even though the difference was not statistically significant. Decrease in HCV by hemodialysis procedure might be associated with the slow progression of hepatitis in hemodialysis patients with HCV infection.

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PIVKA-II, an abnormal prothrombin induced by vitamin K deficiency, is widely used as a specific marker for hepatocellular carcinoma. We observed a marked elevation of PIVKA-II in the serum from 12 patients with hepatocellular carcinoma just after hepatectomy, when we determined PIVKA-II by CLEIA (431-23,968mAU/ml). However, 10 of the 12 patients showed normal levels of PIVKA-II when re-tested by ECLIA (1-21mAU/ml). The false positive results with CLEIA were thought to be associated with the use of anti-bleeding sheets at hepatectomy.

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