A 75-year-old male who had undergone hepatic artery chemoembolization for hepatocellular carcinoma 14 times presented with obstructive jaundice due to bile duct invasion. Metallic stents were placed; however, the obstructive jaundice relapsed two months later. Duodenoscopy showed bleeding from the papilla and endoscopic retrograde cholangiography revealed a common bile duct hematoma. The bleeding source was identified as part of a hepatocellular carcinoma and nasobiliary drainage was performed. Considering liver function and the difficulty of embolization to blood vessels feeding the tumor, palliative radiation therapy was conducted. Radiation with anteroposterior parallel-opposed fields of 30 Gy in 10 fractions gradually resolved the hemobilia. A stent was placed in the obstructed branch of the bile duct after radiation therapy. Thereafter, treatment could be continued without anemia or jaundice relapse. This case report is considered valuable because there is no previous report addressing palliative radiation therapy for hemobilia due to the bile duct invasion of hepatocellular carcinoma.

A 53-year-old woman visited a previous hospital because of chronic cough; upon examination, bilateral pleural effusion was identified. During a detailed examination, she was diagnosed with hepatitis C and decompensated liver cirrhosis. Abdominal computed tomography revealed a splenic artery aneurysm measuring 25 mm in diameter; hence, she was referred to our hospital for coil embolization. She was administered lusutrombopag for thrombocytopenia (platelet count: 4.9×10⁴ /μL). After her platelet count increased to 7.6×10⁴ /μL, she underwent coil embolization for splenic artery aneurysm. She experienced no side effects attributed to the drug and no adverse events after coil embolization. The results obtained in this case are valuable because successful coil embolization, to our knowledge, has never been reported before in the context of liver cirrhosis with thrombocytopenia corrected by lusutrombopag.

The patient was a 37-year-old woman not taking oral contraceptives. An 80-mm single nodule was found in S7 of the liver by screening ultrasonography. MRI revealed hypo-intensity on T1WI and iso-intensity on T2WI. CT during hepatic arteriography was strongly enhanced and that during portography demonstrated the nodule to be a defective lesion. The patient underwent percutaneous biopsy. Histopathologically, the biopsied specimens of the inner and outer nodules consisted of hepatocytes with mild atypia. Immunohistochemically, the tumor cells of both regions were positive for β-catenin, suggesting the presence of β-catenin-activated hepatocellular adenoma (b-HCA). The tumor was resected. It exhibited a nodule-in-nodule structure, was 9.8 cm in diameter, and was diagnosed as b-HCA. Mutation analysis revealed a mutation in the telomerase reverse-transcriptase (TERT) promoter region only in the inner nodule. The nodule-in-nodule structure and localized TERT promoter mutation of the inner nodule suggested a precancerous change in multistep carcinogenesis.

A 58-year-old male was referred by a nearby doctor for jaundice, liver dysfunction, and abdominal pain. Blood sampling suggested the presence of jaundice, hepatic dysfunction, and increased eosinophil count. Computed tomography imaging revealed irregular-shaped low-density areas in the liver and edematous thickening of the duodenal bulb. Upper gastrointestinal endoscopy noted erosion and mucosal inflammation in the duodenal bulb. Endoscopic biopsy and biopsy of the low-density area of the liver revealed no malignancy and marked infiltration of eosinophils. This case fulfilled the diagnostic criteria for eosinophilic gastroenteritis. Low-density areas of the liver can also be diagnosed as suggesting an eosinophilic inflammatory mass. Steroid treatment was started. Blood collection and imaging findings improved several days after the start of treatment. Since then, steroid tapering has progressed and the patient is currently being managed on an outpatient basis with prednisolone 5 mg/day. Two years after onset, no recurrence has occurred and the imaging findings have normalized.

In 2019, the number of reported cases of hepatitis E in Gunma prefecture was 1.44 per 100,000 people, which was the highest in all of Japan. We examined the clinical characteristics of 20 cases of hepatitis E reported in 2019 and analyzed the hepatitis E virus (HEV) genomes of seven sporadic cases. All HEV strains isolated from these cases belonged to subgenotype 3a and were 99.7% to 100% identical to each other within the 412-nucleotide ORF2 sequences. Of these seven cases, six had eaten raw or undercooked pig liver/intestine within the past three months, suggesting that they had been infected with a swine-derived HEV strain. When a small epidemic is suspected, HEV genome analysis should be performed to identify the cause of infection, even in sporadic cases.