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A patient with spinal metastasis from hepatocellular carcinoma discovered from neurological findings

World Journal of Gastroenterology 2007年第19期13卷 2758-2760页

作者： Katsuyoshi Tamaki Ichiro Shimizu Mari Urata nao kohno Hiroshi Fukuno Susumu Ito Nobuya Sano Department of Digestive and Cardiovascular Medicine Institute of Health Biosciences The University of Tokushima Graduate School Japan Division of Pathology Tokushima University Hospital Tokushima Japan

Although spinal tumors are uncommon, they may reduce survival or cause serious functional disorders in the extremities. Metastatic spinal tumors from malignant tumors can induce symptoms of spinal cord compression, such as paraplegia, quadriplegia, and vesicorectal disturbance, which are aggravated with progression of the diseases and time. We report a patient with hepatocellular carcinoma (HCC) who was suspected of having spinal lesions based on neurological findings, and a metastatic spinal tumor was found by imaging examination. Assuming that metastasis had occurred at the time lumbar pain developed, the patient reached the level of gait disturbance within only 4 mo, showing a rapid advancement of symptoms. If early diagnosis had been possible, treatment could be performed before acute myelopathy progressed to complete paralysis. We speculate that the terminal stage of HCC is not only liver failure associated with intrahepatic lesions but also metastasis to other regions, treatment for individual pathologies therefore, will be needed, which constitutes an important issue.

关键词： Hepatocellular carcinoma Spinal cord metastasis Brain metastasis

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Female hepatology:Favorable role of estrogen in chronic liver disease with hepatitis B virus infection

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World Journal of Gastroenterology 2007年第32期13卷 4295-4305页

作者： Ichiro Shimizu nao kohno Katsuyoshi Tamaki Masayuki Shono Hui-Wei Huang Jiang-Hong He Deng-Fu Yao Department of Digestive and Cardiovascular Medicine Institute of Health Biosciences University of Tokushima Graduate School Kuramoto-cho Tokushima 770-8503 Japan Support Center for Advanced Medical Sciences University of Tokushima Graduate School Kuramotocho Tokushima 770-8503 Japan Department of Physiology Faculty of Medicine Nantong University Nantong 226001 Jiangsu Province China Key Laboratory of Neuroregeneration of Jiangsu Province Nantong University Nantong 226001 Jiangsu Province China Research Center of Clinical Molecular Biology Affiliated Hospital Nantong University Nantong 226001 Jiangsu Province China

Chronic hepatitis B virus (HBV) infection is the most common cause of hepatic fibrosis and hepatocellular carcinoma (HCC),mainly as a result of chronic necroinflammatory liver disease. A characteristic feature of chronic hepatitis B infection,alcoholic liver disease and nonalcoholic fatty liver disease (NAFLD) is hepatic steatosis. Hepatic steatosis leads to an increase in lipid peroxidation in hepatocytes,which,in turn,activates hepatic stellate cells (HSCs). HSCs are the primary target cells for inflammatory and oxidative stimuli,and these cells produce extracellular matrix components. Chronic hepatitis B appears to progress more rapidly in males than in females,and NAFLD,cirrhosis and HCC are predominately diseases that tend to occur in men and postmenopausal women. Premenopausal women have lower hepatic iron stores and a decreased production of proinflammatory cytokines. Hepatic steatosis has been observed in aromatase-deficient mice,and has been shown to decrease in animals after estradiol treatment. Estradiol is a potent endogenous antioxidant which suppresses hepatic fibrosis in animal models,and attenuates induction of redox sensitive transcription factors,hepatocyte apoptosis and HSC activation by inhibiting a generation of reactive oxygen species in primary cultures. Variant estrogen receptors are expressed to a greater extent in male patients with chronic liver disease than in females. These lines of evidence suggest that the greater progression of hepatic fibrosis and HCC in men and postmenopausal women may be due,at least in part,to lower production of estradiol and a reduced response to the action of estradiol. A better understanding of the basic mechanisms underlying the sex-associated differences in hepatic fibrogenesis and carciogenesis may open up new avenues for the prevention and treatment of chronic liver disease.

