We investigated the incidence of acute hepatitis B (AH-B) infection in the metropolitan area from 1994 to 2017. A total of 246 AH-B cases were recorded. The number of patients with AH-B increased between 1994 and 2004 but decreased after 2010. After initiating the observation period, the incidence of infections with genotype (GT) A gradually increased and accounted for most cases after 2006. Infections were also observed in young men; moreover, sexual transmission was frequently observed. Among 166 patients who were continuously observed, 5 developed chronic infections (GTA, 3 patients; GTC, 1 patient; and GTH, 1 patient). The evaluation of amino acid polymorphisms in the a-determinant region revealed that seven patients had amino acid substitutions. Continuous monitoring of the incidence and characterization of AH-B is required, and education regarding the importance of HB vaccination is necessary for controlling this viral infection.

Here, we report a case of granulocyte colony-stimulating factor (G-CSF)-producing undifferentiated liver carcinoma with rapid progression. A 61-year-old man presented to our hospital with anorexia and pain in the right shoulder. Laboratory data revealed leukocytosis and elevated CRP levels. Abdominal computed tomography revealed a 50 mm-sized tumor in the lateral segment of the liver and multiple lymphadenopathies. Within two months the tumor size increased to 90 mm, and portal and stomach invasions were newly observed. The tumor as diagnosed as hepatocellular carcinoma, for which the patient underwent hepatic lateral segmentectomy. Perioperative pathological diagnosis confirmed the presence of cancer cells and marked neutrophil infiltration of the lymph nodes, leading us to the suspicion of G-CSF-producing hepatocellular carcinoma. Serum G-CSF levels at the patient's first consultation were elevated (58 pg/mL). Histopathological examination revealed undifferentiated carcinoma, and immunostaining was positive for G-CSF in tumor-cell cytoplasm. The postoperative course was uneventful. However, lymph node metastases and disseminated lesions rapidly spread, and the patient died on postoperative day 95.

We examined the characteristics of patients with stage 1 non-B, non-C hepatocellular carcinoma (NBNC-HCC) (n = 195) and patients with diabetes mellitus (DM) without cancer (n = 82) and developed a new scoring index for the early detection of NBNC-HCC based on the common blood tests used in general practice. The formula for the new index, referred to as DM-HCC, was based on the results of logistic regression analysis and was AST-3 × Plt+20 (unit: 10⁴/μL). The area under the receiver operation curve was 0.88. The sensitivity and specificity for predicting NBNC-HCC at a cut-off value of zero were 79% and 88%, respectively. Thus, this new scoring index is useful for the early prediction of NBNC-HCC in patients with DM. Additionally, image screening for HCC is recommended for patients with scores of greater than zero.