RESUMEN
The present study aimed to investigate the incidence of hepatocellular carcinoma (HCC) and factors related to HCC occurrence after direct-acting antiviral (DAA) treatment in the Fukushima Liver Academic Group (FLAG). We conducted a multicenter retrospective cohort study of 1068 patients without cirrhosis (NC) or with compensated liver cirrhosis (LC) who achieved a sustained virologic response (SVR). First, we compared the cumulative HCC incidence and survival rates in NC (n = 880) and LC (n = 188) patients without a history of HCC treatment. Second, we performed multivariate analysis of factors related to HCC occurrence after DAA treatment. Overall, the average age was 65 years, and the male/female ratio was 511/557. Thirty-nine (4%) patients developed HCC. The cumulative 4-year HCC incidence and survival rates were 3.0% and 99.8% in NC patients and 11.5% and 98.5% in LC patients, respectively. The independent factors affecting HCC occurrence identified by multivariate analysis were the serum albumin (ALB) level before SVR for NC patients and the ALBI score, platelet count, and diabetes before SVR for LC patients. The factors related to HCC occurrence differed between NC and LC patients. Careful surveillance of post-SVR patients with these risk factors is needed.
Asunto(s)
Antivirales/uso terapéutico , Carcinoma Hepatocelular/diagnóstico , Hepatitis C Crónica/tratamiento farmacológico , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/diagnóstico , Anciano , Carcinoma Hepatocelular/complicaciones , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/mortalidad , Complicaciones de la Diabetes/patología , Femenino , Genotipo , Hepacivirus/genética , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/virología , Humanos , Neoplasias Hepáticas/complicaciones , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/mortalidad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Albúmina Sérica/análisis , Tasa de Supervivencia , Respuesta Virológica SostenidaRESUMEN
A 19-year-old Japanese woman had melena 2 months after systemic lupus erythematosus was diagnosed. Colonoscopy showed diffuse ulceration with bleeding in the ileum, suggesting that the melena was due to ischemic enteritis associated with lupus enteritis. Because treatment with high doses of steroid, anticoagulants, and cyclophosphamide pulse was ineffective, surgical intervention was planned. On exploration, it was impossible to determine the extent of resection visually. Intraoperative esophagogastroduodenoscopy clearly revealed the border between the ulcer and normal area, permitting successful resection of the ileum and ileostomy. This is the first report to document the usefulness of esophagogastroduodenoscopy in surgical treatment of ischemic enteritis in a patient with systemic lupus erythematosus.
Asunto(s)
Endoscopía del Sistema Digestivo , Enteritis/complicaciones , Enteritis/diagnóstico , Lupus Eritematoso Sistémico/complicaciones , Adulto , Enteritis/cirugía , Femenino , Humanos , Ileítis/complicaciones , Ileítis/diagnóstico , Ileítis/cirugía , Íleon/irrigación sanguínea , Periodo Intraoperatorio , Isquemia/complicaciones , Isquemia/diagnóstico , Isquemia/cirugíaRESUMEN
Pseudoaneurysm after pancreas resection poses serious complications, including rupture and hemorrhage. Here we report a case of delayed massive hemorrhage from celiac and superior mesenteric arteries, which was successfully treated with a combined endovascular and surgical approach. The patient was a 52-year-old man who presented with pseudoaneurysms of the celiac and superior mesenteric arteries after distal pancreatectomy. Following the detection of sentinel bleeding from the abdominal drain, emergency angiography of the celiac and superior mesenteric arteries revealed stenosis of the celiac artery and pseudoaneurysms in the superior mesenteric artery. We occluded these lesions with a platinum coil, using an interventional radiological technique combined with bypass grafting between the abdominal aorta and the SMA, using the saphenous vein. However, re-bleeding into the abdominal cavity occurred from the proximal SMA pseudoaneurysm. We inserted an endoluminal stent-graft into the abdominal aorta and completed bypass grafting between the aorta and bilateral renal arteries. The hemorrhage ceased and the postoperative course was uneventful. The patient was discharged 34 days after the treatment (149 days after the initial operation). In conclusion, this combined endovascular and surgical approach is feasible and seems appropriate for pseudoaneurysms arising from proximal sites in visceral arteries.
