Metabolic dysfunction-associated steatotic liver disease (MASLD) affects an estimated 25%-30% of the global population, and its prevalence continues to increase. Accurate liver fat quantification is essential for monitoring treatment response, assessing prognosis, and evaluating risks for cardiovascular disease and diabetes mellitus. Magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) has become the new reference standard, replacing invasive liver biopsy. Although conventional B-mode ultrasound remains widely accessible, it is limited by operator dependence and low sensitivity for mild steatosis. Recent developments in ultrasound attenuation technologies now allow objective fat quantification. In Japan, four methods-controlled attenuation parameter, ultrasound-guided attenuation parameter, improved attenuation, and attenuation imaging-have been validated in multicenter studies. Among these approaches, B-mode-guided techniques demonstrate stronger correlations with MRI-PDFF, improved diagnostic accuracy, and reduced influence from body habitus compared with one-dimensional measurements. Combining multiple acoustic parameters beyond attenuation coefficient may further enhance performance. Standardization will require unified acquisition protocols and clarification of confounding factors.

Donor organ shortage in Japan remains unsolved. In Western countries, the number of liver transplantations substantially increased following the introduction of machine perfusion for grafts from extended-criteria donors. Normothermic machine perfusion (NMP), which maintains the graft under physiologic conditions ex vivo, allows prolonged preservation and real-time functional assessment, thereby facilitating safer graft selection. In addition, NMP attenuates ischemia-reperfusion injury, reduces early graft dysfunction, and enables planned daytime surgery, contributing to improved transplantation workflows.

In Japan, although the annual number of deceased-donor liver transplants has recently exceeded 100 cases, considerable challenges remain, including logistic constraints and the underutilization of grafts from extended-criteria donors. To address these issues, five institutions are planning the first phase I/II clinical trial of NMP in Japan, supported by the Ministry of Health, Labor, and Welfare (grant no: 24CA2038, 2024), with the anticipation that NMP will become a key technology for expanding organ utilization and ensuring the long-term sustainability of liver transplantation in Japan.

Endocrine therapy is a recommended treatment modality for hormone receptor-positive breast cancer, with tamoxifen being a key agent. However, tamoxifen is a well-recognized entity to cause drug-induced liver injury associated with hepatic steatosis. In this study, we retrospectively analyzed 186 patients who received postoperative endocrine therapy, including tamoxifen for a median duration of 4.7 years (interquartile range, 3.4-5.0) between 2008 and 2023 at our institution. Liver function tests and imaging scans were evaluated before and after treatment. The analysis revealed significant increases in alanine aminotransferase (ALT) (P = 0.002), γ-glutamyl transpeptidase (P < 0.001), and the fibrosis-4 index (P < 0.001), whereas the albumin-bilirubin score did not change significantly (P = 0.054). Among patients with elevated ALT levels at the end of the observation period, 67% developed hepatic steatosis. These findings suggest that fatty liver potentially contributes to liver dysfunction during tamoxifen therapy and underscore the importance of regular liver function monitoring and collaboration with hepatologists.

We retrospectively analyzed 481 patients with hepatitis C virus (HCV) infection in the Chikuho region, Japan, and compared the clinical characteristics of 137 people who inject drugs (PWID; 28.5%) with those of non-PWID. Compared with non-PWID, PWID were younger, predominantly male, and more frequently infected with genotype 2. Loss to follow-up occurred more frequently among PWID, resulting in a lower sustained virologic response rate in the intention-to-treat analysis (70.8% vs. 91.9%). However, no significant difference was observed in the per-protocol analysis (95.1% vs. 98.4%). Referrals from psychiatric hospitals were more common among PWID than non-PWID, liver fibrosis at treatment initiation was milder, and a small number of reinfections were observed. Population-adjusted distribution by municipality indicated geographic clustering. These findings suggest that coordinated and continuous support across medical, welfare, correctional, and psychiatric services may be important to support regional HCV elimination efforts.

