International Autoimmune Hepatitis Group (IAIHG) developed a new simplified scoring system for autoimmune hepatitis (AIH) in 2008. In this study, we re-analyze patients with AIH using simplified system, and compare the utility of original and simplified systems. We studied 59 patients with biopsy-proven AIH at our hospital from 1965 to 2008. All patients with AIH were classified as definite or probable AIH using both systems. We determined the concordance and discrepancies between these systems. The frequency of a definite AIH was greater by simplified system than by original system, however the frequency of non-diagnostic scores was greater by simplified system than by original system. The simplified system didn't grade patients with other disease as definite AIH. Taken together, the simplified system is simpler and more likely to be utilized. However, we must observe individuals carefully and make a definite diagnosis of AIH using both systems.

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Among 389 hepatocellular carcinoma (HCC) cases treated in our institution, 29 cases (7.5%) were HBV antigen and HCV antibody negative. Of them, ten cases (2.6%) were clinicopathologically diagnosed as NASH. In those patients, we examined host factors, background liver pathology, blood work, liver function, and tumor analysis. Seven males and three females had an average age of 70.9±8.1 years. Body Mass Index (BMI) was greater than 25 Kg/m² in six, and six had diabetes mellitus. Associated liver disease was pathologically steatohepatitis in six, and cirrhosis in four. Half of patients with steatohepatitis revealed the slight to moderate fibrotic change according to Brunt classification. Nine patients (90%) had multiple tumors, and multicentric growth was suspected in six. In our series, 60% of HCCs developed from patients with steatohepatitis, and 67% of multiple HCCs showed multicentric growth. We should follow NASH patients carefully, even for patient with only early stage steatohepatitis.

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Since the number of deceased donor donors has been limited in Japan, many patients without live donors must abandon liver transplantation. Physicians should be aware of imbalance between expected increase in number of applicants and scarce opportunities of deceased donor liver transplantation, and adequately evaluate liver transplant candidacy. University of Tokyo hospital became designated institution since 2001, and nine deceased donor liver transplantations have been performed. After setting up the Organ Transplantation Service division in April 2003, uniform patient evaluation and follow-up system has been established. We have evaluated 101 patients between April 2003 and December 2008, and 41 of them were listed. All candidates were required follow-up visit every 3 months, although actual visit time was only 48% of all required visit times. As of March 2009, 7 were transplanted and alive, 16 died without transplantation, 5 were delisted, and 13 were waiting. We report the process of our evaluation and follow-up system, and discuss on issues to be resolved.

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A 29-year-old woman with acute hepatitis C visited our hospital at November 21, 2007. ALT did not become normal. HCV serotype revealed Group 2 and HCV RNA was 3.0 Log IU/ml(Real time method) at March 21, 2008. Liver Biopsy showed chronic hepatitis F1A1 at March 21, so she was treated with pegylated interferon α 2a for 12 weeks and attained sustained virological response. On the other hands, her fiancé treated for acute hepatitis C at another hospital revealed HCV Group 2 and HCV RNA was 430 KIU/ml(High ranged method). The HCV isolates from the patients and her fiancé shared 100% identity in the 338 nucleotide sequences of the NS5B region. Phylogenitic analysis of the 338 sequences revealed that the two isolates segregated into a cluster. Thus the patient has acquired HCV infection from her fiancé, most likely by sexual transmission.

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An asymptomatic, 38-year-old, HCV-positive female had a 5-cm hepatic nodule detected by routine health check. Various imaging modalities (ultrasonography, CT, MRI and Angio-CT) demonstrated a hypervascular nodule with homogenous enhancement in the arterial phase and washout in the late phase in segment 7. Histopathologically, the tumor biopsy showed mild atypia suggestive of well-differentiated HCC or a dysplastic nodule. As these findings did not correlate with the imaging diagnosis, the patient was referred to our hospital. We performed contrast-enhanced ultrasonography (CEUS) with Levovist. Tumor feeding arteries, mainly from the posterior branch of the right hepatic artery, and homogenous enhancement were seen in the arterial phase and washout was evident at one minute. While CEUS findings were not typical for HCC, we concluded that this tumor was malignant and performed a posterior segmentectomy of the liver. The resected specimen was a non-encapsulated, yellowish tumor. The microscopic findings were consistent with an adrenal cortical tumor with minimal invasion into the adjacent liver parenchyma, leading to a final diagnosis of adrenal cortical carcinoma. This case suggests that adrenal tumors may be mistaken for a segment 7 hepatic tumor due to the close anatomical relationship between the liver and adrenal gland.

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A 64-year-old man was referred to our hospital with high fever and right upper abdominal pain. Dynamic computed tomography (CT) scan revealed a 60×40-mm abscess in the right lobe of the liver. B mode and color doppler ultrasonography (US) imaging of the abdomen could not depict the abscess as clearly as the CT. An 81-mm hypervascular lesion was observed in segment 5/6 during the early vascular image of contrast-enhanced US performed using Sonazoid^®. A 50.2×39.7-mm defect, which was considered to represent necrosis and cavity of the abscess, was clearly depicted during the Kupffer image of imaging. Percutaneous transhepatic drainage of the abscess was performed safely under contrast-enhanced US guidance (during the Kupffer image of imaging). The size of the abscess and the clinical healing course were tracked using the Kupffer-image imaging data. This case suggests that contrast-enhanced US with Sonazoid^® is an excellent modality for treatment and follow-up of a liver abscess.

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