Asunto(s)
Aneurisma Falso/cirugía , Implantación de Prótesis Vascular , Arteria Celíaca/cirugía , Arteria Mesentérica Superior/cirugía , Implantación de Prótesis Vascular/métodos , Arteria Celíaca/diagnóstico por imagen , Humanos , Escisión del Ganglio Linfático , Masculino , Arteria Mesentérica Superior/diagnóstico por imagen , Persona de Mediana Edad , Pancreatectomía/efectos adversos , Neoplasias Pancreáticas/cirugía , Radiografía , Radiología Intervencionista , StentsRESUMEN
Case 1 was a 43-year-old woman, who was diagnosed as having PBC. After one month, she was hospitalized owing to sudden temporary unconsciousness. She was diagnosed as having acute lymphoid leukemia (ALL) by bone marrow examination. Chemotherapy was done, but she died after 6 months. Case 2 was a 54-year-old woman, who was diagnosed as having PBC with CREST syndrome. Seven years later, she was diagnosed as having acute promyelocytic leukemia (APL) by bone marrow examination. Chemotherapy was continued, and her symptoms are at present, stable. To date, there have been no reports of PBC complicated by acute leukemia.
Asunto(s)
Leucemia Promielocítica Aguda/complicaciones , Cirrosis Hepática Biliar/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Western Blotting , Síndrome CREST/complicaciones , Acetiltransferasa de Residuos Dihidrolipoil-Lisina/metabolismo , Resultado Fatal , Femenino , Humanos , Leucemia Promielocítica Aguda/tratamiento farmacológico , Hígado/patología , Cirrosis Hepática Biliar/enzimología , Cirrosis Hepática Biliar/patología , Persona de Mediana Edad , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológicoRESUMEN
A 69-year-old man with autoimmune hepatitis (AIH) was admitted to hospital with high fever and cough. Chest roentgenogram and computed tomography showed pleural and pericardial effusion. Serological tests showed a high titer of antinuclear antibodies and positive anti-DNA antibody and lymphocytopenia. He fulfilled the American College of Rheumatology criteria for systemic lupus erythematosus (SLE). After administration of corticosteroids, his symptoms and liver dysfunction improved. To the authors' knowledge, this is the first male case of overlap between AIH and late-onset SLE.
RESUMEN
A 79-year-old woman, who had been treated because of mixed connective tissue disease (MCTD), was admitted to the hospital for the intensive examination of a hepatic tumor that was unexpectedly found on computed tomography. The hepatic tumor was approximately 40 mm in diameter. Her transaminase levels were slightly elevated but hepatic virus markers were negative. However, a liver aspiration biopsy revealed moderately differentiated hepatocellular carcinoma (HCC). In the surrounding non-tumor area, nonspecific reactive hepatitis was detected. MCTD associated with HCC has not yet been reported in the past. This case appears to be very interesting in terms of the etiology of HCC.
Asunto(s)
Carcinoma Hepatocelular/etiología , Neoplasias Hepáticas/etiología , Enfermedad Mixta del Tejido Conjuntivo/complicaciones , Anciano , Femenino , HumanosRESUMEN
We report a case of biliary varices associated with extrahepatic portal vein obstruction (EHPVO) that were identified via intraductal sonography during endoscopic retrograde cholangiography. A 35-year-old man was admitted to our hospital because of jaundice that had developed during an episode of EHPVO. Laboratory data showed obstructive jaundice. Endoscopic retrograde cholangiography showed some bile duct stenosis with smooth stricture along the extrahepatic biliary duct. Intraductal sonographic examination revealed numerous vessels around the lower and upper parts of the bile duct. Compression by these vessels was suspected as the cause of the biliary stricture.
Asunto(s)
Conductos Biliares/irrigación sanguínea , Endosonografía , Vena Porta/diagnóstico por imagen , Várices/diagnóstico por imagen , Adulto , Conductos Biliares/diagnóstico por imagen , Colangiografía , Colangiopancreatografia Retrógrada Endoscópica , Colestasis Extrahepática/etiología , Enfermedades del Conducto Colédoco/etiología , Estudios de Seguimiento , Humanos , Hipertensión Portal/complicaciones , Ictericia Obstructiva/etiología , Masculino , Várices/etiologíaRESUMEN
A 20-year-old woman given a diagnosis of hyperthyroidism (Basedow's disease) had been subsequently treated with methimazole since 1999. As she could not be made euthyroid, surgery was planned to relieve the symptoms. Because of liver dysfunction after discontinuation of methimazole and administration of iodine, she was admitted to the hospital. She was negative for hepatitis A, B and C virus serologies, but positive for anti-nuclear antibodies. A liver biopsy, which showed features of chronic active hepatitis, led to the diagnosis of autoimmune hepatitis (AIH). Interestingly, normalization of serum T4 correlated with improvement of serum aminotransferases. This leads us to speculate that this patient's liver dysfunction may have been AIH exacerbated by the liver dysfunction of hyperthyroidism rather than acute deterioration of AIH itself.
