Kenji Kino

Undiagnosed cirrhosis occurs frequently in the elderly and requires periodic follow ups and medical treatments

Background:  Autopsy examinations frequently reveal undiagnosed cirrhosis, but its characteristics have rarely been addressed in the elderly.

Hepatocellular carcinoma arising in an elderly male with primary biliary cirrhosis

We report the case of an elderly male with asymptomatic primary biliary cirrhosis (PBC) who developed a hepatocellular carcinoma (HCC). The 89-year-old man, who was otherwise healthy, was admitted for investigation of mild hepatic dysfunction, which had been detected during a routine physical check-up. Serum chemistry, positive anti-mitochondrial antibody (M2) and liver biopsy results led to a diagnosis of PBC. Three years later, at age 92, computed tomography (CT) and ultrasound scans of his abdomen revealed a large hepatic tumour, which was confirmed on liver biopsy to be HCC. The tumour ruptured 3 months after diagnosis and the patient was successfully stabilized by coil embolization of his right hepatic artery. We believe that, to date, this is the oldest reported patient to have had interventional radiology for the management of HCC.

Large Cell Carcinoma of the Lung with Metastasis to the Gastric Submucosa.

A 66-year-old man was admitted with dyspnea on exertion and an abnormal shadow on chest roentgenogram. Transbronchial biopsy yielded a diagnosis of large cell carcinoma of the lung. His dyspnea improved following irradiation and corticosteroid treatment and one month later, he was admitted again for chemotherapy. Because occult blood in stool was detected, upper gastrointestinal endoscopy was performed. Gastric submucosal large cell carcinoma was diagnosed, and this was considered to be metastatic from the lung. Such cases diagnosed prior to death are rare.

Early carcinoma of the distal second part of the duodenum treated by wedge resection.

A case of early carcinoma of the distal second part of the duodenum, in a 74-year-old man, is presented. Endoscopic retrograde cholangiopancreatography was performed for diagnosis of a common bile duct stone. During this procedure, small elevated lesions were found incidentally in the distal second part of the duodenum, and the histologic examination of a biopsy specimen showed adenocarcinoma. The lesions were removed by wedge resection, and pathologic examination revealed duodenal carcinoma limited to the lamina propria. Although carcinoma of the duodenum, other than of the ampulla of Vater region, is very rare, it is sometimes possible to detect asymptomatic early tumors. However, this requires careful observation of the entire duodenal mucosa, including that of the distal duodenum, at duodenoscopy.

Change of liver weight in the elderly.

60歳以上の高齢者における肝重量の加齢的変化につき, 肝重量に影響を及ぼす病的因子を可及的に除外した剖検582例 (男性291例・女性291例) を対象として, 定量的に検討した.肝重量および肝重量体重比はいずれも加齢と共に減少した. 肝重量および肝重量体重比はいずれも肥満の影響を受け, 肥満者では前者は高く, 後者は低値を示した. 肥満度別に検討しても肝重量および肝重量体重比は逐齢的に減少した. 男女の比較では同じ年齢では, 女性は肝重量は低い傾向を示したが, 肝重量体重比は高い傾向を示し, 肥満度別の検討でも同様の結果であった.

Extreme right lobar atrophy of the liver : A rare complication of autoimmune hepatitis

Lobar atrophy is a rare morphologic change of the liver. We describe a 73-year-old woman with mild liver dysfunction and history of Sjögrens syndrome who had right hepatic lobar atrophy. Serum biochemistry levels were as follows: albumin, 4.5 g/dl; total bilirubin, 1.0 mg/dl; alanine aminotransferase, 25 international units/l; aspartate aminotransferase, 27 international units/l; alkaline phosphatase, 333 international units/l; and gamma-glutamyl transpeptidase, 332 international units/l. Serological data were as follows: rheumatoid factor, 27.9; anti-nuclear antibody, 1:640; and antismooth muscle antibody, 1:80. Viral markers for hepatitis B were all negative. Anti-hepatitis C virus (anti-c-100) was negative. Portal hypertension developed thereafter, and the patient died of hepatic failure at age 76. Postmortem examination revealed autoimmune hepatitis with moderate fibrosis, portal vein thrombus, and complete obstruction of the right hepatic duct due to hepatolithiasis. Terminal hepatic failure resulted from combination of decreased hepatic volume due to the right lobar atrophy, exacerbation of autoimmune hepatitis in the remnant left hepatic lobe, decreased portal venous blood flow due to thrombosis, portal hypertension, and cholangitis with hepatolithiasis. This is the first reported case of hepatic lobar atrophy due to autoimmune hepatitis. From a clinical standpoint, patients with hepatic lobar atrophy, even if asymptomatic, should be followed up with careful attention to progression of liver diseases, portal hypertension, and biliary complications.

