Kanzo

Original Article

The status of polycystic liver disease in Japan: a questionnaire survey of patients

Koichi Ogawa, Kiyoshi Fukunaga, Tomoyo Takeuchi, Naoki Kawagishi, Masa ...

Article type: Original Article
2011 Volume 52 Issue 11 Pages 709-715
Published: 2011
Released on J-STAGE: November 29, 2011

DOIhttps://doi.org/10.2957/kanzo.52.709

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Polycystic liver disease (PLD) is genetic disorder characterized by the progressive development of multiple liver cysts. Because of rarity of PLD, therapeutic consensus is controversial. The aim of this study was to investigate a situation of PLD treatment by a questionnaire survey. In this study, 422 patients with PLD participated, and 223 patients underwent treatment. The most common symptom was abdominal distension (73%). The treatments were performed as follows; percutaneous aspiration in 27% of patients, liver resection in 12%, cyst fenestration in 9%, and liver transplantation in 3%. The efficacies of these treatments were recognized in 77%, 96%, 92%, and 100% of each patient, respectively. Because of no effect of primary therapy, additional treatment was performed in only 4.3% of patients. In general, the choice of primary treatment for PLD was considered reasonable and proper, in Japan.

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Case Reports

A case of alpha-fetoprotein-producing adenocarcinoma of the endometrium with hepatoid component detected by elevated serum alpha-fetoprotein in chronic hepatitis C patient

Yoko Maekawa, Soo Ryang Kim, Susumu Imoto, Taisuke Nakajima, Kenji And ...

Article type: Case Report
2011 Volume 52 Issue 11 Pages 716-721
Published: 2011
Released on J-STAGE: November 29, 2011

DOIhttps://doi.org/10.2957/kanzo.52.716

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We describe a case of α-fetoprotein (AFP)-producing adenocarcinoma arising from the uterine endometrium in a 64-year-old woman with chronic hepatitis C. The patient started peginterferon α-2b and ribavirin therapy in August 2008 when the serum AFP level was 4.58 ng/mL. HCV RNA negativity was attained after 12 weeks. Thereafter, the serum AFP level rose continuously, however: AFP 69.7 ng/mL and lens culinaris agglutinin-reactive fraction of AFP (AFP-L3) 88.8% at 24 weeks after the start of treatment. Hepatocellular carcinoma was not detected, however, and imaging studies revealed an 11×8×7 cm cystic tumor in the pelvic cavity. Radical hysterectomy and partial ovariectomy were carried out. Histological studies showed AFP-positive hepatoid adenocarcinoma cells with eosinophilic cytoplasm and hyaline globules in some portion of the endometrium. After the surgery and six subsequent courses of weekly administration of carboplatin and paclitaxel, serum levels of AFP and AFP-L3 dropped within normal ranges.

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A female patient developing hepatocellular carcinoma 4.5 years after sustained virological response to interferon therapy for chronic hepatitis C: Comparison with cases of male patients

Manri Kawakami, Yasuhiro Umekawa

Article type: Case Report
2011 Volume 52 Issue 11 Pages 722-731
Published: 2011
Released on J-STAGE: November 29, 2011

DOIhttps://doi.org/10.2957/kanzo.52.722

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We report on a female case who developed hepatocellular carcinoma (HCC) 4.5 years after sustained virological response (SVR) to interferon (IFN) therapy for chronic hepatitis C. A 69-year-old Japanese woman achieved SVR to IFN-β therapy for chronic hepatitis C of histological stage F3/A2. 4.5 years later, HCC of 2.3 cm in diameter was found and she received liver resection. The histological examination of the resected specimen showed a moderately differentiated HCC with surrounding non-cancerous tissues of improved fibrosis and inflammation (F2/A1). Hepatitis B virus was suspected to be related to carcinogenesis. HCC developing after SVR to IFN therapy for chronic hepatitis C are reportedly common in male patients, but rare in female patients.

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Two cases of recurrent hepatocellular carcinoma that progressed rapidly in an unusual manner after radiofrequency ablation combined with transcatheter arterial infusion chemotherapy

Nao Fushiya, Yoshifumi Masui, Hiroshi Onoda, Shigeto Murakami, Hisato ...