Asunto(s)
Enfermedad de Graves/complicaciones , Hepatitis Autoinmune/etiología , Adulto , Anticuerpos Antinucleares/análisis , Biomarcadores/análisis , Femenino , Enfermedad de Graves/terapia , Hepatitis Autoinmune/diagnóstico , Hepatitis Autoinmune/patología , Humanos , Yodo/uso terapéutico , Hígado/patología , Metimazol/uso terapéuticoRESUMEN
Reportedly, bacterial DNA containing unmethylated cytosine-guanosine dinucleotide motif-containing oligodeoxynucleotides (CpG-ODNs) can induce Th1-type adjuvant effects. We produced autoantibodies and induced hepatitis in mice using extracted proteins from human hepatocytes with CpG-ODNs as adjuvant. Western blot analysis was performed of sera from immunized mice and two patients with autoimmune hepatitis (AIH). When a common band was detected, N-terminal amino acid sequencing was performed to determine its site. For detection of antibodies against the identified protein (calreticulin), ELISA was performed of sera of 50 patients with AIH: 45 with primary biliary cirrhosis (PBC), 24 with chronic hepatitis C (CH), and 24 healthy controls. Mice were immunized with calreticulin protein with CpG-ODNs as adjuvant. Several reacted bands were detected in their sera; in addition, a common band to the sera of patients with AIH was detected at 60 kDa. Subsequent N-terminal amino acid sequencing revealed that the protein was human calreticulin. ELISA showed that, of patients with AIH, PBC, and CH, 30.0% (15/50), 17.8% (8/45), and 12.5% (3/24), respectively, were positive for anti calreticulin antibodies. Splenocytes from immunized mice produced IFN-gamma after they were pulsed with calreticulin protein. Histological analyses of liver specimens taken from mice immunized with calreticulin protein together with CpG-ODNs showed spotty and focal necrosis. Immunofluorescence analysis showed increased expression of calreticulin in the liver treated with CpG-ODNs. These results suggest that a breakthrough of immune self tolerance to calreticulin is induced with CpG-ODNs as adjuvant and that calreticulin protein might be a target antigen in this model.
Asunto(s)
Adyuvantes Inmunológicos/farmacología , Calreticulina/inmunología , Hepatitis Autoinmune/inmunología , Tolerancia Inmunológica , Oligodesoxirribonucleótidos/farmacología , Secuencia de Aminoácidos , Animales , Western Blotting , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Inmunización , Interferón gamma/biosíntesis , Interleucina-4/biosíntesis , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BLRESUMEN
A 23-year-old woman was admitted to our hospital with jaundice and hepatic coma. She had taken a weight-loss supplement for one month before admission. Her clinical and laboratory findings were consistent with fulminant hepatic failure and fulfilled the criteria of autoimmune hepatitis. Despite corticosteroid pulse therapy and plasma exchange, her symptoms and laboratory findings deteriorated. Her condition improved after she received a living donor-liver transplant from her sister. Autoimmune hepatitis usually follows a chronic course, but it should be considered a type of fulminant hepatic failure and treated promptly.
