Kanzo

Case Reports

A case with patient with hepatic epithelioid hemangioendothelioma treated with interleukin-2 and review of previous reports

Satoshi Hidaka, Atsushi Hiraoka, Yukoo Shimizu, Yuusuke Imai, Hiroki U ...

2013 Volume 54 Issue 2 Pages 103-111
Published: 2013
Released on J-STAGE: March 05, 2013

DOIhttps://doi.org/10.2957/kanzo.54.103

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A 49-year old Japanese woman consulted a local doctor because of a high level of serum γ-GTP. Abdominal ultrasonography revealed multiple hypo-echoic lesions in the liver, and computed tomography showed multiple liver tumors and small nodules in the lung. A fine-needle liver biopsy was performed and the findings led to a diagnosis of hepatic epithelioid hemangioendothelioma with lung metastasis. We treated the patient with intravenous injections of interleukin-2 and the therapy has been well tolerated with minimal toxicity. We consider interleukin-2 to be a therapeutic option in such cases.

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A case report of the enlarged hepatic angiomyolipoma

Rie Sato, Nobuo Waguri, Yoshihisa Arao, Shunzo Igarashi, Toru Setsu, M ...

2013 Volume 54 Issue 2 Pages 112-119
Published: 2013
Released on J-STAGE: March 05, 2013

DOIhttps://doi.org/10.2957/kanzo.54.112

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A 65-year-old female patient was referred to our institute for enlarged liver tumor in segment 2. Computed tomography demonstrated a 53-mm low-density tumor with faint heterogeneous enhancement. The tumor appeared as a high-intensity lesion on T1- and T2-weighted images of magnetic resonance imaging (MRI). A fat suppressed T1-weighted image (opposed phase) showed the tumor as a low-intensity lesion. The differential diagnoses were well-differentiated liposarcoma and hepatic angiomyolipoma. Hepatic lateral segmentectomy was performed, and histological examination of a surgically obtained specimen revealed hepatic angiomyolipoma. The tumor was enlarged, but its main component was a mature adipose tissue and the proliferative potential of the tumor was low. The course of the tumor size increase would provide valuable information.

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A case of acute hepatitis C with hepatitis C virus (HCV) genotype 3a -discussion of IL28-B-

Tomoki Kobayashi, Yoshiiku Kawakami, Akira Hiramatsu, Hidehiko Takigaw ...

2013 Volume 54 Issue 2 Pages 120-127
Published: 2013
Released on J-STAGE: March 05, 2013

DOIhttps://doi.org/10.2957/kanzo.54.120

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A 51-year-old man had a sexual relationship with a commercial sex worker in Thailand on a business trip. After returning to Japan, he saw a doctor because of fever and jaundice, feeling of fullness. He was admitted to the hospital because of liver dysfunction and abdominal dropsy on a diagnosis of acute hepatitis. Laboratory findings showed positive for anti-HCV as well as HCV RNA but negative for other virus markers. Thus he was diagnosed as having acute hepatitis C. Higher spontaneous clealance of HCV and sensitive for IFN therapy was expected due to HCV genotype 3a and IL28B (rs8099917) TT genotype. But he did not reach natural clealance of HCV. He was treated with pegylated interferon α2b and ribavirin therapy for 24weeks and attained sustained virological response finally. IL28B genotype assessment might be helpful in deciding the suitable management and treatment of acute HCV infection, but further accumulation and analyses of the future cases are necessary in the genotype 3.

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A case of recurrent hepatocellular carcinoma with obstructive jaundice treated successfully with biliary drainage and sorafenib

Tsukasa Aihara, Hiroya Iida, Munehumi Tomomatsu, Akihiro Maeda, Naohit ...

2013 Volume 54 Issue 2 Pages 128-134
Published: 2013
Released on J-STAGE: March 05, 2013

DOIhttps://doi.org/10.2957/kanzo.54.128

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A 73-year-old man who had previously undergone surgical therapy four times for hepatocellular carcinoma (HCC) was admitted for obstructive jaundice due to hilar and hepatoduodenal ligament lymph node metastases. Firstly, he was treated with endoscopic biliary drainage. Although the serum total bilirubin level was still as high as 7.5 mg/dl and his Child-Pugh classification was grade C, we started to administer sorafenib (800 mg/day) because his Child-Pugh class had been grade A before jaundice and the tumors had grown on CT images. The patient showed no remarkable adverse events, and his serum bilirubin level decreased gradually. After sorafenib therapy for 7 months, the lymph node metastases declined in size on CT images and the alpfa-fetoprotein level decreased to 10 ng/mL from 165 ng/ml. This response persisting for more than a year was evaluated as Partial Response (PR) by Response Evaluation Criteria in Solid Tumors criteria (RECIST) and modified RECIST (mRECIST) criteria. Our case suggested that sorafenib therapy can be an alternative treatment for advanced HCC with obstructive jaundice in case with effective biliary drainage and good liver reserve (Child-Pugh A).

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A Case of hepatocyte nuclear factor 1α-inactivated hepatocellular adenoma, involving anomalous portal tract, difficult to be differentiated from FNH-like lesion

Katsuhiko Ito, Fukuo Kondo, Satoru Otawa, Takayuki Ishii, Yoshiaki Shi ...

