Katsuhiko Horii

Successful Treatment of a Hepatic Abscess that Formed Secondary to Fish Bone Penetration by Percutaneous Transhepatic Removal of the Foreign Body: Report of a Case

We describe herein the case of a hepatic abscess that developed secondary to fish bone penetration which was successfully treated without laparotomy. A 61-year-old man was admitted to our hospital with a high fever that had persisted for 2 weeks in spite of medication. Abdominal ultrasonography (AUS) and computed tomography (CT) of the abdomen revealed a hepatic abscess with a linear calcified foreign body and gas. Percutaneous abscess drainage was performed under ultrasonographic guidance. After drainage, the patient became afebrile, and AUS and CT findings demonstrated that the abscess cavity had decreased in size, but still contained the foreign body. Under ultrasonographic guidance and fluoroscopy, we inserted endoscopic forceps into the sinus tract and succeeded in removing the foreign body from the liver. It was found to be a fish bone that was 2.8 cm long and 0.3 cm wide.

Erythrocytosis caused by an erythropoietin-producing hepatocellular carcinoma

A case of erythrocytosis caused by a hepatocellular carcinoma (HCC) that produced erythropoietin (Epo) is described. A 64‐year‐old man, with a huge HCC tumor in the right lobe of the liver, showed a high concentration of hemoglobin and increased levels of serum Epo, α‐fetoprotein (AFP), and protein induced by vitamin K absence II (PIVKA‐II). Right lobectomy of the liver was performed. Histological findings of the specimen showed a moderately differentiated HCC. The existence of Epo was confirmed immunohistochemically only in the tumor tissue and not in the normal liver tissue. Erythrocytosis disappeared and the serum levels of Epo, AFP, and PIVKA‐II returned to the normal range after the operation. Within 2 months after the operation, recurrent tumors appeared in the remnant liver, and the patient died 13 months after the operation. J. Surg. Oncol. 2000;75:197–202.

Spontaneous Regression of Hepatocellular Carcinoma: Report of a Case

A spontaneous regression of hepatocellular carcinoma is an extremely rare phenomenon. A 69-year-old Japanese man with hepatitis C virus-related chronic hepatitis presented with a liver tumor. We diagnosed the tumor to be hepatocellular carcinoma in the course of spontaneous regression, by imaging studies and changes in the tumor markers. Because the possible presence of viable cancer cells could not be ruled out, we recommended surgery. He refused all treatments at first, but finally agreed to undergo surgery about 10 months after presentation. A hepatectomy was performed. Histologically, no viable tumor cells were found. In our case, the vascularity of the tumor according to the imaging findings was followed up during the clinical course. The patient is now doing well and without any evidence of recurrence at 37 months after surgery.

Effect of the presence of hepatitis b e antigen on prognosis after liver resection for hepatocellular carcinoma in patients with chronic hepatitis B

We examineded the clinical effects of serum hepatitis B e antigen (HBeAg) positivity on clinicopathologic findings and prognosis after liver resection for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B. A series of 56 patients who underwent curative resection were divided into two groups: 25 HBeAg-positive patients (group 1) and 31 HBeAg-negative patients (group 2). The mean age was significantly lower in group 1 than in group 2 (p=0.0021), and the proportion of patients with symptoms was significantly higher in group 1 than in group 2 (p=0.037). There were no significant differences in other clinical findings between the two groups, including laboratory test results, coexisting medical conditions, and operative methods. Although tumor size, degree of differentiation of the main tumor, and the prevalence of vascular invasion did not differ between the groups, the prevalence of intrahepatic metastasis and the proportion of patients with active hepatitis were significantly higher in group 1 than in group 2 (p=0.009 and p=0.043, respectively). Tumor-free and cumulative survival rates were significantly lower in group 1 than in group 2 (p=0.022 and p=0.0001, respectively). Multivariate analysis of various possible risk factors demonstrated serum HBeAg positivity to be an independent risk factor for recurrence [risk ratio (RR) 2.49; 95% confidence interval (CI) 1.12–5.49; p=0.032] and an independent unfavorable factor for the survival time (RR 7.58; 95% CI 2.10–27.8; p=0.0020). We concluded that the prognosis after liver resection for HCC is worse for HBeAg-positive patients than for HBeAg-negative patients.RésuméChez des patients ayant une hépatite chronique B, et une résection hépatique pour carcinome hépatocellulaire (CHC), on a cherché à connatre le retentissement clinique (basé sur les données pathocliniques et pronostique) de la positivité de l’antigène de l’hépatite Be (HBeAg) dans le sérum. Cinquante-six patients qui ont eu une résection à visée curative ont été divisés en deux groupes: 25 patients HBeAg-positifs (groupe 1) et 31 patients HBeAg-négatifs (groupe 2). L’âge moyen a été significativement plus bas dans le groupe 1 que dans le groupe 2 (p=0.0021). La proportion de patients symptomatiques a été significativement plus élevée dans le groupe 1 que dans le groupe 2 (p=0.037). Il n’y avait aucune différence significative entre les deux groupes en ce qui concerne les autres données cliniques, y compris les résultats de laboratoire, les autres conditions médicales ou des méthodes opératoires. Bien que la taille tumorale, le degrhe de dédifférenciation de la tumeur principale et la prévalence de l’invasion vasculaire ne différaient pas entre les deux groupes, la prévalence de métastases intrahépatiques et la proportion de patients avec une hépatite active étaient significativement plus élevées dans le groupe 1 que dans le group 2 (p=0.0009, p=0.043, respectivement). Les taux de survie sans tumeur et cumulative étaient significativement plus bas dans le groupe 1 que dans le groupe 2 (respectivement, p=0.022 et p=0.0001). En analyse multivariée des potentiels facteur de risque, la positivité de l’HBeAg dans le sérum est un facteur de risque indépendant pour la récidive (rapport de côte: 2.49; Cl 95%, 1.12–5.49; p=0.032) et un facteur défavorable indépendant de survie (7.58, 2.10–27.8, p=0.0020). Nous concluons que, en cas de résection du foie pour CHC, le pronostic est plus mauvais chez les patients HBeAg-positifs que chez les patients HBeAg-négatifs.ResumenEn enfermos con hepatitis crónica B, tras resección hepática por hepatocarcinoma celular, se investigan los efectos clínicos del antígeno sérico positivo de hepatitis. Be (HBeAg) tanto sobre los hallazgos clínco-patológicos como por lo que al pronóstico atañe. 56 pacientes, sometidos a una resección curativa, se dividieron en dos grupos: grupo 1: 25 pacientes con HBeAg positivo y grupo 2: 31 pacientes con HBeAg negativo. La edad media fue signifcativamente menor en el grupo 1 que en el 2 (p=0.0021). El número de pacientes con sintomatología fue significativamente mayor en el grupo 1 que en el 2 (p=0.037). Entre ambos grupos no se registraron otras diferencias significativas, ni en los hallazgos clínicos, incluyendo los análisis de laboratorio, ni en afecciones médicas coexistentes, ni en los métodos operatorios. Aunque el tamaño del tumor, grado de diferenciación de la neoplasia principia, y predominio de la invasión vascular no fueron diferentes entre ambos grupos, la frecuencia de metástasis intrahepáticas y el número de pacientes con hepatitis activa fue significativamente mayor en el grupo 1 (p=0.0009) que en el 2 (p=0.043). Los porcentajes de pacientes libres de enfermedad tumoral y los de supervivencia fueron significativamente menores en el grupo 1 (p=0.022) que en el grupo 2 (p=0.0001). Los análisis multivariates de varios posibles factores de riesgo demostraron que la positividad sérica del HBeAg constituye un factor de riesgo independiente para la recidiva (cociente de riesgo, 2.49; 95% CI, 1.12–5.49, p=0.032) y un factor independiente desfavorable por lo que al tiempo de supervivencia se refiere (7.58, 2.10–27.8, p=0 .0020). Conclusión: El pronóstico para pacientes con HCC tras resección hepática es peor para los enfermos con HBeAg positivo que para los HBeAg-negativos.