Asunto(s)
Hepatitis Autoinmune/diagnóstico , Hepatitis Autoinmune/cirugía , Fallo Hepático Agudo/diagnóstico , Fallo Hepático Agudo/cirugía , Trasplante de Hígado , Donadores Vivos , Enfermedad Aguda , Adulto , Fármacos Antiobesidad/efectos adversos , Diagnóstico Diferencial , Femenino , Humanos , Fallo Hepático Agudo/inducido químicamenteRESUMEN
Hepatic hydrothorax is often resistant to various treatments. A failure in the treatment for hepatic hydrothorax may be associated with poor prognosis. We report two cases of intractable hepatic hydrothorax successfully treated by combining chemical pleurodesis using OK-432 with nasal continuous positive airway pressure. Combination therapy may provide a minimally invasive and effective treatment for intractable hepatic hydrothorax.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Hidrotórax/terapia , Cirrosis Hepática/complicaciones , Anciano , Femenino , Humanos , Hidrotórax/etiología , Masculino , Máscaras , Picibanil/administración & dosificaciónRESUMEN
A 46-year-old woman was diagnosed with palmoplantar pustulosis (PPP) at the Department of Dermatology, Fukushima Medical University Hospital in 2000, and was treated with ointment. However, because liver dysfunction developed in 2003, she was referred to our department, where primary biliary cirrhosis (PBC) was also diagnosed on the basis of clinical findings. One year later, at the age of 49, she developed manifestations of Behçet's disease (BD), including erythema nodosum in the lower extremities. Because she had a history of uveitis, recurrent oral ulceration was present, and the HLA typing was positive for B51, BD was additionally diagnosed. Liver function normalized within three months of the start of treatment with ursodesoxycholic acid (UDCA). This is the first case of PBC associated with BD and PPP.
Asunto(s)
Síndrome de Behçet/complicaciones , Cirrosis Hepática Biliar/complicaciones , Psoriasis/complicaciones , Adulto , Femenino , HumanosRESUMEN
We evaluated the expression of human glucocorticoid receptor beta (hGRbeta) in patients with severe autoimmune hepatitis (AIH). The subjects were 27 patients with AIH, including 6 with severe type (prothrombin time [PT] < 40%) and 21 with non-severe type (PT>40%). Total RNA extracted from peripheral blood mononuclear cells (PBMCs) was reversed using reverse transcriptase. The resultant complementary DNA was amplified by reverse transcription polymerase chain reaction (RT-PCR) using specific primers for hGR alpha and beta. The six patients with severe AIH were female; three presented fulminant hepatic failure with hepatic encephalopathy. In all patients with AIH, hGR a was detected. The incidence of hGR beta expression in patients with non-severe type was 42.9% (9/21) ; it was 100% (6/6) in those with severe type. The positive ratio was significantly higher in severe-type patients. These results suggest that hGR beta expression in PBMCs is a novel predictor of AIH severity.
Asunto(s)
Hepatitis Autoinmune/metabolismo , Leucocitos Mononucleares/metabolismo , Receptores de Glucocorticoides/sangre , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Receptores de Glucocorticoides/genética , Reacción en Cadena de la Polimerasa de Transcriptasa InversaRESUMEN
To clarify the clinicolaboratory characteristics of patients with primary biliary cirrhosis (PBC)-autoimmune hepatitis (AIH) overlap, we analyzed their clinicolaboratory findings and compared them with those of patients with AIH or PBC retrospectively. We analyzed the laboratory findings of 177 patients that diagnosed 103 PBC and 74 AIH patients at our department during the period from January 1990 to April 2005. Of 103 PBC patients with a diagnosis of PBC, we identified 10 cases (9.7%) of PBC-AIH overlap (2 male, 8 female; mean age 56.5 years). PBC preceded AIH in 2 patients, and both diseases occurred simultaneously in the other 8 patients. There is no patients AIH preceded PBC. Positive frequency of anti-smooth muscle antibody (ASMA), IgG and IgM levels were significantly higher in patients with overlap than in those with AIH or PBC. Ursodeoxychoric acid (UDCA) was administered to all 10 patients initially, and later an immunosuppressant, prednisolone or azathioprine, was added in 6 patients. Two of the 10 patients died of liver failure 5 and 12 years after diagnosis, respectively. Both patients had been treated by either prednisolone or UDCA alone. We conclude that in patients with PBC-AIH overlap, the clinical characteristics of both PBC and AIH exist in an enhanced manner.
