This study investigated the impact of atezolizumab/bevacizumab (Atezo/Bev) combination therapy on esophagogastric varices (EGV) in patients with hepatocellular carcinoma (HCC) with portal hypertension (PH). Of the 79 patients treated with Atezo/Bev, EGV progression occurred in 25.6% of the PH group and 2.5% of the non-PH group. Furthermore, variceal rupture occurred only in the PH group. The median overall survival in the PH group was 378 days, which was slightly shorter than that in the non-PH group, although not significant. Logistic regression analysis revealed PH as the only independent risk factor for EGV progression. Notably, variceal rupture occurred even in patients with prior prophylactic treatment, while mild varices occurred in cases with portal vein tumor thrombosis. Although Atezo/Bev remains a treatment option for HCC with PH, careful endoscopic monitoring and early intervention are essential, especially in patients with portal vein invasion.

A woman in her 40s, gravidity 2, parity 1, with a longstanding history of chronic liver disease since childhood, suspected to be autoimmune hepatitis, was diagnosed with cirrhosis during a previous pregnancy. She had previously delivered via cesarean section at 30 weeks of gestation. In her current pregnancy, she developed edema at 20 weeks. By 25 weeks, she experienced significant weight gain and worsening liver function. Due to the high risk of maternal liver failure, she underwent three sessions of plasma exchange, followed by a cesarean delivery at 26 weeks and 6 days. Postpartum, her liver function improved, and her weight decreased. Pregnancies complicated by cirrhosis require careful monitoring, particularly for esophageal and gastric varices and fluid overload. A prepregnancy MELD score of ≥10 is associated with a high risk of severe maternal and fetal complications.

The patient was a 19-year-old man who had undergone a Fontan procedure at 3 years of age for complete transposition of the great arteries and pulmonary artery stenosis. A routine abdominal ultrasound examination revealed a hepatic mass, which was pathologically diagnosed as benign and remained stable without significant changes during follow-up. Liver cirrhosis and hepatocellular carcinoma are serious late complications that can occur after the Fontan procedure. We report this case of a hepatic tumor following the Fontan procedure, diagnosed by liver biopsy and monitored over a mid- to long-term period. This report highlights the importance of differential diagnosis and appropriate diagnostic approaches for hepatic tumors in the context of Fontan-associated liver disease.

The patient was a woman in her 70s. She died approximately 1 month after the onset of symptoms due to malignant lymphoma, which developed 15 years after undergoing liver transplantation. It was difficult to obtain tissue samples and establish a definitive diagnosis before her death; a diagnosis of diffuse large B-cell lymphoma was made during the pathological autopsy. EBV-DNA and soluble interleukin-2 receptor levels, which were elevated at the onset of the disease, were measured from stored serum samples collected up to 1 year prior to disease onset to assess their usefulness for early diagnosis. However, no significant elevation was observed before the onset of symptoms in either marker. The incidence of de novo malignancies after liver transplantation is considered high and may be associated with immunosuppressive therapy, although the exact mechanisms remain unclear. It is desirable to establish protocols for the adjustment of immunosuppressive drugs and for the screening of de novo malignancies.