A pathological study on multiple gastric cancers in aged people.

老年者 (平均年齢73歳) 胃癌手術512例のうち408例 (80%) が分化型癌であり, 104例 (20%) が未分化型癌であった. このうち多発癌は75例であり, 71例 (95%) が分化型のみの癌巣 (2～5個) から成っている. それ故に, ここでは分化型癌のみを検索対象とした.分化型多発胃癌は男性に多く (76%), 年代別多発頻度は70歳台が最高 (20%) である. 又, 分化型多発胃癌は各癌巣の深達度による組合せをみると, Mucosal Cancer and Mucosal Cancer の組合せが21例 (30%) であり, Mucosal Cancer and Invasive Cancer は35例 (49%), Invasive Cancer and Invasive Cancer は15例 (21%) であった. 大部分 (79%) が少なくとも1個の粘膜 (内) 癌々巣をもっている. 粘膜癌々巣 (2～4個) のみから成る多発癌21例のうち, 各癌巣中心点相互間の距離が3.9cm以内の14例を選び出し, 各癌巣の最大径, 中心点存在部位について単発粘膜癌49例と対比検討した. これにより, 最大径3cmをこえる単発粘膜癌は多発粘膜癌が衝突した結果, 一つの癌巣となっている可能性が高いことを示唆された.分化型多発胃癌71手術例のうち, 死亡が確認されたのは30例である. 17例が剖検されており, そのうち4例 (24%) は他臓器原発の悪性腫瘍が死因となっていた. 更に, そのうちの2例が, 胃癌・肝癌・結腸癌, 胃癌・食道癌・結腸癌の3重癌であった.

Elderly case of duodenal ascariasis removed by endoscopy: A caution for ascariasis as a revived infection in Japan

A case of duodenal ascariasis in an 89‐year‐old woman is presented. Gastrointestinal endoscopy was performed for chest pain. During this procedure a cord‐like structure was found incidentally in the second part of the duodenum; it was removed and identified as a female specimen of Ascaris lumbricoides. Recently ascariasis in Japan has revived because fresh vegetables without agricultural chemicals are now common. Careful observation of the entire duodenum at gastrointestinal endoscopy is required in elderly patients, especially those in poor general condition as in the present case, because complications of ascariasis such as acute pancreatitis, acute cholangitis, and liver abscess may be more critical for them.

Gastric cancer in the elderly

Gastric cancer in the elderly was evaluated with regard to age-related pathomorphological changes. Resected gastric cancer was studied with regard to location, stage, morphology and histology in male young old (65-74 years old) which were 25 cases and 31 lesions, respectively male middle old (75-84 years old); 104 cases and 120 lesions, male very old (85 years-); 96 cases and 110 lesions, female young old; 22 cases and 31 lesions, female middle old; 91 cases and 106 lesions, female very old; 51 cases and 55 lesions. Multiple gastric cancers were more frequent in female older group. In early cancer the frequency of elevated type increased significantly and that of depressed type decreased in very old group. In advanced cancer Borrmann I type was not so common in very old group. Histologically the frequency of signet ring cell cancer decreased and of tubular adenocarcinoma and of papillary adenocarcinoma increased significantly in female very old group. Hepatic metastasis increased significantly in male very old group. Lymph node metastasis and peritoneal metastasis did not show any change in age-related frequency.