A male patient in his 50s diagnosed with aplastic anemia was found to have elevated aspartate aminotransferase and alanine aminotransferase levels after two months of transfusion therapy. Liver biopsy was avoided due to the high risk of bleeding when considering the patient's low platelet count. Magnetic resonance imaging with IDEAL-IQ revealed diffuse hyperintensity of the liver parenchyma on an R2* map, resulting in the diagnosis of liver hemochromatosis associated with post-transfusion iron overload. The administration of oral deferasirox as an iron chelator led to an improvement of hepatic dysfunction and a reduction in R2* value.
Liver biopsy is an invasive test that is also associated with sampling errors. Although R2* value and mapping do not fully replace liver biopsy, they are considered useful as a noninvasive approach for diagnosis and evaluation.
A 48-year-old man was referred to our hospital for nivolumab administration for the treatment of unresectable squamous cell carcinoma of the lung. He had hepatitis C virus infection with virus genotype type 2a and was not treated with antiviral therapy with interferon or direct-acting antivirals. Nivolumab was administered three times every 2 weeks. The serum transaminase levels increased 2 weeks after the third administration. At first, drug-induced liver injury due to nivolumab was suspected; however, liver biopsy revealed acute exacerbation of chronic hepatitis C (new Inuyama classification, F1/A2). A 12-week combination therapy of sofosbuvir and ribavirin was initiated. The serum transaminase levels improved, and a sustained virological response was obtained 24 weeks after the completion of antiviral therapy. No subsequent transaminase elevation has been observed.
A 73-year-old man presented with multiple space occupying lesions in both liver lobes upon chest computed tomography, which was originally conducted as a follow-up examination for the presence of pulmonary nodules. Percutaneous liver tumor biopsy revealed the absence of any malignancies. Following laparoscopic liver tumor resection, the patient was diagnosed with primary hepatic angiosarcoma. After one course of paclitaxel treatment, the patient was treated with pazopanib. However, treatment was discontinued early due to poor performance status, and the patient died approximately 4 months after initiating chemotherapy. Hepatic angiosarcoma is a rare disease with high risk of malignancies. Because accurate diagnosis via imaging is not easy, laparoscopic resection is useful for diagnosing hepatic angiosarcoma.