Kanzo

Original Article

Bipolar percutaneous radiofrequency ablation of liver cancers: Report of an initial experience

Yuji Eso, Yukio Osaki, Tadashi Inuzuka, Sooki Kim, Azusa Sakamoto, Sum ...

2013 Volume 54 Issue 9 Pages 577-588
Published: September 20, 2013
Released on J-STAGE: October 22, 2013

DOIhttps://doi.org/10.2957/kanzo.54.577

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[Background] Percutaneous radiofrequency ablation (RFA) is widely accepted as standard therapy for small liver cancer. RFA has been performed by monopolar devices in Japan, but bipolar RFA device has also been used overseas since 2003. [Methods] We treated 27 patients with 33 small liver tumors by bipolar RFA devise (CelonPOWER system) and evaluated the efficacy and safety of the CelonPOWER system. [Results] Among 33 tumors, the percentage of tumors obtained enough ablative margin by 1st RFA was 84.8% (28/33). Four tumors without enough ablative margin by 1st RFA were all able to obtain enough ablative margin by additional RFA sessions. Among 31 tumors that obtained enough ablative margin, 2 tumors (6.5%) developed local recurrence during the observation period (average: 13.8 months). Postoperative complication requiring additional treatment was observed only in one patient (3.7%). [Conclusions] The CelonPOWER system was considered to be an effective and safe next-generation RFA devise.

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Case Reports

A case of sarcomatous intrahepatic cholangiocarcinoma with a history of transcatheter arterial chemoembolization

Osamu Jindou, Shohachi Suzuki, Kazuhiko Fukumoto, Keisuke Inaba, Hidet ...

2013 Volume 54 Issue 9 Pages 589-599
Published: September 20, 2013
Released on J-STAGE: October 22, 2013

DOIhttps://doi.org/10.2957/kanzo.54.589

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Herein, we report a case of intrahepatic cholangiocarcinoma (ICC) with sarcomatous change. A 61-year-old woman was referred to our hospital for a rapidly growing hepatic tumor in segment (S) 4 of the liver with presence of peritoneal disseminated lesions. She had previously suffered from chronic hepatitis B. In December 2009, hepatocellular carcinomas (HCCs) were detected in S3 and S4 and treated by transarterial chemoembolization. In February 2011, HCC recurred in S3, and it was treated with radiofrequency ablation (RFA). In May 2011, computed tomography revealed an inhomogeneously enhancing tumor in S4 and inferior phrenic peritoneal nodules. These lesions seemed to result from HCC recurrence and peritoneal dissemination. We performed left hepatic lobectomy and resection of the nodules. Histopathological examinations revealed that the tumor in S4 was an ICC with sarcomatous change, having various histological characteristics such as spindle and pleomorphic cells, and that the RFA scar in S3 was necrotized with presence of a slightly viable HCC. The tumor recurred 2 months after surgery, and the patient died 8 months after surgery. ICC with sarcomatous change is rare and is associated with a poor prognosis because of early recurrence.

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Patient with drug-induced hepatic injury caused by long-term administration of an angiotesin II receptor antagonist, losartan

Yuki Fujise, Masahiko Koda, Satoshi Kuwamoto, Kenichi Miyosi, Manabu K ...

2013 Volume 54 Issue 9 Pages 600-606
Published: September 20, 2013
Released on J-STAGE: October 22, 2013

DOIhttps://doi.org/10.2957/kanzo.54.600

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A woman in her fifties who had been receiving losartan for six years was admitted to our hospital with suspected dermatomyositis and acute liver injury. Laboratory data revealed marked elevation of both aspartate aminotransferase and alanine aminotransferase. The drug-lymphocyte stimulation test for losartan was positive. Liver biopsy showed moderate fat deposition in the hepatocytes, apoptosis, portal inflammation, and infiltration with lymphocytes and eosinophils. After cessation of losartan administration, the liver injury gradually and slowly recovered. According to the diagnostic scale proposed at the Digestive Disease Week-Japan 2004, her liver injury was classified with a high possibility as hepatocellular injury type. Taken together, the liver injury was diagnosed as losartan-induced hepatic injury. Herein, we report a case of drug induced liver injury after long-term administration of losartan, and review the literature for similar cases.

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A case of hepatocellular carcinoma that has shown normal AFP level and elevated AFP-L3 fraction level measured by highly sensitive assay for 3 years before the clinical diagnosis

Mutsuumi Kimura, Itaru Ozeki, Yoshiyasu Karino, Tomohiro Arakawa, Tomo ...

2013 Volume 54 Issue 9 Pages 607-613
Published: September 20, 2013
Released on J-STAGE: October 22, 2013

DOIhttps://doi.org/10.2957/kanzo.54.607

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A 65-year-old woman was diagnosed as having chronic hepatitis B and treated with interferon. However her disease progressed to cirrhosis and then she was treated with lamivudine. Because she developed resistance to lamivudine, combination therapy of lamivudine and adefovir, and then adefovir and entecavir was introduced. Afterwards along with decrease of serum HBV DNA level, sustained normalization of serum alanine aminotransferase was obtained. But by periodical CT and MRI, 10 mm sized of classical hepatocellular carcinoma (HCC) was diagnosed in segment 3 of her liver. At the time of diagnosis, AFP (26.5 ng/ml) and AFP-L3 fraction (48.0%) showed abnormal high value and PIVKA-II was within normal value. Surgical resection of hepatic lateral segment was carried out, and the pathological findings showed well differentiated HCC. Using stored serum, AFP and AFP-L3 fraction, which measured by the highly sensitive assay, revealed that her AFP-L3 fraction level has been abnormally high before the clinical diagnosis of HCC for three years in spite of normal AFP level. By the highly sensitive assay, some patients show high AFP-L3 fraction level prior to the elevation of AFP level and the clinical diagnosis of the HCC, and it was thought to be a useful marker which extracts the high risk group of the HCC.

