80歳，女性．心窩部痛を主訴に近医受診．CT像上，肝左葉に9 cmの占拠性病変が認められた．白血球数とCRP，ALP，LDH値が上昇していたが，腫瘍マーカーは正常範囲内であった．血管造影像上，乏血管性の腫瘍として描出され，Gaシンチ像上，肝内病変にのみ異常集積像が認められた．肝内胆管癌の診断のもとに切除した．腫瘍は白色充実性の腫瘍であり，病理組織検査では異型細胞のびまん性増殖が認められ，酵素抗体法ではLCA，L-26陽性，UCHL-1，CD5，CD10陰性でありDiffuse large B cell type malignant lymphomaと診断された．非癌部肝組織所見は原発性硬化性胆管炎と診断された．術後，エトポシド25 mg/日の投与を継続し術後6カ月間を経過した時点で肝以外に病変はみられないため，最終的に肝原発悪性リンパ腫と診断した．術28カ月後の現在，再発兆候なく通院中である．
We evaluate the Acoustic Radiation Force Impulse (ARFI) for the non-invasive assessment of liver fibrosis in chronic liver disease patients, compared with transient electrography (FibroScan®502). Liver stiffness values measured by FibroScan®502 correlates well with liver fibrosis stage (F0-1: 5.5 Kpa, F2: 8.6 Kpa, F3: 10.5 Kpa, F4: 17.8 Kpa). In addition, liver stiffness quantification by ARFI is very well correlated with liver stiffness values by FibroScan®502 (r=0.88, P<0.001). ARFI is considered a new useful tool for assessment of the liver fibrosis with non-invasive methods.
Double filtration plasmapheresis was approved in April 2008 in Japan for the retreatment of chronic hepatitis C patients with genotype 1b and high viral loads, whose hepatitis C virus was not eradicated by previous pegylated IFN plus ribavirin combination therapy. Eight patients with non-sustained virological response (SVR) to the combination therapy were enrolled in this study, and early viral dynamics were assessed. DFPP plus consecutive intravenous IFN-β treatment for 4 weeks reduced the viral load by 1 log in 2 of 5 (40%) patients 24 hours and 1 week after the start of treatment, and in 4 of 5 (80%), and by 2 log in 2 of 5 (40%) 4 weeks after the start of treatment. The present study suggests that DFPP plus consecutive intravenous IFN-β treatment for 4 weeks appears to be a promising treatment for non-SVR patients with genotype 1b and high viral load previously treated with PEG-IFN+RBV therapy.
A 60 years old man died of fulminant hepatitis E on 21st April, 2009, in Hakodate, Hokkaido, Japan. The hepatitis E virus (HEV) genomic sequence from this patient segregated to genotype 4, which is known to be more pathogenic than genotype 3 and more prevalent in Hokkaido than in other areas of Japan. To our surprise, however, this HEV isolate co-clustered with the so-called "Kitami/Abashiri strain", which had been recovered from fulminant hepatitis patients in Kitami and Abashiri (also Hokkaido) in 2004 and 2006, respectively. Thus, an apparent association of this lineage of HEV with fulminant hepatitis has been observed 3 times, leading us to suspect a causal relationship. Most likely this HEV lineage is being passaged/propagated in pig farm (s) somewhere in Hokkaido, and may cause another case(s) of severe hepatitis unless countermeasures are taken.
●P. 384の左カラムの上から5―6行目： （旧）免疫染色ではhepatocyte（＋）・AFP（－）・CA19-9（－）であった． →（新）免疫染色ではhepatocyte paraffin 1（＋）・AFP（－）・CA19-9（－）であった． ●P. 385 Fig. 2 legend： （旧）Histopathological features of the tumor located in the right pubic bone. Tumor tissue was examined by immunostaining with （a） hepatocyte, （b） CA19-9, and （c） AFP. Tumor cells showed strong expression of hepatocyte and CA19-9, but not AFP expression. →（新）Histopathological features of the tumor located in the right pubic bone. Tumor tissue was examined by immunostaining with （b） hepatocyte paraffin 1 and （c） AFP. Tumor cells showed strong expression of hepatocyte paraffin 1, but not AFP expression. （a）: HE staining．（下線部が修正箇所）