Kanzo
Online ISSN : 1881-3593
Print ISSN : 0451-4203
ISSN-L : 0451-4203
Volume 59, Issue 1
Displaying 1-7 of 7 articles from this issue
Review Article
  • Yuji Nishikawa
    2018 Volume 59 Issue 1 Pages 7-22
    Published: January 20, 2018
    Released on J-STAGE: January 29, 2018
    JOURNAL FREE ACCESS

    Despite striking morphological and functional differences, hepatocytes and bile duct cells, composing the liver epithelial system, are derived from albumin-expressing hepatoblasts during development. To understand the pathogenesis of ductular reaction in chronic liver diseases, as well as of liver tumors, it is important to elucidate how these epithelial cells behave in disease states. Mature hepatocytes retain phenotypic plasticity to transdifferentiate into bile duct cells, which is triggered by microenvironmental changes, especially increases in collagenous matrix. Hepatocyte lineage tracing experiments in mice have revealed that ductular reaction in chronic liver diseases could be attributed to both transdifferentiation of hepatocytes at the injured area and robust remodeling of the exisiting bile duct system. Furthermore, an AAV8-mediated efficient hepatocyte lineage tracing system has unexpectedly provided evidence showing that regenerative nodules in cirrhosis may be formed by clonally proliferated hepatocytes, suggesting that hepatocytes may be heterogeneous in regard to the regenerating capacity in response to stimulation instigated by chronic injury. Transformation of hepatocytes in regenerative nodules is associated with dedifferentiation, which is characterized by reactivation of expression of the genes that are actively transcribed in fetal and neonatal livers. Using a mouse hepatocarcinogenesis model induced by hepatocyte-specific somatic integration of various oncogenes, primary liver cancers of hepatocytic origin have been shown to demonstrate widely varying degrees of phenotypic complexity, according to altered differentiation states of transformed hepatocytes via transdifferentiation and dedifferentiation.

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Original Articles
  • Ryuta Shigefuku, Tsunamasa Watanabe, Takuya Ehira, Hiroyasu Nakano, No ...
    2018 Volume 59 Issue 1 Pages 23-32
    Published: January 20, 2018
    Released on J-STAGE: January 29, 2018
    JOURNAL FREE ACCESS

    The aim of this study is to elucidate clinical features of pyogenic liver abscess (PLA) due to Fusobacterium (F-PLA). We report 9 F-PLA cases together with bibliographic consideration of previously reported in Japan. We diagnosed 9 F-PLA cased (7%) out of 125 PLA cases, from 1998 to 2017. Three cases were due to Fusobacterium species, 1 case was due to Fusobacterium necrophorum and 5 cases were due to Fusobacterium nucleatum. The median age was 76 year-old and male gender was predominated. Underlying diseases were intestinal disease, atrophic gastritis, pancreatic cancer, dental disease and pharyngitis. Notably, 6 cases of Fusobacterium nucleatum PLA with colorectal cancer were reported, and Fusobacterium necrophorum PLA patients are likely to be complicated by Lemièrre's syndrome, suggesting there might be different clinical features among different Fusobacterium species. All cases had good prognosis.

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  • Aya Sugiyama, Terumi Kaishima, Kazuaki Sakamune, Junko Tanaka
    2018 Volume 59 Issue 1 Pages 33-40
    Published: January 20, 2018
    Released on J-STAGE: January 29, 2018
    JOURNAL FREE ACCESS

    In this study the actual status of the hepatitis medical care coordinator (HMCC) was analyzed based on the study in Hiroshima and nationwide survey. In the study in Hiroshima, nurse (the HMCC of medical institutions) have most frequent opportunities to contact "carriers who were already hospitalized", however the public health nurse (the HMCC of local governments) have most frequent opportunities to contact "carriers who had been aware of being infected, but not consulted". Contents of their work were also different. In the nationwide survey, only 30-40% medical staffs recognized the HMCC. However, medical staffs who know the HMCC expected the effectiveness of the HMCC. In the nationwide survey, the works of the HMCC were also different depending on the types of job and facilities they belong to. The role of the HMCC should be classified based on their professions and notified to all.