Asunto(s)
Hepatitis Autoinmune/complicaciones , Cirrosis Hepática Biliar/complicaciones , Adulto , Anciano , Alanina Transaminasa/sangre , Femenino , Hepatitis Autoinmune/tratamiento farmacológico , Hepatitis Autoinmune/inmunología , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Inmunosupresores/uso terapéutico , Cirrosis Hepática Biliar/tratamiento farmacológico , Cirrosis Hepática Biliar/inmunología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Ácido Ursodesoxicólico/uso terapéuticoRESUMEN
Cytotoxic T lymphocyte antigen-4 (CTLA-4) is an important inhibitor of T-lymphocyte response. Polymorphisms in the CTLA-4 gene have been reported to be associated with numerous autoimmune diseases. The aim of this study was to determine whether polymorphisms of CTLA-4 exon 1 (+49) genes are associated with susceptibility and clinicolaboratory findings of primary biliary cirrhosis (PBC) in the Japanease population. Blood samples were obtained from 45 patients (6 men and 39 women, aged 23-56 years) with PBC and 73 healthy controls (48 men and 25 women, aged 22-72 years). CTLA-4 exon 1 (+49) polymorphism was defined using a polymerase chain reaction-restriction fragment length polymorphism with Bst71I restriction enzyme. The genotype frequencies of A/A, A/G, and G/G in 45 patients with PBC were 11% (5 patients), 44% (20 patients), and 44% (20 patients), respectively. There was no significant difference between frequencies in PBC patients and healthy controls. PBC patients with G/G genotype had significantly higher serum levels of ALT, GGT, and IgM than those in patients with A/A or A/G genotype. In conclusion, CTLA-4 gene polymorphisms are not associated with susceptibility of PBC in Japan; however, G/G genotype may be associated with liver damage.
Asunto(s)
Antígenos CD/genética , Antígenos de Diferenciación/genética , Cirrosis Hepática Biliar/genética , Polimorfismo Genético , Adulto , Anciano , Alanina Transaminasa/sangre , Antígeno CTLA-4 , Femenino , Genotipo , Humanos , Inmunoglobulina M/sangre , Hígado/fisiopatología , Cirrosis Hepática Biliar/sangre , Masculino , Persona de Mediana Edad , gamma-Glutamiltransferasa/sangreRESUMEN
We report a case of 14-year-old male patient who underwent bile-duct-to-jejunum anastomosis because of congenital biliary atresia at the age of 2 months. A 15 mm hypervascular nodule was detected for the first time in the S1 region of the liver at the age of 9 years. Two years later, 6 hypervascular nodules were found in the liver. A tumor biopsy was performed. It was diagnosed as a focal nodular hyperplasia (FNH). However, the number of nodules increased from 6 to 12 and those diameters were enlarged two to seven times one year later; the tumor biopsy was performed again. Histologically, the findings were consistent with those obtained previously, which indicated FNH. We consider that this is a very rare case of FNH in which both the number of nodules and the size were increased in a short period of time. We present it here as a valuable case report.
Asunto(s)
Hiperplasia Nodular Focal/patología , Adolescente , Hiperplasia Nodular Focal/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To investigate the effects of an intradermal injection of oligodeoxynucleotides (ODNs) containing unmethylated CpG motifs on concanavalin A (Con A)-induced hepatitis, an experimental model of immune-mediated hepatitis. METHODS: Con A was injected intravenously into Balb/c mice. Twelve hours after Con A challenge, blood and liver samples were obtained. CpG ODN was injected intradermally 48 hours before Con A challenge. The extent of liver injury was assessed by determining serum alanine transaminase (ALT) and by liver histology. Serum levels of cytokines, including interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-4 and IL-5, were measured by enzyme-linked immunosorbent assay. RESULTS: Co-administration of Con A and CpG ODN significantly increased serum ALT in mice compared with that in the case of administration of Con A alone (10,268 +/- 4,654 and 1,140 +/- 832 IU/1, respectively, p<0.05). In liver histology, mice treated with CpG ODN and Con A showed more extensive midzonal necrosis than did mice treated with Con A alone. These mice also showed significant increases in serum TNF-alpha and IFN-gamma and decrease in serum IL-5. CONCLUSIONS: The results indicate that CpG ODNs aggravate Con A-induced hepatitis by stimulating the production of T-helper-1 (Th1) cytokines, TNF-alpha and IFN-gamma, suggesting that bacterial DNA that contains unmethylated CpG motifs may contribute to the exacerbation of immune-mediated liver injury.
