The clinical practice recommendations for hepatocellular carcinoma were revised in 2021. In this revision, another algorithm was introduced in the surveillance algorithms to first conduct EOB-MRI imaging after a nodule is identified by ultrasound. In the treatment algorithm, resection and ablation are suggested equally for single hepatocellular carcinoma less than 3 cm in diameter, and resection is advised first for vascular invasion-positive hepatocellular carcinomas, followed by systemic therapy for unresectable cases, and then by hepatic arterial infusion chemotherapy and TACE equally. A new algorithm or systemic therapy has been developed to complement the treatment algorithm as the number of systemic therapies for hepatocellular carcinoma has greatly risen since the last revision. Furthermore, the combination of systemic therapy and TACE, which was weakly recommended in the previous edition, has been revised to a weak recommendation in the present revision.

Nonalcoholic fatty liver disease-associated hepatocellular carcinoma (NAFLD-HCC) is on the rise globally, which is a significant clinical problem. Here, we retrospectively examined the clinical characteristics and diagnostic process of NAFLD-HCC in real-world practice. Among 756 patients with HCC treated in Kurashiki Central Hospital between January 2009 and December 2018, 65 (8.6%) matched the NAFLD criteria. Twenty-nine patients (44.6%) of the NAFLD-HCC patients had cirrhosis. The proportions of receiving HCC surveillance before diagnosis were 65.5% in cirrhotic patients and 25.0% in non-cirrhotic patients. Despite the higher prevalence of cirrhosis, patients under surveillance tended to have longer overall survival. Receiving surveillance was found to be significantly associated with a decreased risk of mortality in a multivariate analysis (hazard ratio, 0.36 [95% CI, 0.14-0.92], p = 0.032). For NAFLD patients with cirrhosis, HCC surveillance should be encouraged. More research is required to improve the likelihood of non-cirrhotic NAFLD patients receiving an early diagnosis of HCC.

In Japan, chemotherapy is recommended for peritoneal metastasis of hepatocellular carcinoma. For peritoneal metastasis of colorectal cancer, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are considered in the NCCN guidelines, and their efficacy is expected for peritoneal metastasis of hepatocellular carcinoma. This is the case of the man in his 70s.Ten months after undergoing hepatectomy for ruptured hepatocellular carcinoma, peritoneal metastases had been found. He underwent partial peritoneal resection and hyperthermic intraperitoneal chemotherapy after undergoing lembatinib treatment for 6 months. Peritoneal cancer index was 6. Surgery achieved weight loss resection score = 0. Without any issues, he was released from the hospital 12 days following the operation. He received no postoperative adjuvant chemotherapy, and his overall health got better. He has not had a recurrence 2 years after surgery and is still alive.

A 70-year-old man with a history of HBV infection and slight liver dysfunction was admitted for further examination of a 3.8 cm tumor in segment 5: ultrasound (US) revealed a hypo-iso-hypo pattern and computed tomography (CT) revealed a low-iso-low density pattern (double-target-sign).

While CE US revealed slight hypovascularity, early washout in the portal phase, and defect in the Kupffer phase, contrast-enhanced (CE) CT and ethoxybenzyl diethylenetriamine penta-acetic acid-enhanced magnetic resonance imaging (EOB MRI) revealed slight hypervascularity and slight hypointensity at the hepatobiliary phase. Echo planar imaging of MRI revealed remarkable hypointensity.

The aforementioned imaging modalities raised suspicions of inflammatory pseudotumor (IPT), atypical hepatocellular carcinoma, cholangiocellular carcinoma, cholangiolocellular carcinoma, and metastatic liver cancer.

US-guided biopsy, however, showed hepatic IPT, and histopathological analysis disclosed the proliferation of fibroblasts, lymphocytes, plasma cells, and macrophages with hemosiderin on a background of collagen fibers.

Without receiving any kind of treatment, the tumor had shrunk from 3.8 to 2.6 cm three weeks after the diagnosis.

We conducted surveys to assess the hepatitis B (HB) vaccination status of dentists. From 2020 to 2022, 1,033 members of dental associations in Aichi and Hiroshima prefectures were questioned regarding their HB vaccination status. The respondents were determined to have been properly vaccinated if they had received three or more doses of vaccine or had been vaccinated but their hepatitis B surface antibody titers had not increased. Of the respondents, 20.6% (213/1,033) had undergone appropriate vaccination, 34.8% (360/1,033) were unvaccinated, and 42.8% (442/1,033) had received two doses. In dentistry, there are several opportunities for exposure to saliva and blood and needlestick accidents may occur. Dental professionals will be made aware of the HB immunization schedule using precise infection control procedures.