Ryosuke Inokuchi

Phosphorylated Smad2 and Smad3 signaling: Shifting between tumor suppression and fibro-carcinogenesis in chronic hepatitis C.

Insight into hepatic fibrogenesis and carcinogenesis (fibro‐carcinogenesis) caused by hepatitis C virus (HCV) infection has come from recent analyses of transforming growth factor (TGF)‐β signaling. TGF‐β type I receptor and pro‐inflammatory cytokine‐activated kinases differentially phosphorylate Smad2 and Smad3 to create C‐terminally (C), linker (L) or dually (L/C) phosphorylated (p) isoforms. This study aimed to elucidate how HCV infection affected hepatic fibro‐carcinogenesis, particularly via phospho‐Smad signaling.

Acute necrotizing pancreatitis as a fatal complication following DC Bead transcatheter arterial chemoembolization for hepatocellular carcinoma: A case report and review of the literature

Transcatheter arterial chemoembolization (TACE) is one of the most effective palliative measures for patients with inoperable hepatocellular carcinoma (HCC). Acute pancreatitis is a rare but well-known complication following TACE. We herein present the case of a patient with HCC who developed fatal complications (acute necrotizing pancreatitis and upper gastrointestinal ulcers) after TACE with DC Beads. The patient was diagnosed with HCC in segments 4 and 8, measuring ~70 mm in greatest diameter, and he was treated by TACE. Hepatic arteriography revealed replacement of the origin of the right hepatic artery to the superior mesenteric artery, while the left hepatic artery originated from the celiac artery. After selection of the segmental arterial branches feeding the tumor, 2 ml of 100-300-µm-sized DC Beads loaded with 150 mg epirubicin were injected through the microcatheter. The patient complained of abdominal pain after the TACE procedure. Upper gastrointestinal endoscopy revealed longitudinal ulcers from the esophagus to the duodenum, and contrast-enhanced computed tomography revealed swelling of the pancreas and focal areas of low density in the pancreatic body, suggesting necrosis. The patient developed respiratory insufficiency, renal failure and sepsis, and finally succumbed to the complications 54 days after the procedure, despite general management of the acute pancreatitis. An autopsy revealed that the main cause of the patients death was extensive pancreatic necrosis due to a gastroduodenal artery embolism after TACE with DC Beads. Therefore, it is crucial for treating physicians to be aware of this complication following TACE with DC Beads, particularly in patients with anatomical variations.

S-1 monotherapy in a patient with cholangiolocellular carcinoma: A case report

A 71-year-old man with alcoholic cirrhosis was found to have multiple hypervascular lesions in the liver on enhanced computed tomography. An ultrasound-guided biopsy of the lesion was performed. Immunohistochemical analysis for hepatocyte paraffin 1 expression was negative; cytokeratin (CK) 7, CK19, epithelial cell adhesion molecule and epithelial membrane antigens were positive; mucicarmine staining was negative. The tumor was thus histologically diagnosed as cholangiolocellular carcinoma (CoCC). The tumor was inoperable due to the associated advanced liver disease. In addition, the patient preferred systemic chemotherapy using only orally administered agents. Thus, S-1 monotherapy was recommended. S-1 was initially administered orally at a dose of 80 mg/day. Although the levels of tumor marker (prothrombin induced by vitamin K absence/antagonist-II and carbohydrate antigen 19-9) levels were marginally elevated, their values did not change over the entire course. The patient achieved a partial response according to the Response Evaluation Criteria In Solid Tumors (RECIST) and modified RECIST 1 year after chemotherapy initiation. In conclusion, S-1 monotherapy exhibited promising efficacy against unresectable CoCC.

A case of hepatocellular carcinoma complicated with biliary pleuritis after liver infarction due to per-cutaneous radiofrequency ablation

症例は65歳の男性. 肝S8肝門部の肝細胞癌に対しTAE後に経皮的ラジオ波焼灼治療 (PRFA) を施行したところ肝梗塞を合併. その後敗血症性ショックにより再梗塞を惹起. さらに胆管胸腔瘻が形成され胆汁性胸膜炎を来した. 胆管内圧の減圧を目的に内視鏡的胆管ドレナージを施行し, 瘻孔閉塞に成功したが長期間の入院加療が必要となった. 以前よりラジオ波焼灼による脈管障害は軽微と報告されているが, 時として本症例のように重大な合併症を引き起こす可能性がある. 特に脈管損傷を来しやすい肝門部に位置する肝細胞癌に対し本法を施行するに当たっては, 患者に対する術前の十分な説明と術後の注意深い経過観察が必要である. PRFAにより肝梗塞を合併し, その後胆管胸腔瘻から胆汁性胸膜炎に至った肝細胞癌の1例を経験したので報告した.