Takashi Nakai

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.

A case of focal nodular hyperplasia of liver diagnosed by Power Doppler ultrasonography at first visit.

症例は24歳, 女性. 他院での腹部超音波で肝内腫瘤を認め, 当院を紹介された. 当科外来初診時の腹部超音波では肝のCouinaud分類のS5領域に径35mm大の辺縁がやや不明瞭で, 内部が均一な低ェコー腫瘤を認めた. 同時に施行したパワードプラエコーでは腫瘤内に放射状の血流シグナル, いわゆる車軸状血管像を認め, 肝FNHと診断した. 99mTc-Snコロイドシンチでは同部に円形のhot spotを認め, 腹部血管造影にても車軸状血管像を認めた. しかし肝生検にて他の肝腫瘍も疑われたため肝切除術を施行した. 腫瘤は肉眼上やや赤褐色調が強く, 中央に暗赤褐色を示す領域が放射状に認められたが, 明らかな中心性瘢痕を伴わず, また組織では異型性のない軽度腫大した肝細胞より構成された過形成性病変であったが, グリソン鞘周辺では類洞の著明な拡張を認めるなど, 非定型的なFNHであった.