Tomohiro Shiro

A correlation of argyrophilic nucleolar organizer regions with stages of hepatocellular carcinoma

Background. Recently, the number and morphologic features of argyrophilic nucleolar organizer regions (AgNOR), silver‐stained nucleolar organizer regions, were thought to reflect the cellular proliferative activity and the grade of malignancy. In liver diseases, it has been reported that AgNOR scores for hepatocellular carcinomas (HCC) were significantly higher than those for benign and borderline lesions; the scores increased with histologic tumor grade.

Percutaneous transhepatic microwave coagulation therapy for hepatocellular carcinoma proliferating in the bile duct.

Hepatocellular carcinoma (HCC) often invades the portal system or hepatic veins. Along with recent increases in the incidence of HCC, there have been several reports of HCC proliferating in the bile duct and causing obstructive jaundice (1-4). Since radical hepatectomy is rarely possible in these cases, conservative therapy is the sole therapeutic modality. Transcatheter arterial embolization (TAE) is reported to be effective in some cases, but the number of studies is limited and the efficacy of the procedure has not been established (5-7). Surgical treatment was not possible and TAE we found to be ineffective in the present case of HCC proliferating in the bile duct. We applied percutaneous ethanol injection therapy (PEIT) (8, 9), percu taneous t ranshepat ic microwave coagulat ion therapy (PTMCT), and radiotherapy, and the combination produced satisfactory clinical results. To our knowledge, this is the first reported case in which local treatment was successfully applied to HCC that had infiltrated the bile duct.

Laparoscopic observation of retroperitoneal cystic lymphangioma

Abstract A case of retroperitoneal cystic lymphangioma observed laparoscopically is reported. In a 60 year old asymptomatic male patient, an 8 cm multi‐loculated cystic lesion was detected incidentally near the splenic hilum with ultrasonography. Endosonography, computed tomography and magnetic resonance imaging revealed the lesion with thin wall and clear fluid.

Retroperitoneal haematoma due to ruptured microaneurysm of the pancreaticoduodenal artery

A case of retroperitoneal haematoma due to a ruptured microaneurysm of the posterior superior pancreaticoduodenal artery in a 61 year old man is described. Ultrasonography and computed tomography revealed cystic masses near the gall‐bladder. Selective coeliac angiography disclosed a microaneurysm of the posterior superior pancreaticoduodenal artery. Surgical extirpation of the cystic masses was performed, and the histological finding was an encapsulated old haematoma.

Development of local necrosis and side-effects after hepatic injections of acetic acid solutions

Abstract Acetic acid injection therapy has recently been studied as a treatment for hepatocellular carcinoma. Since trials of this therapy have just begun, both basic and clinical studies of it are presently required. Therefore, the efficacy and safety of this therapy as a treatment for hepatocellular carcinoma were examined in rats. When acetic acid was injected into normal rat liver, the extent of necrosis at the site of injection expanded in a dose-dependent manner. At concentrations of 30% and above, acetic acid began to prove fatal, and mortality increased in a dose-dependent fashion. At a concentration of 45% and above, all rats died within 2 days after injection due to acute multi-organic circulatory failure. On histological examination, distinct thorombus formation was observed in the liver. We conclude that additional detailed examination of the effects of various amounts and concentrations of acetic acid and of the effects of acetic acid injection on other organs should be performed prior to clinical application of this therapy.

Usefulness of the high sensitivity PIVKA-II measurement method in diagnosis of hepatocellular carcinoma: A comparison with the conventional method

Abstract We investigated a new PIVKA-II assay kit (Eizai, ED-008) that incorporates the use of an improved secondary antibody compared with the conventional EIA method, and is highly sensitive to PIVKA-II (sensitivity: 0,0125 AU/ml). Using this new kit, we measured plasma PIVKA-II levels in 76 subjects in whom the conventional PIVKA-II assay was negative (≤ 0.0625 AU/ml). There were 30 patients with HCC, 14 patients with liver cirrhosis (six with α-fetoprotein ≥ 50 ng/ml), 11 patients with chronic active hepatitis C, 11 patients with chronic inactive hepatitis C, and ten healthy volunteers. The new assay kit detected PIVKA-II (≥ 0.0125 AU/ml) in 11 patients with HCC (36.7%), and one patient with liver cirrhosis (7.1%), but was negative in the patients with chronic active or inactive hepatitis C and the controls. Among the 11 HCC patients positive for PIVKA-II, the plasma α-fetoprotein level was greater than 100 ng/ml in two patients (18.2%), while it was above this level in three of the 19 patients negative for PIVKA-II. The mean size of the main tumor in the patients positive and negative for PIVKA-II was 2.16 + 0.87 cm and 2.62 + 1.50 cm, respectively, with no significant difference between the groups (P = 0.47). However, in seven patients positive for PIVKA-II, the tumor size was less than 2 cm. This assay also showed a high specificity for HCC (0.98). We concluded that this assay may allow PIVKA-II to be used as a more effective indicator of HCC.