Yutaka Shimokawa

Clinical aspects of intrahepatic bile duct carcinoma including hilar carcinoma. A study of 57 autopsy‐proven cases

The clinical features of 57 autopsied cases of intrahepatic bile duct carcinoma including 28 cases of the peripheral type (cholangiocarcinoma in the narrow sense) and 29 cases of the hilar type are described in comparison with those of hepatocellular carcinoma, with a review of the literature on the clinicopathological aspects of intrahepatic bile duct carcinoma. As compared with hepatocellular carcinoma, the average age of the patients was older; the male predominance was not obvious, chronic parenchymal liver disease was infrequent in the past history, association of primary cirrhosis was seldom, cholestatic features were frequently the early signs and more pronounced during the course, the liver was enlarged to a lesser extent, ascites was less common, signs of portal hypertension were absent or minimal, and extrahepatic metastases were less frequent. In many respects, the hilar type resembled extra‐hepatic bile duct carcinoma, and the peripheral type was somewhat between it and hepatocellular carcinoma. Although the overall survival was not much different from that for hepatocellular carcinoma, early diagnosis is emphasized; this would make surgical management possible. Differential diagnosis from hepatocellular carcinoma may be possible in the majority with direct cholangiography, liver scan, celiac angiography, determination of α‐fetoprotein and hepatitis B antigen, and blood chemistry such as SGOT, SLDH, serum bilirubin and alkaline phosphatase. Illustrative cases are given including one patient with a hilar carcinoma who survived for more than 2 years after transhepatic biliary drainage.

Clinicopathologic features of encapsulated hepatocellular carcinoma. A study of 26 cases

The clinicopathologic features of 26 cases of hepatocellular carcinoma (HCC) surrounded by a grossly distinct capsule‐like fibrous tissue were studied. The frequency of this type was 10.3% among autopsy cases of HCC. The mean age of the patients was 64.1 years, which was significantly older compared with that of 143 cases of nonencapsulated HCC. Hepatitis‐B surface antigen in serum was positive in 18.7% of the cases studied, the positivity rate being lower than that of HCC in general. Histologically, the tumor was relatively well differentiated and the capsule was the product of slow expanding growth. Intravenous tumor invasion was less frequent compared with other types of HCC. Clinically, celiac angiography proves to be a most useful diagnostic method; a thick capsule may be demonstrated as a thin radiolucent rim around the mass. The clinical course from the early stage is protracted and, if detected early, this type of HCC may be removed surgically.

Serum glutamic oxalacetic transaminase/glutamic pyruvic transaminase ratios in hepatocellular carcinoma.

Serum enzyme activities were studied in 131 cases of hepatocellular carcinoma (HCC), 76 cases of metastatic liver carcinomas (MLC) and 234 cases of hepatic cirrhosis. SGOT was elevated above SGPT in most of the time in these patients, SGOT/SGPT was greater in HCC compared with other groups, and that this ratio increased during the preterminal period more markedly in patients with HCC because of the significant increase of SGOT in the face of relatively stable SGPT. Preterminal rises of alkaline phosphatase and LDH activities were more pronounced in MLC. Leucine aminopeptidase activity exhibited no characteristic feature of diagnostic value. Of the five enzymes, SGOT changes were more closely correlated with the growth of HCC; SGPT reflected more of the liver parenchymal damage while SGOT was probably accounted for in part by tumor‐derived GOT. Other clinical and pathological implications are discussed. Cancer 40:319–324, 1977.

Localized submassive liver cell necrosis as a terminal event of liver carcinoma.

Six cases of hepatocellular carcinoma (HCC) and one case of metastatic liver carcinoma in which SGOT, SGPT, and SLDH were suddenly and markedly elevated immediately before death are described. All had a large blood loss and systemic hypotension in the preterminal period; autopsy disclosed irregularly shaped, patchy necrotic areas or infarcts, often clearly demarcated by hemorrhagic rims, in the noncancerous liver parenchyma. Tumor growths in the intrahepatic portal branches were extensive in all six cases with HCC; in the metastatic case, invasion and narrowing of the portal branches were extensive. The incidence of this terminal catastrophe was 3.3% (6 of 184 cases) for HCC and 1.15% (1 of 87) for metastatic carcinoma. The terminal liver necrosis was probably a result of sudden reduction in portal perfusion which had been inadequate because of tumor thrombosis, combined with hypotension of hepatic arteries.

Liver scintillation scanning in the diagnosis of chronic schistosomiasis japonica.

Thirty-seven scans were made in 27 cases of chronic schistosomiasis japonica in our series of over 800 liver scans. The spleen was visualized in the majority of the patients. In 7 (26%), the liver con

Intestinal absorption of35S-labeled reduced gultathion. (II)

We have already reported that a disorder of amino-acid metabolism appeared as the ratio of essential amino-acid to nonessential , even in the early stage when the serum albumin showed still normal level. In order to clarify the mechanism of this phenomenon, the following three exper iments were carried out. The results obtained were as follows: 1. Behavior of homeostasis for amino-acids was compared between the totally gastrectomized dog and the mal-nourished one, by measur ing the amount of free amino-acids in the intestinal tract. The homeostasis for amino-acid was disturbed much earlier in the gastrectomized dog than in the mal-nourished one. 2. When a mixture of amino-acids which was lack of one of the essential, was intravenously administered, a low level of the proper amino-acid in the se rum was observed for longer duration in the gastrectomized dog than in the mal-nourished one. It was assumed from the above findings tha t stability of amino-acid balance in the serum was not easily established due to a poor intestinal homeostasis , in the gastrecotmized dog. And we could insist that the homeostasis , for amino-acids exists also in the blood as well as in the gastro-intest inal tract. 3. In the rats which were fed with a protein-free diet, the homeostasis ability for amino-acids was analysed following an oral adminis t ra t ion of zein, in two different g roups : the one which had been infused intravenously with a mixture of essential amino-acids, lacking of threonine and the other which had been given by 5% glucose. Better homeostasis was obtained in the group of administrat ion of the amino-acid. It was proved herein also tha t the homeostas is for amino-acids was well carried out in the blood.