Yutaro Kobayashi

A case of complete necrosis of well-differentiated early hepatocellular carcinoma by percutaneous transhepatic portal embolization

The patient was a 49-year-old male under observation for chronic hepatitis B. In July 1997, abdominal ultrasonography showed multiple hyperechoic nodules in the right lobe, the largest with a diameter of 3.5 cm. Abdominal computed tomography did not reveal enhanced nodules, and the patient was hospitalized for suspected multiple liver tumors. All biochemical tests were normal, except for a slight decrease in platelets. The patient was positive for HBs antigen, negative for HBe antigen and positive for anti-HBe antibody. Hepatocellular carcinoma (HCC) with patent portal blood flow was strongly suspected based on the results of various imaging techniques. A tumor biopsy was conducted, and findings of multiple early hepatocellular carcinoma of a well-differentiated type were observed. Based on the HCC stage and liver function, an extensive right hepatectomy was indicated. Before the surgical resection, a percutaneous transhepatic portal embolization (PTPE) was performed using gerfoam sponzel in the right portal vein. Complete necrosis of the tumor lesions was observed in the resected liver. Early HCC thought to have developed multifocally concurrently with chronic inactive hepatitis was observed. It is highly possible that complete necrosis of these tumors occurred due to PTPE, suggesting that they are supplied by the portal blood flow.

Effect of Interferon Treatment with Chronic Hepatitis C on Serum Level of Thrombomodulin.

C型慢性活動性肝炎22例のIFN治療時の血中TM濃度の推移に関して検討した. IFNは2週もしくは4週間連日投与の後, 週3回隔日投与を22週もしくは20週間行った. IFN治療前の血中TM濃度は健常対照者と比較して有意に高値を示した (p<0.01). IFN投与中の血中TM濃度は投与1週及び2週後に有意に低下した (各々p<0.0001). IFN投与終了時は, R群, NR群とも, 連日投与中に比して, 血中TM濃度は上昇傾向を示し, 治療前と比較して低下を認めなかった. IFN有効群 (R群) での血中TM濃度は, 投与終了6カ月後は治療前値と同程度まで上昇し, 投与終了1年後は健常対照者と同程度に低下した. 無効群(NR群) では投与終了6カ月後の血中TM濃度は, R群に比して有意に高値であった (p<0.05). IFN連日投与中の血中TM濃度の低下は, 肝炎の鎮静化などの病態変化によるものではなく, IFNの血管内皮細胞への直接的な遊離抑制によるものと考えられた. 一方, IFNによるTMの遊離抑制の反作用や, IFNによる血管内皮細胞の傷害が, IFN投与終了後の血中TM濃度上昇に関与している可能性も考えられた.