Hideo Horigome

Standards for selecting percutaneous ethanol injection therapy or percutaneous microwave coagulation therapy for solitary small hepatocellular carcinoma: consideration of local recurrence

OBJECTIVES:Percutaneous ethanol injection therapy (PEIT) and percutaneous microwave coagulation therapy (PMCT) are effective treatments for small hepatocellular carcinoma (HCC). There are no clear standards, however, for the selection of PEIT or PMCT. We determined standards based on local recurrence.METHODS:The subjects were 88 patients with solitary HCC measuring ≤30 mm in diameter, who were treated by PEIT (n = 45) or PMCT (n = 43) and judged to be cured using computerized tomography (CT) with contrast medium after treatment. Patient characteristics, including age, gender, viral markers, Child-Pugh classification, tumor size, tumor cell differentiation, and serum α-fetoprotein (AFP) concentration we analyzed, and the factors influencing the local recurrence in the PEIT and PMCT groups were determined, using univariate and multivariate analysis.RESULTS:Univariate analysis indicated that tumor cell differentiation and serum AFP concentration influenced local recurrence in the PEIT group, and tumor size did so in the PMCT group. Multivariate analysis revealed that tumor cell differentiation influenced local recurrence in the PEIT group, and tumor size did so in the PMCT group. PEIT was effective for treating well-differentiated HCC, and PMCT was effective for treating HCC measuring ≤15 mm in diameter. PMCT was superior to PEIT for treating patients with HCC measuring ≤15 mm in diameter. In such cases with well-differentiated HCC, PEIT was as effective as PMCT.CONCLUSIONS:The selection of PEIT or PMCT to treat patients with HCC should be based on tumor size and cell differentiation.

Limitations of imaging diagnosis for small hepatocellular carcinoma: Comparison with histological findings

Background and Aims : The purpose of this study was to clarify the value and limitation of imaging modalities for diagnosing small hepatocellular carcinoma (HCC).

Percutaneous radio-frequency ablation therapy using a clustered electrode for malignant liver tumors.

Goals To examine the safety and effectiveness of percutaneous radio-frequency ablation therapy (PRAT) for malignant liver tumors, using a needle with cluster radio-frequency (RF) electrodes. Study The subjects were 13 patients with solitary malignant liver tumors: 10 had hepatocellular carcinoma and 3 had metastatic liver tumors. One session of PRAT with cluster RF electrodes was performed until roll-off occurred two times. Dynamic computed tomography (CT) and fine needle tumor biopsy under ultrasonographic guidance were conducted to assess the therapeutic efficacy. Aspartate aminotransferase, alanine aminotransferase, lactic dehydrogenase, and total bilirubin were evaluated before and 1, 3, and 7 days after PRAT. Results There were no serious complications. Aspartate aminotransferase, alanine aminotransferase, and lactic dehydrogenase levels peaked 1 day after PRAT and decreased thereafter. No icterus occurred. Of the 13 tumors, 12 showed complete necrosis on dynamic CT; however, one of them showed histologically incomplete necrosis in the tumor biopsy. In both of the ineffective cases, the tumors were located near relatively large vessels. There was no recurrence in the liver in all cases of PRAT that were effective (observation periods: 6–14 months; mean, 10 months). Conclusions Percutaneous radio-frequency ablation therapy using a clustered electrode is a safe and effective treatment of malignant liver tumors, if the tumor is not located near the large vessels.

Original ContributionsStandards for selecting percutaneous ethanol injection therapy or percutaneous microwave coagulation therapy for solitary small hepatocellular carcinoma: consideration of local recurrence

Abstract OBJECTIVE: Percutaneous ethanol injection therapy (PEIT) and percutaneous microwave coagulation therapy (PMCT) are effective treatments for small hepatocellular carcinoma (HCC). There are no clear standards, however, for the selection of PEIT or PMCT. We determined standards based on local recurrence. METHODS: The subjects were 88 patients with solitary HCC measuring ≤30 mm in diameter, who were treated by PEIT (n = 45) or PMCT (n = 43) and judged to be cured using computerized tomography (CT) with contrast medium after treatment. Patient characteristics, including age, gender, viral markers, Child-Pugh classification, tumor size, tumor cell differentiation, and serum α-fetoprotein (AFP) concentration we analyzed, and the factors influencing the local recurrence in the PEIT and PMCT groups were determined, using univariate and multivariate analysis. RESULTS: Univariate analysis indicated that tumor cell differentiation and serum AFP concentration influenced local recurrence in the PEIT group, and tumor size did so in the PMCT group. Multivariate analysis revealed that tumor cell differentiation influenced local recurrence in the PEIT group, and tumor size did so in the PMCT group. PEIT was effective for treating well-differentiated HCC, and PMCT was effective for treating HCC measuring ≤15 mm in diameter. PMCT was superior to PEIT for treating patients with HCC measuring ≤15 mm in diameter. In such cases with well-differentiated HCC, PEIT was as effective as PMCT. CONCLUSIONS: The selection of PEIT or PMCT to treat patients with HCC should be based on tumor size and cell differentiation.

Endoscopic injection sclerotherapy for esophageal varices using a transparent hood.

Lymphatic drainage of the testis is to the para-aortic nodes from where duodenal invasion occurs. Spread can also occur hematogenously and by direct invasion. Presenting symptoms were due to duodenal obstruction or chronic blood loss. Our patient is unusual in that initially there was no evidence of metastases or testicular mass prior to his presentation with massive hematemesis. In conclusion, testicular cancer may occasionally present with GI involvement. Hence, the presence of gastrointestinal bleeding or intestinal obstruction in the setting of metastasis in a young man should prompt the consideration of testicular cancer in the differential diagnosis.