Kanzo

Original Articles

The choice of treatment and efficacy for the advanced hepatocellular carcinoma with inferior vena cava tumor thrombus (IVC-TT): a retrospective study

Takaaki Sugihara, Masahiko Koda, Toshiaki Okamoto, Kenichi Miyoshi, To ...

2016 Volume 57 Issue 5 Pages 205-212
Published: May 20, 2016
Released on J-STAGE: May 31, 2016

DOIhttps://doi.org/10.2957/kanzo.57.205

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Background/Aims: The prognosis of hepatocellular carcinoma (HCC) with tumor thrombus in inferior vena cava (IVC-TT) is extremely poor. We retrospectively evaluated the efficacy of trans-arterial treatment and prognosis in these cases. Methods: Between May 2004 and March 2013, a total of 10 patients (median age 69, range: 62-82, 9 males and 1 female) were diagnosed as HCC with IVC-TT and treated with trans-arterial treatment. Results: These patients underwent trascatheter arterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC) and combination with TACE and HAIC (TACE: HAIC: TACE+HAIC=1 : 6 : 3). One patient was also treated with radiation therapy in combination with HAIC. Two patients were treated by sorafenib after treatment failure of the trans-arterial intervention. Disease control rate (TE2+TE4) was 40% (4/10). The median survival time was 11.6 months (1-72 months). Conclusions: Multidisciplinary treatment includes HAIC/TACE for HCC with IVC-TT may improve the prognosis.

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The transition of participants who received health check-up programs and had a positive result of viral hepatitis B or C, but didn't consult a hospital, for the last two decades

Akihiro Obora, Takao Kojima, Masahide Hamaguchi

2016 Volume 57 Issue 5 Pages 213-219
Published: May 20, 2016
Released on J-STAGE: May 31, 2016

DOIhttps://doi.org/10.2957/kanzo.57.213

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We aimed to clarify the prevalence of participants who didn't consult a hospital, although they received health check-up programs and had a positive result of hepatitis B or C. The study subjects were consisted with cumulative total number of 176,979 participants who received health check-up programs in Medical Health Check-up Center, Murakami Memorial Hospital, Asahi University. We calculated the prevalence of participants with positive results, and the prevalence of participants who didn't consult a hospital after receiving the positive result. As a result, the total positive rate of HBs antigen (B) was 1.45% and the total positive rate of anti-HCV antibody (C) was 0.96%, respectively. In regards with the basic characteristics of participants with HBs antigen or anti-HCV antibody, AST, ALT, ZTT were significantly higher and white blood cell count, platelet count, albumin, total bilirubin were significantly lower than those in apparently healthy participants. The prevalence of participants who didn't consult a hospital after receiving a positive result of viral hepatitis as follows; B/C=89.2/72.7% in 1995-1999, 84.2/68.7% in 2000-2004, 78.1/54.4% in 2005-2009, 77.3/47.4% in 2010-2014. The rate gradually decreased in chronological order. However, the rate was as high as 77.3/47.4% even in 2010-2014. Further medical action that is encouraged participants with a positive result of hepatitis B or C in the medical check-up programs to consult a hepatologist has been necessary to achieve the elimination of viral hepatitis.

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Case Reports

A case of liver abscess caused by Clostridium perfringens complicated with bleeding from abscess and hemorrhagic shock after percutaneous transhepatic abscess drainage

Haruyasu Ito, Yuriko Fujita, Satoshi Imamura, Tsuyoshi Ito, Yuya Tsuno ...

2016 Volume 57 Issue 5 Pages 220-226
Published: May 20, 2016
Released on J-STAGE: May 31, 2016

DOIhttps://doi.org/10.2957/kanzo.57.220

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A 54-years-old man was diagnosed as diabetes mellitus in 2007. He was admitted to our hospital because of a low back pain, vomiting and high fever. Laboratory data showed anemia, thrombopenia and jaundice. Computed tomography demonstrated a pneumatic abscess, 3.5 cm in diameter, in the right lobe of the liver. He was treated with antibiotic therapy and percutaneous transhepatic abscess drainage immediately. The fluid from the abscess cavity was bloody. Blood pressure was decreased suddenly while treating, since bleeding from abscess to abdominal cavity was suspected, transcatheter arterial embolization was performed. He died of rapid aggravation in spite of various treatments. Clostridium perfringens (C. perfringens) was detected by the blood culture water. Autopsy was perfomed. The puncture cavity did not cause vascular injury. Pathological findings showed that the vessel wall was destroyed, and the lumen of the blood vessel and liver abscess cavity were connected. The cause of his death was considered to be C. perfringens sepsis and hemorrhagic shock.

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A case of erythropoietic protoporphyria with severe liver damage

Moriyasu Anai, Shiho Miyase, Keiko Ishinuki, Natsumi Tsukano, Hirofumi ...