2013 Volume 54 Issue 2 Pages 135-142
Published: 2013
Released on J-STAGE: March 05, 2013

DOIhttps://doi.org/10.2957/kanzo.54.135

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A 26-year man visited a nearby clinic because of epigastralgia and a large hepatic mass. He was referred to our hospital. According to the laboratory date, the levels of ALT, AST, WBC and CRP were increased. On the abdominal CT scan, the hepatic large mass was found in the S4 segment. The abdominal dynamic CT scan indicated no enhanced area on the central portion. The peripheral portion of the mass was irregularly enhanced. As various diagnosis containing hepatocellular carcinoma, hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) were suspected and bleeding from the tumor was possible, the patient underwent hepatectomy of left lobe. The hepatic large mass was completely encapsulated with a clear boundary and hematoma existed in the central portion of the mass. On the peripheral portion of the mass, there was benign liver tissue and anomaly of the portal tract. According to the clinical date and the pathology of anomalous portal tract, we firstly suspected FNH-like lesion. Ultimately, we diagnosed HCA according to the L-FABP immunostaining.
This case indicated the disparity in new immunohistochemical diagnosis and clinical diagnosis, at the point of presence of anomalous portal tract and absence of the characteristic, like pill, in hepatocellular adenoma.

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Two cases of hepatic angiomyolipoma with difficulty for imaging differential diagnosis with hepatocellular carcinoma

Iori Motoo, Terumi Takahara, Koushi Matsui, Hideto Kawabe, Kengo Kawai ...

2013 Volume 54 Issue 2 Pages 143-151
Published: 2013
Released on J-STAGE: March 05, 2013

DOIhttps://doi.org/10.2957/kanzo.54.143

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Case1 was a 79-year-old male with liver tumor. Dynamic CT showed a high density lesion in early phase and low in equilibrant phase. Gd-EOB-DTPA-enhanced MRI showed a high intensity lesion in arterial phase and a low intensity lesion in hepatobiliary phase. US-guided biopsy led to histopathological diagnosis as hepatic angiomyolipoma.
Case2 was a 40-year-old with liver tumor. Dynamic CT showed a high density lesion in early phase, low with coronal enhancement in portal phase and low in equilibrant phase. Gd-EOB-DTPA-enhanced MRI showed a high intensity area in arterial phase, low with coronal enhancement in portal phase and low in hepatobiliary phase. Both CT and MRI showed peritumoral coronal enhancement in portal phase. Histological diagnosis of laparoscopic surgery was hepatic angiomyolipoma. Immunohistochemical examination showed OATP was negative in the tumor but the cellular membranes of adjacent normal hepatocytes were positive. We also detected immunostaining of CD34 in the dilated vessels in fibrous capsule around the tumor and in the adjacent normal liver.

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A Case of primary hepatic neuroendocrine tumor with prominent calcification

Hajime Yamazaki, Kunihiko Tsuji, Hayato Shida, Akiko Tomonari, Hironor ...

2013 Volume 54 Issue 2 Pages 152-160
Published: 2013
Released on J-STAGE: March 05, 2013

DOIhttps://doi.org/10.2957/kanzo.54.152

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A 45-year old woman initially presented with a liver mass. Abdominal ultrasound revealed a 14 cm round mass with clear borders in the right hepatic lobe; the mass demonstrated both hyper- and hypoechogenicity with calcification and acoustic shadows. Abdominal computed tomography (CT) showed an expanding mass with a thin capsule, and it consisted of a non-enhanced, hypodense area with prominent calcification and an enhanced, solid peripheral area. Since no primary lesion had been found, the patient was diagnosed as having a primary hepatic malignant tumor for which right lobe hepatectomy was performed. Pathology results showed eosinophilic small tumor cells with trabecular and solid growth patterns with massive necrosis, myxomatous interstitium, and calcification. Immunohistochemical results demonstrated strongly positive synaptophysin and CD56. Primary hepatic neuroendocrine tumor (PHNET), therefore, was confirmed. The MIB-1 index showed 2% in most of the tumor but 5-10% in the rest, leading to a classification of PHNET grade 2. The patient had no recurrence of the mass twelve months post-operatively. This is a rare case of PHNET with prominent calcification.

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Short Communication

Simple method for predicting prognosis following transcatheter arterial chemo-embolization for switching to next therapy for advanced hepatocellular carcinoma without venous invasion or metastasis

Atsushi Hiraoka, Yuko Shimizu, Akiko Shiraishi, Yusuke Imai, Hiroki Ut ...

2013 Volume 54 Issue 2 Pages 161-163
Published: 2013
Released on J-STAGE: March 05, 2013

DOIhttps://doi.org/10.2957/kanzo.54.161

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Criteria for switching from transcatheter arterial chemo-embolization (TACE) to sorafenib or other chemotherapy in patients with hepatocellular carcinoma (HCC) resistant to repeated TACE have not been established. Herein, we propose an easy to implement method for such determination. One hundred six patients with advanced HCC (beyond Milan criteria) without venous invasion by the tumor or extra-hepatic metastasis and with good liver function (Child-Pugh A class) who were treated by repeated TACE from 2000 to 2011 were analyzed. We combined the scores for the tumor markers alpha-fetoprotein (AFP, ≥100 ng/mL), fucosylated AFP (AFP-L3, ≥10%), and protein induced by vitamin K absence-II (PIVKA-II, ≥100 mAU/mL) into a single prognostic marker, then added up the positive factors in each case. In patients with a score under 2, TACE could control HCC. When HCC is not controlled by TACE after the patient has a score of 2 or more points, switching to the next therapy should be considered.

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