PIVKA-II is a tumor marker highly specific for hepatocellular carcinoma. We investigated the utility of Architect PIVKA-II, a chemiluminescent immunoassay, in 168 patients with liver disease (chronic hepatitis, n = 29; liver cirrhosis, n = 28; and hepatocellular carcinoma by stage: stage 1, n = 29; stage 2, n = 29; stage 3, n = 26; and stage 4, n = 27). Architect PIVKA-II was measured in preserved serum and compared with Lumipulse^® PIVKA-II and alpha fetoprotein (AFP) values measured that had been measured during patient evaluation. Both methods indicated increasing PIVKA-II levels with each higher stage of hepatocellular carcinoma. The diagnostic accuracy when combined with AFP was equivalent. Architect PIVKA-II has a diagnostic accuracy comparable to conventional tests in cases of hepatocellular carcinoma and should be useful in clinical practice.

Sarcoidosis is typically characterized by the presence of lesions in the lungs, heart, eyes, and skin. However, in some cases, lesions have also been found in the liver. Although the diagnosis of hepatic sarcoidosis is difficult, liver biopsy can occasionally offer a definite diagnosis when blood test results indicate liver dysfunction of an unknown etiology. We encountered five cases of hepatic sarcoidosis at our hospital that were diagnosed based on liver dysfunction and compared these cases with previously reported cases. In our case series, hepatic sarcoidosis was predominantly diagnosed in middle-aged women, and biliary enzymes were elevated in most cases. Corticosteroids, ursodeoxycholic acid, or both were used for treatment. Despite the application of these therapies, some patients progressed to showing cirrhosis or even died. Thus, in cases with severe hepatitis, steroid therapy may not be effective and cirrhosis may develop. Moreover, the findings suggest that ursodeoxycholic acid can help in delaying the progression of hepatic sarcoidosis.

Bone lesions greatly affect the quality of life of patients with chronic liver disease. We investigated bone mineral density (BMD) in 613 patients with chronic liver disease using computed tomography (CT) images to examine the relationship between the pathologic condition of the liver and BMD. We further evaluated the association between changes in BMD and sarcopenia, a disease characterized by loss of muscle mass. Based on CT, the rate of complications associated with osteoporosis was found to be 30%. Multivariate analysis revealed that age, cirrhosis, alanine transaminase level, and muscle mass were the contributing factors for decreased BMD. Bone mass is a notably important parameter to monitor in aging patients with liver disease in Japan. Thus, the measurement of BMD using CT images may be useful for screening for bone lesions.

A 65-year-old woman was admitted with fever, abdominal pain, and laboratory markers indicating an inflammatory reaction. An abdominal ultrasound (US) showed a 60-mm hyperechoic lesion in the left lateral segment of the liver diagnosed as a liver abscess. Antibiotics were administered. Percutaneous drainage was attempted but was difficult because of poor liquefaction. On day 6, the abscess had enlarged and progressed to involve the medial segment. Hypermucoviscous Klebsiella pneumoniae was detected in blood and abscess cultures. Repeat US showed poor liquefaction, suggesting that percutaneous drainage would again fail. As the abscess was deemed resistant to medical treatment, a left hepatic lobectomy was performed. Postoperatively, the patient's general condition and inflammatory reaction quickly improved. Hypermucoviscous K. pneumoniae is often resistant to antibiotics because of the organism's extremely mucoid capsule. Percutaneous drainage is also difficult, so surgical resection should be considered.

We report a rare case of hepatic sclerosed hemangioma recognized as a metastatic tumor in a patient with a history of gastric cancer. An 85-year-old male was followed up in our hospital after gastrectomy for gastric cancer. Abdominal computed tomography and magnetic resonance imaging after nine months showed a tumor measuring 1.5 cm in diameter in segment 7 of the liver, and the lesion was recognized as a metastatic tumor. Following systemic chemotherapy, the tumor shrank. Chemotherapy was considered effective; however, only partial hepatectomy was performed because no other metastatic lesions were observed, and the patient became intolerant to chemotherapy. In the resected specimen, histopathological findings suggested hepatic sclerosed hemangioma.

A 52-year-old woman with Hashimoto's disease was admitted to our hospital following acute onset jaundice and liver dysfunction. We diagnosed her with autoimmune hepatitis and initiated prednisolone therapy. Subsequently, her liver dysfunction improved, while anemia of an uncertain cause progressed. Thus, we diagnosed concurrent autoimmune hemolytic anemia via a peripheral blood and bone marrow tests. The patient's liver dysfunction and anemia gradually improved with continuation of prednisolone. Although patients with autoimmune hepatitis may present with other autoimmune disorders due to the dysfunction of immunologic mechanisms, the concurrence of autoimmune hemolytic anemia is rare. Immunosuppressive treatment including steroid therapy is effective in cases with autoimmune hepatitis and autoimmune hemolytic anemia. This case presented findings of hemolytic anemia after liver dysfunction, suggesting a diagnosis of acute onset autoimmune hepatitis with secondary autoimmune hemolytic anemia.