Ryuji Furukawa

Production of abnormal prothrombin (des-γ-carboxy prothrombin) by hepatocellular carcinoma: A clinical and experimental study

We measured plasma abnormal prothrombin (des-gamma-carboxy prothrombin; DCP) levels in normal subjects and in patients with hepatocellular carcinoma and other various diseases using the enzyme-linked immunosorbent assay developed by Motohara et al. (Pediatr Res 1985; 19: 354-357). Fifty-eight percent of 52 patients with hepatocellular carcinoma had elevated DCP levels; 24 of 28 patients with advanced or moderately advanced hepatocellular carcinoma were positive. By contrast, 50 normal controls, 13 pregnant women and 10 patients with acute hepatitis had normal levels. Three of 55 patients with chronic liver disease, and 6 of 32 patients with other malignancies, showed a slight increase. Thus, increased plasma DCP appears useful for the diagnosis of hepatocellular carcinoma. To elucidate the mechanism for the increase of DCP in hepatocellular carcinoma, we cultured a human hepatoma cell line, huH-2, and measured the levels of this abnormal prothrombin in the medium. The huH-2 cells produced large amounts of DCP in the medium without added vitamin K. It increased in a cell concentration- and time-dependent fashion. These cells produced no detectable amount of DCP in the medium with added vitamin K. Thus, human hepatoma cell line huH-2 produces DCP, and its production is dependent on the amount of vitamin K available in the medium. Des-gamma-carboxy prothrombin may be a useful tumor marker for the diagnosis of hepatocellular carcinoma.

Clinicopathological study of nonalcoholic fatty liver disease in Japan: the risk factors for fibrosis.

Background/Aims: We evaluated patients with nonalcoholic fatty liver disease (NAFLD) and compared the clinical and pathological features to identify the risk factors for NAFLD with severe fibrosis.

Is bezafibrate histologically effective for primary biliary cirrhosis

acute liver failure was attributed to unusually severe steroid steatohepatitis. In conclusion, we mention that only a short course of high doses of corticosteroid might induce acute steatohepatitis leading to acute liver failure. As corticosteroids are the most widely used drugs associated usually with mild steatosis, clinicians should take into consideration the above rare side effect. Early recognition and rapid tapering of steroids might prevent the fatal outcome.

RADIOIMMUNODETECTION OF CANCER USING ANTIBODIES TO α-FETOPROTEIN AND CARCINOEMBRYONIC ANTIGEN

This study reports the use of radiolabeled antibody to AFP and CEA for the detection and localization of AFP- or CEA-producing tumors. Thirty-one patients received 131I-labeled anti-AFP or anti-CEA antibodies. Photoscans were taken at 24 and 48 hours after injection of radioantibodies. In three of six patients with CEA-producing tumors, radioimmunodetection with anti-CEA antibody showed positive scans. In AFP-producing tumors, 7 of 15 patients had positive findings on immunoscintigraphy using polyclonal anti-AFP antibody, and two of nine patients had positive findings when monoclonal antibodies were used. Analysis of radioantibody in the blood after injection showed both complex and free antibody with immunoreactivity in the circulation, and smaller complexes were seen to form after administration of monoclonal antibodies.

Ultrastructural study of lymphocytic interaction with hepatocytes and endothelial cells in acute non-A, non-B hepatitis.

In the liver biopsy specimens of all six patients with acute non‐A, non‐B hepatitis, the lymphocytic interaction with hepatocytes and sinusoidal endothelial cells was observed by electron microscopic study. Lymphocytes were in a close contact with damaged hepatocytes and interrupted endothelial cells, and the microvilli on the surface of these damaged hepatocytes were degenerated and lost. These findings pointed out the possibility that the lymphocyte may play one of the important roles in hepatocytic damage and endothelial cell damage in acute non‐A, non‐B hepatitis.

[A case of pernicious anemia associated with early gastric cancer (Type IIa + IIc) and squamous cell carcinoma of the oral mucosa].

症例: 71才,男性.既往歴: 65才時, Vit. B12欠乏性臣赤芽球性貧血.現病歴:昭和63年6月全身倦怠感,労作時息切れにて来院.高色素性大球性貧血,骨髄のmegaloblastic change, Vit. B12の低下,低γ-グロブリン血症および低補体価を認め,胃液検査では無酸を呈した.口腔内に扁平上皮癌を,胃幽門部にはIIa+IIc型早期胃癌を認めた.本例は,重複癌を同時性に認め,低γ-グロブリン血症,低補体価を認めた悪性貧血のきわめてまれな例である.

A case report of hepatocellular carcinoma who has survived for 10 years.

3回の摘出術と2回の肝動脈塞栓術(TAE)により10年8カ月生存している肝細胞癌の1例を報告した.症例は62歳の女性,1971年肝生検で肝硬変と診断.1973年10月血中AFP上昇のため当科入院.HBs抗原,HBe抗原ともに陽性.血管造影で腫瘍膿染像をみとめ,摘出術施行,右葉後上区域の3.5cm大の肝癌を摘出した.非癌部は乙型肝硬変であった.6年10カ月後に肝癌の再発がみられ,やはり右葉後上区域にて2.0cm大の肝癌を摘出.さらに10カ月後に肝癌が出現,右葉後下区域より1.0cm大の肝癌を摘出した.組織学的には,3回ともtrabeculartypeであった.さらに1年8カ月後肝癌が出現,TAEを2回施行し外来通院中である.本例の肝癌発生様式は,多中心性と思われるが,血中AFPの厳重なfollowにより3回もの肝癌摘出術に成功し,10年以上の生存をみているため報告した.

Clinicopathological Studies of Minute Hepatocellular Carcinoma. Analysis of 7 Cases

肝細胞癌の早期診断はきわめて難しい.著者らは細小肝細胞癌7例を経験したので,その臨床病理学的特徴につき述べる.7例中6例は診断時自覚症状は軽微であった.臨床所見中変形し増大する肝腫に注目する必要がある.血中AFPは5例が陽性で診断に役立ち,とくに経時的な追跡測定が重要である.特異的診断法ではないが,HBs抗原,アルカリホスファターゼ,総コレステロール,LDH, LAP,トランスアミナーゼ解離が有用な例があった.肝動脈造影は有力な診断法で5例にTumor stainがみられた.AFP陰性,肝動脈造影でTumor stainがみられない2例中1例は腫瘤の吸引細胞診で診断がついた.組織型は全例索状型であった.非癌部組織は全例肝硬変または肝線維症で,肝細胞癌の治療上の問題点につき述べた.術後4年生存している1例では,肝シンチグラム,肝動脈造影で切除部は修復されており,肝硬変でも再生するこ とを示していると考えられた.