2016 Volume 57 Issue 5 Pages 227-232
Published: May 20, 2016
Released on J-STAGE: May 31, 2016

DOIhttps://doi.org/10.2957/kanzo.57.227

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This report describes a patient with erythropoietic protoporphyria (EPP) and severe liver damage. A 42-year-old man who had been diagnosed with EPP at age 10 years was admitted to our hospital for an EPP storm, accompanied by stomachache, constipation and jaundice. Laxatives under light shielding showed no improvement in symptoms and his total bilirubin was elevated to 17.1 mg/dl. Five days after admission, he was administered injections of hemin, an iron-containing protein used to manage porphyria attacks, for a further 5 days. Subsequently, his total bilirubin declined and his stomachache was relieved. Three months after hemin treatment, his liver function and jaundice normalized.

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A case of the hepatopathy developed prior to IgG4 related autoimmune pancreatitis

Nobuyuki Yamashita, Hidetaka Yamamoto, Seiji Oohashi, Hiroshi Miyagawa ...

2016 Volume 57 Issue 5 Pages 233-241
Published: May 20, 2016
Released on J-STAGE: May 31, 2016

DOIhttps://doi.org/10.2957/kanzo.57.233

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We report a case of IgG4-related liver disease. A woman in her 60s was admitted in our hospital, and was diagnosed with malignant liver tumor and gastric cancer. The liver mass was resected and histological examination revealed that infiltration of inflammatory cells, lymphoid follicles, and fibrosis were seen in portal tract. Many portal veins were narrowing and obstructed, and obstructive phlebitis was seen in central veins. IgG4-positive plasma cells were seen less than 25 per high power field, and the ratio of IgG4/IgG positive plasma cell was less than 20%. About a year later she developed autoimmune pancreatitis, therefore former hepatic lesion was thought to be IgG4-related disease, especially IgG4 hepatopathy. This is the first report, which found that IgG4 hepatopathy was developed prior to autoimmune pancreatitis.

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Resected intrahepatic cholangiocellular sarcoma: case report and review of literature

Akiko Toshimori, Atsushi Hiraoka, Akinori Asagi, Kimio Nakanishi, Hide ...

2016 Volume 57 Issue 5 Pages 242-251
Published: May 20, 2016
Released on J-STAGE: May 31, 2016

DOIhttps://doi.org/10.2957/kanzo.57.242

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A 41-year-old Japanese woman was referred to us for further examinations of continuous right hypochondralgia, low grade fever, and a hepatic tumor in the 8th segment (5.0 cm in diameter), suspected to be an abscess. Dynamic CT showed enhancement of the periphery of the tumor, as well as invasion to the diaphragm and lymph node swelling, while contrast enhanced abdominal ultrasonography (US) revealed the entire mass to be hypervascular with a partial avascular area. The hepatic tumor and swollen lymph nodes showed a high level of FDG uptake (SUVmax=13.7) in positron emission tomography/CT findings. Hepatic resection of the tumor was performed as palliative treatment and it was diagnosed as a cholangiocellular sarcoma, which is a special type of cholangiocellular carcinoma (CAM5.2+, vimentin+, CK7+, CK19-, hepatocyte-, desmin-, SMA-). Sixteen months after resection, the patient was being treated with supportive care, following progressive disease treatment with chemotherapy.

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A case of synchronous double cancer of liver metastasis of thymoma and hepatocellular carcinomas, 10 years after achieving sustained virological response treated with peginterferon/ribavirin in chronic hepatitis C virus infection

Yushi Kimura, Kunihiko Tsuji, Takeshi Matsui, Kazunari Tanaka, Jong-Ho ...

2016 Volume 57 Issue 5 Pages 252-259
Published: May 20, 2016
Released on J-STAGE: May 31, 2016

DOIhttps://doi.org/10.2957/kanzo.57.252

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We describe a case of synchronous double cancer of liver metastasis of thymoma and hepatocellular carcinomas. A 70s female achieving sustained virological response treated with peginterferon/ribavirin in chronic hepatitis C virus infection 10 years ago was pointed out four liver tumors on abdominal computed tomography (CT) and magnetic resonance imaging. Chest CT showed an anterior mediastinal tumor suspicious for thymoma. Liver biopsy was done from the largest liver tumor, and after that, video-assisted thoracoscopic thymectomy was performed. Histopathological diagnosis was thymoma which was corresponded to the result of liver biopsy. After surgery, chemotherapy was performed, however, it was ceased because of side effect. There were no new liver tumors, so four liver tumors were resected. Final diagnosis of the largest liver tumor was metastasis of thymoma and that of the other three liver tumors were hepatocellular carcinomas.

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