Kanzo

Case Reports

A case of hepatocellular carcinoma maintained a long partial response by low dose sorafenib with sever chronic renal dysfunction

Yuji Ishihara, Naomi Sugimura, Noriyuki Horiguchi, Koki Asukai, Hiroki ...

2013 Volume 54 Issue 8 Pages 529-534
Published: 2013
Released on J-STAGE: September 02, 2013

DOIhttps://doi.org/10.2957/kanzo.54.529

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A 65-year-old male with HCV-positive hepatocellular carcinoma (HCC) and right renal cell carcinoma was simultaneously treated by surgical resection. During follow-up, a solitary recurrence was found and cured by the radiofrequency ablation, but around then chronic renal failure as a complication of diabetes mellitus was getting worse up to 5.39 mg/dl at the serum creatinine, abbreviated as sCr below, and considered to introduce into hemodialysis (HD). However, MRI examination revealed multiple recurrence of liver, the plan of introducing into HD was quitted, and the interventional therapy under the angiography was also given up. As the patient's liver function was the level of Child-Pugh A, the treatment with solafenib was made a plan in hospital. After admitted, he was treated with sorafenib at a starting dose of 400 mg/day in consideration of renal dysfunction. Seven days after initiation, the dose was reduced to 200 mg/day because of appearing the grade 3 level of diarrhea. At 5 months after the administration of sorafenib, tumor markers, of which AFP and PIVKA-II were maximally at 3774 ng/ml and 14995 mAU/ml respectively were remarkably decreased to the normal level. MRI examination demonstrated the reduction of HCCs in size, and the therapeutic effect was considered as partial response by Response Evaluation Criteria in Solid tumors (RESIST). The enhanced ultrasonography showed no sign of blood flow in all of tumors, suggesting as a remarkable response to sorafenib. Of notice, the level of sCr was gradually down after use of sorafenib (sCr: 1.45 mg/dl at March-13). Sorafenib treatment has been continued with dose of 200 mg/day, and the tumor markers have been kept within normal limit even now.

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A case of multiple hepatocellular carcinoma with inferior vena cava thrombosis which was resectable after multimodality therapy

Takashi Nishimura, Kaoru Tsuchiya, Hiroyuki Nakanishi, Jun Itakura, Yu ...

2013 Volume 54 Issue 8 Pages 535-542
Published: 2013
Released on J-STAGE: September 02, 2013

DOIhttps://doi.org/10.2957/kanzo.54.535

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A 56-year old man with chronic hepatitis B was diagnosed as multiple hepatocellular carcinoma (HCC) with inferior vena cava invasion. Liver function was Child-Pugh class A. Sorafenib was administered after irradiation of HCC invasion into inferior vena cava. CT scan, one month after the start of sorafenib revealed a stable disease by modified RECIST criteria but new leisions appeared. Therefore, treatment was switched to a combination chemotherapy of intra-arterial 5-fluorouracil (5FU) and systemic interferon-α (IFN-α). After four cycles of chemotherapy, HCC reduced in size considerably, the number of viable HCC was reduced to two, and there was no viable HCC in inferior vena cava. At this time, residual HCC was successfully resected by radical surgery. The present case suggest the possibility that, in case with preserved liver function, multimodality therapy including radiation, sorafenib and intra-arterial chemotherapy may prolong survival of selected patients with advanced HCC.

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A case of chronic hepatitis C showing an extremely low level of ALT by the presence of Apo-type ALT who received the antiviral therapy

Kazuo Okumoto, Takafumi Saito, Tomohiro Katsumi, Kyoko Tomita, Chikako ...

2013 Volume 54 Issue 8 Pages 543-547
Published: 2013
Released on J-STAGE: September 02, 2013

DOIhttps://doi.org/10.2957/kanzo.54.543

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A sixty-five-year old man, who suffered from chronic hepatitis C, was admitted to our hospital. The serum ALT level was extremely low showing 2 (U/L). The liver biopsy demonstrated chronic hepatitis with mild inflammation and fibrosis (A1/F2). The serum level of ALT became 36 U/L after addition of pyridoxal phosphate to the assay, this indicated that the ALT of this patient represented an Apo-type one which could not be detected by the current assay system in Japan. The patient received administration of pegylated interferon-α2a for 12 weeks, and a sustained virological response was achieved. We have to pay attention to the patients of chronic hepatitis C showing an extremely low level of ALT, because they may have Apo-type ALT that is not measured in the routine assay in Japan.