A male in his 60s with an asbestos exposure history was referred for anemia evaluation. Screening abdominal ultrasonography revealed a 15-mm hepatic mass in segment 8 with a marginal hypoechoic zone, suggesting metastatic liver tumor. Contrast-enhanced computed tomography revealed prolonged enhancement, and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging demonstrated high signal on diffusion-weighted imaging and low signal in the hepatobiliary phase, increasing suspicion of a primary hepatic malignancy, including intrahepatic cholangiocarcinoma or cholangiolocellular carcinoma. As imaging findings were inconclusive, ultrasonography-guided biopsy was performed, and intrahepatic bile duct adenoma was diagnosed. The lesion has not progressed for >4 years. Intrahepatic bile duct adenoma is rare, and its etiology remains unclear. Although the patient had an asbestos exposure history, no association was identified. This case highlights the significance of histological confirmation, as imaging alone may be insufficient for diagnosing rare hepatic tumors, including intrahepatic bile duct adenoma.

An 80-year-old man with decompensated cirrhosis secondary to primary biliary cholangitis had been receiving treatment at our hospital for rectal varices and thrombocytopenia. Following partial splenic artery embolization, he developed ascites along with portal and splenic vein thrombosis, for which anticoagulation therapy was initiated. Subsequently, he presented with recurrent bleeding from an externally protruding rectal varix. Four-dimensional computed tomography (4D-CT) demonstrated inflow from the inferior mesenteric vein to the rectal varix and multiple drainage pathways through the anal lesion into the internal pudendal and internal iliac veins. Balloon-occluded retrograde transvenous obliteration was attempted but failed. Further, direct injection of N-butyl-2-cyanoacrylate into the anal varix under visualization was performed; however, rebleeding occurred. Hemostasis was ultimately achieved using endoscopic injection sclerotherapy for rectal varices. As no standard treatment for anal varices has been established, this case highlights the successful management of bleeding from an external protruding rectal varix following detailed hemodynamic evaluation with 4D-CT.

We report the case of a woman in her 70s with decompensated cirrhosis secondary to primary biliary cholangitis. She underwent cell-free and concentrated ascites reinfusion therapy (CART) for more than 7 years to manage intractable ascites. Regular supplementation with autologous protein through long-term CART helped maintain her nutritional status, and consequently, her hepatic reserve remained relatively stable. However, progression of the underlying liver disease was not suppressed, leading to gradual worsening of liver fibrosis and the development of hepatorenal syndrome. While long-term CART may improve overall survival in patients with intractable ascites, this case also highlights the therapy's limitations.

Here, we report a rare and clinically significant case of a 70-year-old man with unresectable hepatocellular carcinoma arising in the setting hepatitis B-related cirrhosis. After the failure of transarterial chemoembolization, the patient was switched to systemic therapy with atezolizumab and bevacizumab. After completing the 11th treatment cycle, the patient developed a high-grade fever, followed 5 days later by progressive pain radiating from the left buttock to the thigh. Laboratory tests revealed markedly elevated inflammatory markers, and contrast-enhanced computed tomography showed ill-defined low-density areas with fascial enhancement, findings consistent with necrotizing fasciitis. Prompt treatment with intravenous cefazolin and surgical drainage resulted in gradual clinical improvement. Streptococcus dysgalactiae was identified in the abscess fluid culture. This case highlights that severe soft tissue infections such as necrotizing fasciitis can occur as rare but serious adverse events during bevacizumab therapy, possibly related to impaired wound healing and tissue perfusion caused by vascular endothelial growth factor inhibition.

A man in his 50s had undergone 6 months of adjuvant chemotherapy with capecitabine plus oxaliplatin (XELOX regimen) for rectal cancer 12 years earlier. He later developed esophageal variceal rupture and was managed for alcohol-related liver cirrhosis due to his history of heavy drinking. He was referred to our hospital after recurrent hematemesis. Contrast-enhanced computed tomography (CE-CT) revealed portal vein thrombosis, for which anticoagulant therapy was initiated. Although CE-CT showed large portosystemic shunts, the liver surface appeared smooth with progressive atrophy, raising suspicion of oxaliplatin-induced porto-sinusoidal vascular disorder (PSVD). Liver and spleen stiffness measurements and subsequent liver biopsy ruled out liver cirrhosis, thereby confirming the diagnosis of PSVD. This case illustrates PSVD with progressive liver atrophy, portal vein thrombosis, and recurrent variceal rupture over a prolonged 12-year interval after oxaliplatin administration. Oxaliplatin-induced PSVD should be recognized as a potential cause of progressive portal hypertension.