Asunto(s)
Adyuvantes Inmunológicos/farmacología , Concanavalina A/toxicidad , Hepatitis/etiología , Oligodesoxirribonucleótidos/farmacología , Alanina Transaminasa/sangre , Animales , Femenino , Hepatitis/patología , Interferón gamma/fisiología , Interleucina-5/fisiología , Hígado/patología , Ratones , Ratones Endogámicos BALB C , Factor de Necrosis Tumoral alfa/fisiologíaRESUMEN
OBJECTIVE: : The possible involvement of eosinophils in primary biliary cirrhosis (PBC) has been suggested for many years. Activated eosinophils release basic granule proteins and are thought to be involved in the tissue damage of PBC. Eosinophil peroxidase (EPO) is one of the eosinophilic granule proteins and is toxic to epithelial cells. In this study, we examined whether autoantibodies to EPO are present in sera of patients with PBC and we evaluated the relationship between the presence of anti-EPO antibodies and the clinical features of PBC. METHODS: : Sera obtained from 61 patients with PBC, 31 patients with autoimmune hepatitis (AIH), 87 patients with chronic viral hepatitis (CVH), 27 patients with bronchial asthma, and 20 healthy controls were examined. Enzyme-linked immunosorbent assay (ELISA) and Western blot methods were used for detection of anti-EPO antibodies. RESULTS: : The mean OD value of anti-EPO antibodies, as determined by ELISA, was significantly (p<0.01) higher in patients with PBC (0.197+/-0.121) than in patients with AIH (0.124+/-0.077), CVH (0.090+/-0.038) or bronchial asthma (0.073+/-0.025) and in healthy controls (0.072+/-0.029). The results of ELISA showed that 32 (52.5%) of the 61 patients with PBC, 9 (29.0%) of the 31 patients with AIH, 7 (8.0%) of the 87 patients with CVH, and 1 (3.7%) of the 27 patients with bronchial asthma were positive for anti-EPO antibodies. In addition, PBC patients who were positive for anti-EPO antibodies had a significantly smaller number of peripheral eosinophils than did patients who were negative for anti-EPO antibodies (99.2+/-54.4cells/mul versus 176.9+/-117.5cells/mul, p<0.01). However, there was no correlation between the titers of anti-EPO antibodies and those of AMA or AMA-M2, ANA or serum levels of IgM. CONCLUSIONS: : This is the first report of the detection of anti-EPO antibodies in patients with PBC. Further study is needed to clarify the role of anti-EPO antibodies in the pathogenesis of PBC.
RESUMEN
We report a 72-year-old man who was admitted to our department with multiple nodules of hepatocellular carcinoma (HCC) in a cirrhotic liver because of HCV infection. Unlike most of the nodules, one in segment 2 (S2) showed hypoattenuation on computed tomography (CT) during hepatic arteriography (CTA), and hyperattenuation on CT during arterial portography (CTAP). Fine needle aspiration biopsy of the nodule established the diagnosis of hepatic adenomatous hyperplasia. Why the S2 nodule showed hyperattenuation on CTAP is not clear. Two possibilities are considered: i) greater portal blood flow into the nodule than into the surrounding cirrhotic parenchyma, ii) existence of a period during the course of hepatocarcinogenesis when the portal blood flow into the nodule is higher in density on CTAP.
Asunto(s)
Adenoma de Células Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Adenoma de Células Hepáticas/irrigación sanguínea , Adenoma de Células Hepáticas/patología , Anciano , Biopsia con Aguja Fina , Carcinoma Hepatocelular/irrigación sanguínea , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/patología , Humanos , Hiperplasia , Neoplasias Hepáticas/irrigación sanguínea , Neoplasias Hepáticas/patología , Masculino , Portografía , Tomografía Computarizada por Rayos XRESUMEN
A 23-year-old man was admitted to our department due to hemorrhage from gastric varices. He had been diagnosed as having Wilson's disease at the age of 17. Abdominal ultrasonography and computed tomography (CT) showed portal thrombosis and a large mass occupying most of the right lobe in the liver. The tumor was diagnosed as hepatocellular carcinoma (HCC) by image views and tumor markers. He died 3 months after the diagnosis, and an autopsy was performed. Histologic examination of the tumor showed moderately to poorly differentiated HCC. The nontumorous lesion of the liver revealed cirrhosis. HBX-DNA sequence was not detected in the liver. Hepatic cirrhosis is a well-recognized complication of Wilson's disease, but HCC is extremely rare. We describe the clinical findings of this patient and discuss the relationship of the development of HCC with a review of the relevant literature.