Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
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Volume 51, Issue 12
Displaying 1-9 of 9 articles from this issue
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Original Article
  • Clinicopathological characteristics of surgically treated patients with non-B non-C type hepatocellular carcinoma
    Tomoyuki Hayashi, Satoshi Hirai, Akiyoshi Shimatani, Yosuke Horita, Ko ...
    Article type: Original Article
    2010 Volume 51 Issue 12 Pages 697-705
    Published: 2010
    Released on J-STAGE: December 29, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.697
    JOURNAL FREE ACCESS
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    We evaluated the clinicopathological characteristics of surgically treated patients with non-B non-C (NBNC) type hepatocellular carcinoma (HCC) in comparison with surgically treated patients with B or C type HCC. Of 108 patients with HCC surgically treated in our hospital during the previous 11-year period, 43 (39.8%) showed the NBNC type. HBc antibody presence was investigated in 35 of the 43 patients, and 18 (51.4%) were positive. Of the 108 patients with HCC, 18 (16.7%) and 47 (43.5%) showed the B and C types, respectively. The complication rates of obesity and diabetes mellitus were significantly higher in the patients with the NBNC type than in those with the B or C type. Histological findings in the background liver were milder in the patients with the NBNC type than in those with the B or C type. NASH/NAFLD including burned-out NASH was observed in 6 (33.3%) of 18 non-drinkers with the NBNC type. The mean recurrence-free survival period was 74.6 months in the patients with the NBNC type, 62.6 months in those with the B type, and 38.2 months in those with the C type, being significantly longer for the NBNC type. The mean survival period showed a similar tendency.
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Case Reports
  • A case of chronic EBV infection-related submassive hepatic necrosis
    Katsuya Higami, Koji Ishii, Misato Sawa, Mie Shinohara, Manabu Watanab ...
    Article type: Case Report
    2010 Volume 51 Issue 12 Pages 706-713
    Published: 2010
    Released on J-STAGE: December 29, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.706
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    In April 2008 a 65-year-old Japanese man with chronic renal failure was referred to our department with liver dysfunction of unknown origin. His liver dysfunction resolved with conservative treatment but its origin was unknown. In September 2008, he was admitted to our department because of exacerbation of liver dysfunction along with elevation of anti-EBV-VCA-IgG antibody. We found EBV-DNA in the blood by PCR and then performed laparoscopic liver biopsy. EBV-DNA was also detected in the liver by the ISH and PCR methods, and liver biopsy specimens revealed submassive hepatic necrosis. Therefore, we made a diagnosis of hepatitis related to chronic active EBV infection (CAEBV). His liver function was transiently improved by intravenous injection of Stronger Neo-minophargen C, but his serum transaminases fluctuated. In January 2009, he was readmitted because of ascites. Serum transaminases were normalized by treatment with vidarabine and predonisolone. However, he died of pneumonia caused by aspergillus and cytomegalovirus infection in March 2009. Detection of EBV-DNA in the liver and blood, and making a correct histopathological diagnosis, are thought to be essential when serum anti-EBV-IgG antibody is markedly elevated.
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  • A case of Japanese spotted fever: the first case in Okayama prefecture
    Manri Kawakami, Yasuhiro Umekawa, Kenji Tabara, Kouji Kida, Ritsushi F ...
    Article type: Case Report
    2010 Volume 51 Issue 12 Pages 714-721
    Published: 2010
    Released on J-STAGE: December 29, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.714
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    We encountered the first case of Japanese Spotted Fever in Okayama prefecture. Sixty-four-year-old woman was admitted to our hospital after several days of high fever and general fatigue. Physical examination on admission revealed a high fever over 40°C, eschar on the right chest and erythematous eruptions, which were similar to Tsutsugamushi disease but in palms. Laboratory examination showed thrombocytopenia, liver dysfunction and raised levels of C-reactive protein. She was suspected to have Japanese Spotted Fever and recovered by immediate treatment with minocycline in spite of short period due to the adverse effect suspected by minocycline. Final diagnosis was confirmed based on positive antibody for Richettsia japonica by immunofluoresent test using pared sera, and DNA determination specific for Richettsia japonica extracted from eschar by PCR. In Japan, the distribution of Japanese Spotted Fever, one of the disorders to be reported to a public health center, may be widely spreading year by year. Since Japanese Spotted Fever might be fetal illness unless proper early diagnosis and treatment, the patient with high fever, eruptions and liver damage should be always suspected to have this condition.
