We report a rare case of complete spontaneous necrosis with residual intrahepatic metastasis of hepatocellular carcinoma in viable status. A 59-year-old man followed because of alcoholic liver dysfunction was referred to our hospital for liver tumor. Abdominal MRI and CT showed tumor with 1.5 cm diameter in segment 8 of the liver, and hepatocellular carcinoma was diagnosed. Segmentectomy 8 was performed. In the resected specimen, the nodule had clear border recognized as hepatocellular carcinoma. Histopathological findings showed that the nodule with clear border was replaced granulation tissue and had no viable cancer cell. Another lesion of moderately differentiated hepatocellular carcinoma with 0.2 cm diameter was indicated near the nodule unconnectedly. These findings suggested that viable intrahepatic metastatic lesion just remained although the primary nodule became spontaneous necrosis.

A 45-year-old man was referred to our hospital because of pancytopenia and jaundice. He was diagnosed with acute promyelocytic leukemia (APL) because blast-like cells were detected in the peripheral blood and bone marrow accompanied by promyelocytic leukaemia-retinoic acid receptor alpha fusion gene. In addition, contrast-enhanced computed tomography and upper endoscopy revealed hemobilia caused by hepatocellular carcinoma (HCC). Remission induction therapy for APL using all-trans-retinoic acid was effective and hematological remission was confirmed 1 month after the admission. Because hemobilia caused by HCC spontaneously arrested, transarterial chemoembolization (TACE) for HCC was subsequently conducted. Although the patient maintained hematological remission of APL in response to maintenance and consolidation therapy, TACE was repeatedly performed against recurrent HCC. Because lung metastasis was observed, sorafenib was administered 8 months after the diagnosis. However, he died of HCC rupture 3 months after the start of systemic chemotherapy.

We report an acute hepatitis E complicated with primary biliary cholangitis (PBC). A 55-year-old male who had been histologically diagnosed PBC and had treated with ursodeoxycole acid and bezafibrate, was admitted to our institute due to jaundice and liver damage. Since he had liver damage with atypical lymphocytosis in examination of blood, we considered acute viral hepatitis had occurred with PBC. Liver biopsy revealed massive infiltration of neutrophils, but the cause of the acute hepatitis was not identified. We followed with supportive measures, his liver function improved immediately, and discharged the 13^th day after administrarion. It was revealed that he was positive for IgM and IgA antibodies against HEV as well as for HEV RNA of genotype 3b. Although acute hepatitis E is increasing in japan, there is no case which occurred with PBC. Therefore this case was considered quite unique.

A 54-year-old woman consulted our hospital due to epigastric pain. She lost her consciousness due to shock at outdoor-patient department. Abdominal dynamic CT suggested the existence of abdominal hematoma and two aneurysms in left hepatic artery.

Emergency transcatheter arterial embolization with catheter and coils was performed successfully and she was rescued.

Head plain MRI/MRA, which was examined for the screening of aneurysm of other part, revealed 3 cerebral aneurysms in her internal cervical artery and middle cerebral artery. The case of abdominal visceral aneurysms without local known cause such as trauma or infection in abdomen needs to seek aneurysms in other parts in their body, especially in intracranial part.

An 82-year-old man was found to have hepatopathy by periodic blood testing after cecal cancer surgery. Drug-induced hepatic injury was suspected; drug administration was thus discontinued. However, hepatopathy did not improve, making this possibility unlikely, and the patient was referred to our hospital for detailed examination. Hepatobiliary enzyme abnormalities were demonstrated. Hepatitis virus testing showed HA antibody-IgM, HBs antigen, HBc antibody, HCV antibody, etc., to be negative, while HCV-RNA was positive (5.4 LIU/mL). HCV antibody also later turned positive. Therefore, the patient was diagnosed with acute type C hepatitis. After the diagnosis, we expected that the hepatitis would subside but it persisted. Because the patient was too old for interferon treatment, asunaprevir and daclatasvir, oral anti-HCV drugs, were concomitantly administered, achieving a complete response. This important case suggests the utility of concomitant asunaprevir and daclatasvir administrations in patients with persistent acute type C hepatitis who would not tolerate interferon.