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Case Reports
  • Wataru Jomen, Rie Okutsu, Tomoyuki Masuda
    2018 Volume 59 Issue 1 Pages 41-46
    Published: January 20, 2018
    Released on J-STAGE: January 29, 2018
    JOURNAL FREE ACCESS

    A 60-year-old woman, who had seen in a previous hospital with chief complaints of general malaise, abdominal bloating, weight gain, and metrorrhagia in August 201X, was referred to our hospital because of large ascites and elevated value of CA125. CT and transvaginal ultrasound imaging of gynecologic malignancy and ascitic fluid cytology were all negative. Her liver function had been impaired since the initial visit, but elevated level of ANA and IgG were observed after hospitalization. Histological changes obtained from liver biopsy, which was done after the management of ascites, were consistent with those of autoimmune hepatitis and cirrhosis. After treatment, CT showed ascites had disappeared in January 201X+1, and CA125 was reduced to normal level in May 201X+1.

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  • Masakazu Kobayashi, Kazuhiro Watanabe, Hiroshi Oota, Yoshiyuki Takahas ...
    2018 Volume 59 Issue 1 Pages 47-55
    Published: January 20, 2018
    Released on J-STAGE: January 29, 2018
    JOURNAL FREE ACCESS

    A 49-year-old woman complained of general malaise and anorexia for the previous 4 months, a loss of body weight of 6 kg over 3 months, and the appearance of leg edema during the previous 1 month. Blood tests conducted by her local physician indicated hepatic disorder, and she was thus referred to our department. She had an AST level of 800 IU/L and ALT level of 641 IU/L, thus confirming hepatic disorder. Tumor markers were elevated, with an alpha-fetoprotein level of 103 ng/ml and a calcium 19-9 level of 65 U/ml.

    Abdominal ultrasonography showed an irregular shaped, iso-hypo echoic mass with an unclear tumor margin in left lobe of the liver. The results of computed tomography (CT) and magnetic resonance imaging (MRI) showed enhancement from the hepatic portal region to the center of the liver, which suggested the presence of a tumor. In addition, ascites and lymph node enlargement around the celiac artery were noted.

    Blood examination and symptoms improved while the patient was under observation, and the ascites resolved within 2 months. A liver biopsy led to the histological diagnosis of a hepatic inflammatory pseudotumor. This case is presented as a rare case of hepatic inflammatory pseudotumor involving severe hepatic dysfunction, ascites retention, and swelling of celiac lymph nodes.

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  • Hiromasa Horimoto, Hiroyuki Fujita, Kencho Miyashita, Kimiaki Miwa, Ka ...
    2018 Volume 59 Issue 1 Pages 56-64
    Published: January 20, 2018
    Released on J-STAGE: January 29, 2018
    JOURNAL FREE ACCESS

    An octogenarian female was admitted to our hospital with anorexia. Hematologic tests revealed the elevation of inflammatory response besides high ALP value. Computed tomography demonstrated ischemic liver mass with marginal contrast enhancement as 80 mm diameter. The tumor biopsy was performed and it resulted in no malignancy but also some kind of abscess. Although antibiotics was administered for a month, inflammatory reactions persisted and the size of the tumor increased gradually, therefore the biopsy was enforced again. The results indeed demonstrated the suspicion of sarcoma, so posterior segmentectomy of right hepatic lobe was operated. Histopathological analysis indicated sheet-like growing tumor cells with nuclear atypia, which were positive for vimentin and AE1/AE3. Final diagnosis was undifferentiated carcinoma of the liver (so called sarcomatoid carcinoma). Primary undifferentiated carcinoma of the liver is rare and often difficult to distinguish from liver abscess because of the inflammatory response and the similarity in imaging examination.

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Rapid Communication
  • Hiroko Iijima, Takashi Nishimura, Toshifumi Tada, Chikage Nakano, Tomo ...
    2018 Volume 59 Issue 1 Pages 65-67
    Published: January 20, 2018
    Released on J-STAGE: January 29, 2018
    JOURNAL FREE ACCESS

    Attenuation imaging (ATI) is a method to quantitatively assess steatosis by using fat attenuation technique that is installed on Aplio i800, an all-purpose ultrasound diagnostic device (Toshiba Medical Systems). We assessed the correlation between Controlled Attenuation Parameter (CAP) and ATI in 116 patients with chronic hepatitis. Two methods showed excellent correlation (Pearson's r=0.699, 95% CI 0.592-0.782). ATI can be used as a method to assess steatosis without a device dedicated to ATI method.

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