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A case of advanced intrahepatic cholangiocarcinoma successfully treated with chemosensitivity test-guided systemic chemotherapy

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World Journal of Gastroenterology 2009年第41期15卷 5228-5231页

作者： Kazumichi Abe Takeru Wakatsuki Fumiko Katsushima Kyoko Monoe Yukiko Kanno Atsushi Takahashi junko yokokawa Hiromasa Ohira Department of Gastroenterology and Rheumatology Fukushima Medical University School of Medicine 1 Hikarigaoka Fukushima 960-1295 Japan

Intrahepatic cholangiocarcinoma （ICC） is a relatively rare and highly fatal neoplasm that arises from the biliary epithelium. Prognosis is generally poor and survival is limited to a few months. Here we present a case of advanced ICC successfully treated by chemosensitivity test-guided systemic chemotherapy combining S-1 and cisplatin （CDDP）. A 65-year-old woman with a liver tumor was referred to our hospital on November 21, 2007. Abdominal ultrasonography and computed tomography （CT） showed low-density masses of 50 and 15 mm in diameter, respectively in segment w of the liver and in the enlarged lymph node in the para-aorta. Ultrasonography-guided fine needle biopsy diagnosed the tumors as ICC. Since the patient was inoperable for lymph node metastasis, she underwent systemic chemotherapy with gemcitabine. Six months afcer initiation of chemotherapy, CT revealed ICC progression in the liver and pleural dissemination with pleural effusion. The patient was admitted to our hospital for anticancer drug sensitivity testing on June 9, 2008. Based on the sensitivity test results, we elected to administer systemic chemotherapy combining S-1 and CDDP. Two months into the second chemotherapy treatment, CT revealed a reduction of the tumors in the liver and lymph node and a decrease in pleural *** eight cycles of the second chemotherapy, 17 mo after ICC diagnosis, she is alive and well with no sign of recurrence. We conclude that chemosensitivity testing may effectively determine the appropriate chemotherapy regimen for advanced ICC.

关键词： Chemosensitivity testing Cholangiocarcinoma, Cisplatin Liver neoplasms Gemcitabine S-1 Systemic chemotherapy

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Case of clear-cell hepatocellular carcinoma that developed in the normal liver of a middle-aged woman

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World Journal of Gastroenterology 2008年第1期14卷 129-131页

作者： Atsushi Takahashi Hironobu Saito Yukiko Kanno Kazumichi Abe junko yokokawa Atsushi Irisawa Akira Kenjo Takuro Saito Mitsukazu Gotoh Hiromasa Ohira Department of Internal Medicine Ⅱ Fukushima Medical University School of Medicine 1 Hikarigaoka Fukushima 960-1295 Japan Department of Surgery Ⅰ Fukushima Medical University School of Medicine 1 Hikarigaoka Fukushima 960-1295 Japan

A 36-year-old woman was admitted to our department for close examination of a liver tumor that was found during a medical checkup. Abdominal US, CT and MRI showed a tumor in segment 7 (S7) of the liver. Although imaging suggested hepatocellular carcinoma, laboratory tests showed no abnormality in liver function, hepatitis virus markers were negative, and tumor markers including protein induced by vitamin K absence or antagonist Ⅱ (PIVKA-Ⅱ), α-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), and carcinoembryonic antigen (CEA) were all within normal ranges. Upon aspiration biopsy of the liver, the histopathological diagnosis was moderately differentiated hepatocellular carcinoma. Therefore, right hepatectomy was performed. Although a part of the tumor was necrotic, about 60% of the viable part showed a clear-cell variant. Consequently, it was diagnosed as clear-cell hepatocellular carcinoma. It was noted that the background liver tissue was normal. This case is worthy of reporting because development of clear-cell hepatocellular carcinoma in the normal liver of a middle-aged woman is rarely seen.

关键词： Clear-cell hepatocellular carcinoma Liver Middle-aged

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Development of autoimmune hepatitis type 1 after pulsed methylprednisolone therapy for multiple sclerosis: A case report

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World Journal of Gastroenterology 2008年第35期14卷 5474-5477页

作者： Atsushi Takahashi Yukiko Kanno Yuta Takahashi Natsumi Sakamoto Kyoko Monoe Hironobu Saito Kazumichi Abe junko yokokawa Atsushi Irisawa Hiromasa Ohira Department of Internal Medicine Ⅱ Fukushima Medical University School of MedicineFukushimaJapan

A 43-year-old woman with multiple sclerosis （MS） was treated with pulsed methylprednisolone and interferon 13 at a hospital. Four weeks after initiating treatment, liver dysfunction occurred and she was referred and admitted to our hospital. Clinical and laboratory findings were consistent with and fulfilled the criteria for drug-induced hepatitis, but not for autoimmune hepatitis （AIH）. She was successfully treated with corticosteroids. As ataxia developed after i year, she was treated with pulsed methylprednisolone for 3 days, then readmitted to our hospital when liver dysfunction occurred. Clinical and laboratory findings led to the diagnosis of AIH. To the best of our knowledge, this is the second case of AIH developed after pulsed methylprednisolone for MS.

关键词： Multiple sclerosis Autoimmune hepatitis Pulsed methylprednisolone

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Centrilobular necrosis in acute presentation of Japanese patients with type 1 autoimmune hepatitis

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World Journal of Hepatology 2012年第9期4卷 262-267页

作者： Kazumichi Abe Yukiko Kanno Ken Okai Fumiko Katsushima Kyoko Monoe Hironobu Saito Atsushi Takahashi junko yokokawa Hiromasa Ohira Department of Gastroenterology and Rheumatology Fukushima Medical University School of Medicine1 HikarigaokaFukushima 960-1295Japan

AIM: To compare clinicopathological features of acute presentation of type 1 autoimmune hepatitis (AIH) with or without centrilobular necrosis (CN). METHODS: Our study comprised 41 patients with biopsy-proven acute presentation (acute exacerbation phase 36, acute hepatitis phase 5) of type 1 AIH at our hospital from 1975 to 2009. Elevated serum alanine aminotransferase (ALT) (> 5x upper limit of normal) identified acute presentation of the disease. We compared clinicopathological features of these AIH patients with or without CN. The data used for analysis included patient background (age, sex, type of disease, presence of complications with other autoimmune diseases, human leukocyte antigen, and International Autoimmune Hepatitis Group score), clinical parameters at presentation (ALT, alkaline phosphatase, IgG, anti-nuclear antibodies, and anti-smooth muscle antibodies), histology and therapy. RESULTS: CN was found in 13 (31.7%) patients with acute presentation (acute exacerbation phase 10, acute hepatitis phase 3) of AIH. Serum IgG levels of patients with CN were significantly lower than those of patients without CN (mean: 2307 mg/dL vs 3126 mg/dL, P < 0.05), while antinuclear antibody-negative rates were significantly higher (30.7% vs 3.5%, P < 0.05). However, other clinical features were similar between the two groups. The frequency of advanced fibrosis in patients with CN was significantly lower than in patients without CN (F0-2: 84.6% vs 35.7%, F3-4: 15.4% vs 64.3%, P < 0.05). Other histological features were similar between the two groups. Although there was no significant difference between groups when evaluated using the revised original score (12 vs 14), the simplified AIH score of patients with CN was significantly lower (6 vs 7, P < 0.05). Frequency of DR4 was similar between patients with and without CN. CONCLUSION: CN is observed in both Japanese patients with acute hepatitis phase and acute exacerbation phase of type 1 AIH, although AIH with CN often

关键词： Autoimmune hepatitis Centrilobular necrosis Acute presentation Acute exacerbation phase Acute hepatitis phase

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