Article type: Case Report
2011 Volume 52 Issue 11 Pages 732-744
Published: 2011
Released on J-STAGE: November 29, 2011

DOIhttps://doi.org/10.2957/kanzo.52.732

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Case 1 was a 78 year-old man with alcoholic liver damage, hepatocellular carcinoma (HCC) showed a suspicious tumor in the region of 30 mm diameter segment 5/8 of the liver, but its tumor on CT and MRI images was atypical HCC, was close to the portal vein and hepatic vein. His laboratory data showed an increase in lens culinaris agglutinin A-reactive alpha-fetoprotein (AFP-L3) and protein induced by vitamin K antagonist-II (PIVKA-II). This tumor has been diagnosed with HCC by abdominal angiography, will be preceded by lipiodol-transcatheter arterial infusion chemotherapy (Lip-TAI), underwent radiofrequency ablation therapy (RFA) and percutaneous ethanol injection therapy (PEIT). This tumor exacervated showing a tumor thrombosis in the right portal vein anterior branch after 4 months. This tumor spread gradually that he passed away after 9 months.
Case 2 was a 67 year-old man with liver cirrhosis due to hepatitis C virus and alcohol, HCC detected a tumor in the region of 30 mm diameter segment 6 of the liver, and its tumor on CT image was unclear boundaries, was close to the right portal vein posterior-inferior branch. He had elevated alpha-fetoprotein and AFP-L3 and PIVKA-II. This tumor were treated with Lip-TAI, underwent RFA. This tumor was rapid progress showing a tumor thrombosis in the right portal vein anterior and posterior branch after 4 months. He occurred to a rupture of esophageal varices after 7 months, in the aftermath progressed liver failure, and his death 9 months later. Treatment of HCC is important to understand in detail the nature of the tumor and localization by utilizing the history of tumor markers and various imaging, to determine the therapeutic strategy whether internal or surgical therapy to guess the grade of the tumor, histological degree of differentiation and macroscopic type and the possibility of vascular invasion.

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Hereditary hemochromatosis in a male patient with TFR2 (1861_1872del12) gene mutation: the second biopsy 19 years after diagnosis

Miwa Kawanaka, Jun Nakamura, Yoshihito Oka, Tomonari Kimura, Daisuke G ...

Article type: Case Report
2011 Volume 52 Issue 11 Pages 745-752
Published: 2011
Released on J-STAGE: November 29, 2011

DOIhttps://doi.org/10.2957/kanzo.52.745

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A 68-year old male patient with TFR2 hemochromatosis underwent the second assessment. At the age of 50 years, he already had liver cirrhosis. He was subjected to phlebotomy during the next 19 years and has developed neither diabetes mellitus nor heart failure. Compared with the first biopsy, the second one showed an improvement of iron deposit in hepatocytes and sinusoidal cells as well as of liver fibrosis, as assessed not only by AZAN stain, but also by elastica van Gieson stain and silver stain for reticulum fibers. The key is timing of diagnosis and continued treatment for patients with HH.

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Short Communications

Hepatitis B virus genotypes in a hyperendemic area for genotype B infection

Hisayoshi Watanabe, Takafumi Saito, Kyoko Tomita, Chikako Sato, Rika I ...

Article type: Short Communication
2011 Volume 52 Issue 11 Pages 753-755
Published: 2011
Released on J-STAGE: November 29, 2011

DOIhttps://doi.org/10.2957/kanzo.52.753

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To elucidate genotypes of HBV carriers in a hyperendemic area for HBV genotype B infection and to examine the changes over time in genotypes responsible for acute hepatitis B, 430 HBsAg-positive HBV carriers were determined by genotypes and compared the literal translation of infection status according to two time-period groups: a group seen between 1990 and 1999 and a group seen between 2000 and 2009.
In total, 45% had genotype B and 35% had genotype C in both time-period groups, indicating no changes in genotypes over time. Among 34 acute hepatitis B patients, the percentage of genotype B was significantly lower in the present group (5.9%) than in the past group (58.8%), while the prevalence of genotype A tended to have increased in the last 10 years.
In conclusion, there was an increase in acute hepatitis B infection by genotype A in a hyperendemic area for genotype B infection, even though there was no large change of genotypes between the present and the past percentages of subjects. A nation-wide surveillance of HBV infection status is a matter of urgency in terms of the universal vaccination for HBV.

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The evaluation of the sensitivity between serum and plasma specimen for COBAS TaqMan HBV v2.0

Mariko Kobayashi, Fumitaka Suzuki, Yoshiyuki Suzuki, Norio Akuta, Hito ...

Article type: Short Communication
2011 Volume 52 Issue 11 Pages 756-757
Published: 2011
Released on J-STAGE: November 29, 2011

DOIhttps://doi.org/10.2957/kanzo.52.756

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The sensitivity in serum and plasma for HBV DNA was evaluated by using 104 clinical specimens from 52 patients who were treated with entecavir for ≥1 year and continued ALT levels ≤30 IU/l. The measurement employed the COBAS TaqMan HBV v2.0. Twenty-five specimens (24.0%) were detected from both serum and plasma, and 41 specimens (39.4%) were not detected from both. On the other hand, there were 32 specimens (30.8%) with detectable from plasma but undetectable from serum, and only 6 specimens (5.8%) with detectable from serum but undetectable from plasma. This result suggested the sensitivity of HBV DNA using plasma specimen is more sensitive than that of serum specimen with statistical significance (p<0.001).

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