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Cell-free concentrated ascites reinfusion therapy for refractory ascites associated with alcoholic liver cirrhosis

Hanae Yamada, Yusuke Kajiyama, Kentaro Kikuchi, Toshiki Kumazaki, Atsu ...

2013 Volume 54 Issue 9 Pages 614-619
Published: September 20, 2013
Released on J-STAGE: October 22, 2013

DOIhttps://doi.org/10.2957/kanzo.54.614

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A 58-year-old man was admitted to the hospital because of ascites due to alcohol-related cirrhosis, which was refractory to salt-restricted diet and diuretics. He showed no improvement even after the administration of albumin preparation and developed hepatic encephalopathy due to intravascular volume depletion. Ascites decreased when cell-free concentrated ascites reinfusion therapy (CART) was introduced, without developing hepatic encephalopathy. After introducing temperance guidance, the serum albumin level increased from 2.4 g/dl to 3.6 g/dl and the Child-Pugh score improved from 12 points to 6 points. CART is defined in the clinical practice guideline for liver cirrhosis in Japan that it is as effective as total paracentesis but would not improve the prognosis. However, it was considered from this case that CART is useful for refractory ascites with decompensated cirrhosis because CART do not occur hepatic encephalopathy.

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A male case of autoimmune hepatitis with a episode of hepatocellular carcinoma after long-period steroid therapy

Ken Nakamura, Shinya Fukunishi, Hideko Ohama, Tetsuya Sujishi, Yusuke ...

2013 Volume 54 Issue 9 Pages 620-627
Published: September 20, 2013
Released on J-STAGE: October 22, 2013

DOIhttps://doi.org/10.2957/kanzo.54.620

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A 77-year-old man was diagnosed as having autoimmune hepatitis (AIH) by a local doctor. He received steroid therapy for 13 years and his liver dysfunction improved. At local examination, his serum PIVKA-II was elevated to 120 mAU/ml and both ultrasonography and computed tomography showed a mass lesion in the S4 region (about 2 cm in diameter). Abdominal angiography performed in our department also detected radiographic evidence of tumor vasculature in the same region. TACE, CTAP, and CTHA were then performed. These imaging studies indicated that the mass lesion was a hepatocellular carcinoma (HCC), and a hepatic subsegmentectomy (S4) was performed. The resected specimen from the tumorous lesion showed a moderately differentiated HCC. Here, we report the case of a male with AIH accompanied by a HCC that occurred in the setting of a near-normal liver function due to suppression of the immune system by long-term steroid therapy.

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Two cases with long-term survival following hepatocellular carcinoma with tumor thrombus invasion of the inferior vena cava, after multidisciplinary therapy including surgery

Noriyuki Oba, Takahumi Kurokami, Joji Iseki, Masakazu Takagi, Masaya W ...

2013 Volume 54 Issue 9 Pages 628-634
Published: September 20, 2013
Released on J-STAGE: October 22, 2013

DOIhttps://doi.org/10.2957/kanzo.54.628

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Case 1: A 73-year-old man underwent right hepatectomy, including removal of a tumor thrombus that extended to the right atrium. Bone metastasis was found 29 months postoperatively; however, it was well controlled by radiotherapy and chemotherapy. Presently, five years after the surgery, the patient is symptom free and leading a normal life. Case 2: A 67-year-old man underwent extended left hepatectomy and tumor thrombectomy. Since many liver metastases were found during the operation, transarterial chemotherapy was administered. He has no signs of disease 58 months postoperatively. A possible explanation for the good survival time in these patients involves the resection of the large tumors and tumor thrombi that might have otherwise been symptomatic and exerted harmful effects on the patients, accompanied by treatments for recurrent or remaining lesions that were highly effective. Therefore, multidisciplinary approaches, including surgical procedures, are thought to be the most effective treatments for hepatocellular carcinoma with tumor thrombus extending into the inferior vena cava.

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Short Communication

Evaluation of unenhanced and contrast-enhanced ultrasonography for advanced hepatocellular carcinoma treated with sorafenib

Kazue Shiozawa, Manabu Watanabe, Takashi Ikehara, Yasushi Matsukiyo, ...

2013 Volume 54 Issue 9 Pages 635-638
Published: September 20, 2013
Released on J-STAGE: October 22, 2013

DOIhttps://doi.org/10.2957/kanzo.54.635

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To evaluate the sonographic changes observed in hepatocellular carcinoma (HCC) post sorafenib. Sixteen advanced HCC patients received sorafenib and were studied with unenhanced ultrasonography (US) and contrast-enhanced ultrasonography (CEUS) using Sonazoid at before and less than 4 weeks after treatment. Changes in US findings and Micro Flow Imaging (MFI) findings by CEUS were evaluated. MFI findings were classified Fine, Vascular, and Irregular. Response was as follows D (at least a 30%decrease in the major axis of diameters of intratumoral arterial enhancing target lesion) (n=8), I (at least a 20%increase in the minor axis of diameters of intratumoral arterial enhancing target lesion) (n=6), S (other case; stable) (n=2). MFI findings changed Vascular to Fine 3 on D, Fine to Vascular 2, and Vascular to Irregular 2 on I. MFI findings by CEUS are suggested to be useful for evaluating early responses to sorafenib.

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