The present study investigated the clinical characteristics of non-alcoholic steatohepatitis (NASH) patients who progressed from stage 3, zone 3 bridging fibrosis (F3 stage NASH) to cirrhosis. Of 95 NASH patients with repeated liver biopsies during a period of 4.6 years, 6 patients progressed to cirrhosis. The initial liver biopsies of these 6 patients were diagnosed as F3 stage NASH. Simple clinical variables and non-invasive biological tests were evaluated in 33 cases of F3 stage NASH. Increases in body mass index and fluctuations in transaminase levels, as well as the evaluation of homeostatic model assessment-insulin resistance, ferritin, and hyaluronic acid in F3 stage NASH patients may prove useful in identifying individuals at risk of progression to cirrhosis.
A 40-year-old man who underwent extra-anatomical bypass for aortic coarctation 25 years ago was admitted to another hospital with hematemesis and melena. Esophagogastroduodenoscopy revealed no bleeding site in the stomach or the first and second portion of the duodenum. He was transferred to our hospital due to hemorrhagic shock. Angiography showed the extravasation of the contrast medium from the graft. Emergency operation was performed due to graft-duodenal fistula. In patients with previous aortic graft surgery and present gastrointestinal bleeding, graft-enteric fistula should be suspected.
A case of epithelioid hemangioma of the duodenum causing bleeding was encountered. A 32-year-old man was admitted because of anemia. Endoscopic examination revealed a submucosal tumor with central depression in the 2nd portion of the duodenum. It was considered to be the bleeding focus of anemia. A partial resection of the duodenum was performed. The macro- and microscopic examination of the specimen revealed an epithelioid hemangioma. Hemangiomas of the intestinal tract are rare, representing only 0.3% of all tumors of the intestinal tract, and among them, hemangiomas of the duodenum are extremely rare, representing only 3.4% of those of the intestinal tract. Most hemangiomas of the duodenum are cavernous hemangiomas or capillary hemangiomas. We report the first case of epithelioid hemangioma of the duodenum.
A man in his 50, underwent chemotherapy for esophageal and tonsillar cancers. Diarrhea appeared on the 4th day and worsened daily. On the 12th day, free air was pointed out on abdominal X-ray and he consulted our department. At that time, there was no peritoneal irritation sign. Though CT showed pneumatosis and free air, there were neither perforation nor intestinal necrosis, therefore we diagnosed pneumatosis cystoides intestinalis (PCI). Conservative management was performed. He could ingest orally on the 14th day and was discharged on the 37th day. After that, chemotherapy was performed on several occasions for cancer, but there was no recurrence of PCI.
A 58-year-old man came to our hospital, complaining of diarrhea and bloody stool of about 2 weeks' duration. Colonoscopic examination showed mucosal edema and bleeding, and irregular ulcer in the transverse colon and sigmoid colon. Laboratory data indicated elevated WBC (22300/mm3) and CRP (11.93mg/dl), and hypereosinophilia (30%). We diagnosed ischemic colitis with thrombosis due to hypereosinophilic syndrome. He started medication with prednisolone and heparin. However, after 15 days, he underwent emergency surgery because of perforation of the sigmoid colon. Thrombosis is associated with a high incidence of hypereosinophilia. It is important to consider the possibility of ischemic colitis associated with hypereosinophilic syndrome.
We present a 35-year-old Japanese man with Crohn disease. He underwent ileocolectomy for ileum perforation when he was 28 years old, Crohn ileitis was diagnosed and medical treatment was commenced. When he was 35 years old, he complained of severe pain of the right upper torso and the left leg with no apparent trigger. A full check-up revealed that he had multiple fractures including a transcervical fracture of the left femur, ribs on both sides, and fracture of the sacroiliac joint. He had no history of prior use of steroids, and the fractures were thought to have been caused by vitamin D deficiency. This case suggests that clinicians should be aware of the possibility of osteomalacia caused by malabsorption of fat-soluble vitamin D when examining patients with ileocolic Crohn disease.
A 37-year-old man underwent lobectomy of the right liver for granulocyte colony-stimulating factor (G-CSF) producing hepatocellular carcinoma accompanying type B hepatitis. Within two months after the surgery, lung metastases were revealed and administration of sorafenib was begun, however, the lung metastases continued to enlarge. Changing the patient's medication to tegafur-uracil provided remarkable reduction of the lung metastases. The patient is alive two years after diagnosis and receives outpatient chemotherapy. We concluded that this case is valuable with regard to the extreme rarity of G-CSF producing hepatocellular carcinoma and its successful treatment in this case.
A patient was a 46-year-old man. Multiple lung tumors had been pointed out on a medical examination at age 24. He came to our hospital for further examination. Multiple liver and lung tumors were found out, and epithelioid hemangioendothelioma (EHE) derived from the liver was diagnosed by biopsy. At first we gave recombinant interleukin-2 (rIL-2) by intra-arterial and local injection and then continued it by intramuscular injection for 22 years as maintenance therapy. The tumors have regressed, with partial necrosis. EHE is a rare tumor, but we do not have a standard antitumor therapy except surgical resection. This case suggests that rIL-2 may become a new therapy for EHE. We think that the report of the long-term survival of a case of EHE in which rIL-2 treatment was effective is extremely valuable.