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  • Chronic hepatitis C with autoimmune phenomenon complicated with Pneumocystis pneumonia: A rare case that developed following steroid treatment and finally responded to PEG-IFNα-2b plus ribavirin combination therapy
    Yohei Waseda, Katsura Hirano, Satoko Inagaki, Yoshinori Goto, Shinya Y ...
    Article type: Case Report
    2010 Volume 51 Issue 12 Pages 722-729
    Published: 2010
    Released on J-STAGE: December 29, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.722
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    A 50-year-old Japanese woman with chronic hepatitis C was referred to our hospital for possible PEG-IFNα-2b plus ribavirin combination therapy. A liver biopsy was performed to differentiate from autoimmune hepatitis due to high serum ANA titer and elevated serum IgG level. The biopsy revealed pathological findings of autoimmune dominance, classified 'Probable AIH' according to the scoring system of the International Autoimmune Hepatitis Group. Steroid administration led to the disappearance of serum ANA, but failed in improving the hepatic dysfunction. The patient developed fever and dry cough, symptoms suggestive of Pneumocystis pneumonia. After successful treatment for Pneumocystis pneumonia with trimethoprim-sulfamethoxazole and steroids, PEG-IFNα-2b plus ribavirin combination therapy was found to improve the hepatic dysfunction and to eradicate HCV.
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  • Two cases of liver injury with histologically demonstrated centrilobular zonal necrosis successfully treated with steroids
    Takeshi Yamamoto, Kana Nishioka
    Article type: Case Report
    2010 Volume 51 Issue 12 Pages 730-735
    Published: 2010
    Released on J-STAGE: December 29, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.730
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    Case 1 was a male aged 60 years old, and Case 2 was a male in his 70s. They were asymptomatic, and visited our hospital with the complaint of abnormal liver function in the blood. There was no involvement of viruses or drugs in either case. Liver biopsy showed only centrilobular zonal necrosis (CZN) and no chronic active hepatitis, which characterizes autoimmune hepatitis (AIH). From the serological facts of normal IgG levels and negative findings for various autoantibodies, we considered AIH to be unlikely, but successfully treated the condition with steroids. Because, especially in Case 1, liver function deteriorated upon discontinuation of steroid treatment, the disease was suspected to involve immune abnormalities. Even in patients with a serological dose not meeting AIH, one opinion was that CZN is an initial feature of AIH, but no conclusions were obtained. We consider that these 2 cases contribute to elucidation of this pathogenesis.
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  • A case of living-donor liver transplantstion for liver cirrhosis due to hepatitis C complicated with a borderline ovarian tumor
    Tomoko Haramura, Akihiko Soyama, Mitsuhisa Takatsuki, Masaaki Hidaka, ...
    Article type: Case Report
    2010 Volume 51 Issue 12 Pages 736-741
    Published: 2010
    Released on J-STAGE: December 29, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.736
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    A 53-year-old woman was diagnosed as a giant ovarian tumor that had been growing rapidly during follow-up for liver cirrhosis due to hepatitis C. The tentative diagnosis of the tumor was a borderline ovarian tumor based on imaging examinations and tumor markers; as a result, we planned simultaneous ovarian tumor resection and liver transplantation because of decompensated cirrhosis (Child-Pugh score: 10, class C). Firstly, we resected an ovarian tumor, and subsequently performed living-donor liver transplantation. No evidence of recurrence of an ovarian tumor was observed for 5 years at this writing. Even in a case with decompensated cirrhosis complicated with a non-malignant tumor of other organs, which is difficult to operate due to poor liver function, curative treatment could be safely achieved in a view of both oncology and hepatology.