Mirizzi Syndrome Caused by Xanthogranulomatous Cholecystitis: Report of a case

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. In severe cases, inflammation extends to adjacent structures, and XGC is sometimes confused with a malignant neoplasm. We recently diagnosed XGC as the preoperative cause of Mirizzi syndrome in a patient based on the clinical course. The patient was admitted because of obstructive jaundice, with gallbladder carcinoma as the suspected cause. The gallbladder was swollen with gallstones and the serum level of carbohydrate antigen 19-9 (CA19-9) was 3070 U/ml at admission. A percutaneous transhepatic cholangiodrainage (PTCD) was done, and the common hepatic duct as well as the right and left hepatic ducts were found to be obstructed. Later, the CA19-9 level and swelling of the gallbladder decreased and the obstruction of the bile ducts disappeared. A cholecystectomy was performed and the intraoperative pathohistological diagnosis of chronic cholecystitis was made from frozen sections. The pathohistological diagnosis of XGC was made from paraffin-embedded sections. Mirizzi syndrome such as that seen in our patient is a rare complication of XGC. XGC occassionally causes extensive inflammation; thus, performing a conventional cholecystectomy can be unsafe. However, in our opinion, a total, not subtotal, cholecystectomy should be done whenever possible because the incidence of gallbladder carcinoma accompanied with XGC is higher than that with ordinary cholecystitis or gallstones.

A long-term survivor of intrahepatic cholangiocarcinoma with paraaortic lymph node metastasis

of hepatic tumors was minimal over 7 years (see Fig. 1), very unlikely as metastatic tumors. Additionally, we failed to find any possible primary site for somatostatinoma, even though extensive searches for the primary sites were performed using upper and lower GI endoscopy, CT scan of the head, neck, and trunk, and 67Ga scintigraphy of the whole body. Therefore, it is reasonable to assume that the tumor originated from the liver. Hepatic tumors observed in patients with VRD, although very rare, include plexiform neurofibromas, angiosarcoma, and malignant schwannoma.2 Primary hepatic somatostatinoma, with or even without VRD, is very rare and has been reported only by Ohwada et al.3 It is known that somatostatin-containing cells are present in the intrahepatic biliary tree.4 Thus, intrahepatic tumors have arisen from these endocrine cells, possible affected by a genetic disorder present in patients with VRD.

Hemodynamics in hepatocellular carcinoma evaluated by pigment injection into the portal vein.

早期の微小肝細胞癌(肝癌)ならびにその境界病変における門脈血流の関与を検討するため,肝切除の術中あるいは術後に担癌門脈枝より色素を注入し,術後の病理標本上での結節内色素の有無を観察し,被膜形成ならびに分化度との関係を検索した.対象とした14例17結節を病理組織学的に検討したところ被膜形成のない高分化型肝癌は6結節(腫瘍径:10±7mm)であり,全例結節内に門脈域がみられたが,結節内に色素がみられたものは2結節に過ぎなかった.他の11結節のうち中分化型肝癌(29±26mm)は7結節で,被膜を有さない1結節にのみ色素がみられた.なお残りの4結節(34±10mm)は術前治療のため完全壊死に陥っていた.結節内色素の有無は各結節の組織学的分化度より被膜の有無とよりよく相関しており,肝癌の発育過程で被膜が形成されるに伴い腫瘍内門脈血流が低下することが示唆された.