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A case of liver abscess caused by Fusobacterium species in an immunocompetent patient with periodontitis

Satoshi Fujita, Kaname Yoshizawa, Yasuhiro Maruyama, Masafumi Maruyama ...

2013 Volume 54 Issue 8 Pages 548-552
Published: 2013
Released on J-STAGE: September 02, 2013

DOIhttps://doi.org/10.2957/kanzo.54.548

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A 42-year-old man with no history of severe infections or diabetes mellitus was referred to our hospital because of fever, and general fatigue. Computed tomography revealed a single liver abscess. Fusobacterium species was isolated from liver aspirates. Fusobacterium species are anaerobic gram-negative bacilli found in normal flora of oral cavity, gastrointestinal tract and uro-genital tract. Only a few cases of liver abscess by Fusobacterium have been reported. We surveyed colon and oral cavity. He had no dental symptoms. However, periodontitis was diagnosed and the extraction of a tooth was performed. Systemic survey should be required to find the cause of liver abscess even in an immunocompetent patient.

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Two cases of acute liver failure caused by hepatitis A which were negative for serum IgM-HA antibody at the early stage of the onset

Masaru Muraoka, Masayuki Kurosaki, Shuya Matsuda, Toru Nakata, Yuichir ...

2013 Volume 54 Issue 8 Pages 553-558
Published: 2013
Released on J-STAGE: September 02, 2013

DOIhttps://doi.org/10.2957/kanzo.54.553

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Two patients had acute liver failure which was caused by hepatitis A. They were negative for serum IgM-HA antibody on admission. Patient 1 was the 27-year-old woman, and her liver dysfunction recovered by conservative treatment only. She was negative for serum IgM-HA antibody at the fifth day after the onset of the symptoms, but positive at the sixteenth day. Patient 2 was the 63-year-old man. We gave him plasma exchange three times, and rescued him. He was negative for serum IgM-HA antibody at the seventh day after the onset of the symptoms, but positive at the fourteenth day. Patients with acute liver dysfunction may be negative for serum IgM-HA antibody at the early stage of the onset, so we should check their serum IgM-HA antibody again if we suspect that their liver dysfunction is caused by hepatitis A clinically.

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Short Communications

Is the frequency of screening for hepatitis B infection after educational intervention improving?: Comparison with left ventricular function testing

Toshihiko Kirishima, Yuki Kawamoto, Naoki Okamoto, Koji Takai, Takayuk ...

2013 Volume 54 Issue 8 Pages 559-562
Published: 2013
Released on J-STAGE: September 02, 2013

DOIhttps://doi.org/10.2957/kanzo.54.559

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Hepatitis B virus (HBV) reactivation is a complication of chemotherapy. But the frequency of testing for HBV before chemotherapy was low. An educational intervention was delivered to the oncology team. Of 98 new patients who received chemotherapy, 24.5% underwent HBsAb or anti-HBcAb screening before chemotherapy. But 89.2% of 65 patients who received cardiotoxic chemotherapy underwent LVF test. After educational intervention, the frequency of HBV testing increased to 76.8% of 155 patients received chemotharapy, but still fell short of LVF testing. An intervention resulted a modest improvement. To increase the frequency of HBV screening before chemotharapy, we feel that additional education of HBV reativation in solid tumor.

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The factors for prolonging the prognosis in Sorafenib therapy for hepatocellular carcinoma with extrahepatic metastasis

Atsushi Hiraoka, Nobuaki Azemoto, Akiko Shiraishi, Yuusuke Imai, Haruk ...

2013 Volume 54 Issue 8 Pages 563-566
Published: 2013
Released on J-STAGE: September 02, 2013

DOIhttps://doi.org/10.2957/kanzo.54.563

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Aim/background: Prognosis of hepatocellular carcinoma with extrahepatic metastasis (IVb) was reported less than 6 months. Sorafenib (NEX) is an only established therapy for IVb. We evaluated the clinical factors of IVb treated with NEX for prolonging prognosis.
Method/Patients: Clinical backgrounds of 23 IVb were investigated (Average age; 66.4 years old), retrospectively.
Results: All were Child-Pugh A. In 8 cases, NEX was continued after progressive disease (PD). One year survival rate of them were 58% and average period of treating with NEX beyond PD was 327 days. There was a tendency that NEX was abandoned in IVb with portal vein tumor thrombosis (PVTT) at early timing.
Conclusion: Continuing NEX after becoming beyond PD can be a therapeutic option to improve the prognosis in IVb without PVTT.

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