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  • Two cases of liver cirrhosis complicated with intramuscular hematoma
    Hiroshi Tanaka, Atsushi Naganuma, Hiroyuki Tsuchida, Masashi Namikawa, ...
    Article type: Case Report
    2010 Volume 51 Issue 12 Pages 742-750
    Published: 2010
    Released on J-STAGE: December 29, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.742
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    We present 2 cases of liver cirrhosis complicated with intramuscular hematoma. Case 1 was a 62-year-old man being treated for alcoholic liver cirrhosis. Abdominal pain developed after coughing, and a hematoma of the rectus abdominis muscle was detected on computed tomography (CT). A hematoma in the right femoral region also developed due to central venous puncture performed after admission. Anemia and liver failure progressed gradually, and the patient died. Case 2 was a 74-year-old man who was admitted to our hospital because of hepatic encephalopathy due to type C liver cirrhosis. Coughing associated with pleural effusion had persisted, but hematoma of the right flank developed suddenly. The patient's general condition worsened rapidly, and the patient died 2 days later. Intramuscular hematoma in patients with liver cirrhosis is fatal, and we report these cases because we believe they provide valuable clinical insight.
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  • A case of hepatic epithelioid hemangioendothelioma resulting in hepatic failure from tumor dissemination and spread
    Yutaka Sunose, Keitaro Hirai, Daisuke Yoshinari, Osamu Totsuka, Hiroyu ...
    Article type: Case Report
    2010 Volume 51 Issue 12 Pages 751-757
    Published: 2010
    Released on J-STAGE: December 29, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.751
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    A 27-year-old woman was referred to our hospital to investigate liver tumor. The laboratory tests revealed no abnormal finding in blood chemistry. Abdominal CT demonstrated irregular tumor located in the surface of the bilateral hepatic lobe. PET-CT demonstrated no abnormal FDG-accumulation. Histological findings from tumor biopsy showed epithelioid shaped tumor cells with immunohistochemically positive for factor VIII-related antigen, CD31, CD34, and vimentin, and negative for cytokeratin and desmin. The tumor was diagnosed as epithelioid hemangioendothelioma. The patient received transarterial infusion chemotherapy, since curative resection was not possible. The patient did well with no symptom up to 2007. The liver function was deteriorated with tumor extension after 2008. The tumor occupied in the most lesion of the liver, and the patient was suffered with edema and ascites in 2009. On September 2009, her general condition was remarkably worsened, and she died of hepatic failure and peritoneal dissemination of the tumor.
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Short Communication
  • Transcatheter arterial chemotherapy with miriplatin for patients with hepatocellular carcinoma and Child-Pugh B liver cirrhosis
    Norihiro Imai, Kenji Ikeda, Yuya Seko, Miharu Hirakawa, Yusuke Kawamur ...
    Article type: Short Communication
    2010 Volume 51 Issue 12 Pages 758-760
    Published: 2010
    Released on J-STAGE: December 29, 2010
    DOIhttps://doi.org/10.2957/kanzo.51.758
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    Miriplatin is a novel lipophilic platinum complex developed to treat hepatocellular carcinoma (HCC). Although HCC patients frequently have coexisting severe liver cirrhosis, there is no prospective data regarding clinical toxicity of miriplatin in HCC patients with severe cirrhosis. We retrospectively evaluated the safety and efficacy of transcatheter arterial chemotherapy with miriplatin in 34 HCC patients with severe liver cirrhosis (Child-Pugh grade B). An anti-tumor effect of complete response was achieved in 8 of 34 patients and no serious adverse events were observed. These results suggested that transcatheter arterial chemotherapy with miriplatin can be used safety for HCC patients with Child-Pugh B liver cirrhosis.
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