关键词： Hepatic fibrosis Hepatocellular carcinoma Hepatic stellate cell Estradiol Estrogen receptor Oxidative stress Menopause Hepatic iron

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Effects of estradiol and progesterone on the proinflammatory cytokine production by mononuclear cells from patients with chronic hepatitis C

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World Journal of Gastroenterology 2008年第14期14卷 2200-2207页

作者： Ying Yuan Ichiro Shimizu Mi Shen Eriko Aoyagi Hidetaka Takenaka Tatuzo Itagaki Mari Urata Katsutaka Sannomiya nao kohno Katsuyoshi Tamaki Masayuki Shono Tetsuji Takayama Jiangsu Key Laboratory of Neuroregeneration Nantong University Nantong 226001 Jiangsu Province China Department of Digestive and Cardiovascular Medicine Institute of Health Biosciences Tokushima 7708503 Japan Support Center for Advanced Medical Sciences University of Tokushima Graduate School Tokushima 7708503 Japan

AIM:To investigate the effects of estradiol (E2) and progesterone on the unstimulated and oxidative stressstimulated production of tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-8, and macrophage chemotactic protein (MCP)-1 by peripheral blood mononuclear cells (PBMCs) from patients with chronic hepatitis C and healthy controls. METHODS:The PBMCs were separated from agematched 72 males and 71 females with and without chronic hepatitis C, who were divided into two groups based on a mean menopausal age of 50 years. Oxidative stress was induced by hydrogen peroxide in the cells incubated in serum-free media. Cytokines in the culture supernatant were measured by an enzyme-linked immunosorbent assay. RESULTS:The highest levels of the spontaneous production of TNF-α, IL-1β, IL-8, and MCP-1 by the unstimulated PBMCs were in the older male patients with chronic hepatitis C and the lowest levels were in the premenopausal female healthy controls. E2 inhibited the cytokine production by the unstimulated PBMCs from the older male and post-menopausal female patients, which was further stimulated by progesterone. The exposure to hydrogen peroxide in the PBMCs from the younger male and pre-menopausal female healthy subjects induced the production of cytokines. The change rates of the hydrogen peroxide-stimulated cytokine production were suppressed by E2 and enhanced by progesterone. CONCLUSION:These findings suggest that E2 may play a favorable role in the course of persistent liver injury by preventing the accumulation of monocytes-macrophages and by inhibiting proinflammatory cytokine production, whereas progesterone may counteract the favorable E2 effects.

关键词： Estradiol Progesterone Mononuclear cell Proinflammatory cytokine Chemokine

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High-grade pancreatic intraepithelial neoplasia diagnosed based on changes in magnetic resonance cholangiopancreatography findings:A case report

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World Journal of Clinical Cases 2024年第8期12卷 1487-1496页

作者： nao Furuya Atsushi Yamaguchi naohiro Kato Syuhei Sugata Takuro Hamada Takeshi Mizumoto Yuzuru Tamaru Ryusaku Kusunoki Toshio Kuwai Hirotaka Kouno Kazuya Kuraoka Yoshiyuki Shibata Sho Tazuma Takeshi Sudo Hiroshi kohno Shiro Oka Department of Gastroenterology National Hospital Organization Kure Medical Center and Chugoku Cancer CenterKure 737-0023HiroshimaJapan Department of Gastroenterology Hiroshima University HospitalHiroshima 734-8551HiroshimaJapan Department of Pathology National Hospital Organization Kure Medical Center and Chugoku Cancer CenterKure 737-0023HiroshimaJapan Department of Surgery National Hospital Organization Kure Medical Center and Chugoku Cancer CenterKure 737-0023HiroshimaJapan

BACKGROUND High-grade pancreatic intraepithelial neoplasia(PanIN)exhibits no mass and is not detected by any examination ***,it can be diagnosed by pancreatic juice cytology from indirect *** previous cases were diagnosed based on findings of a focal stricture of the main pancreatic duct(MPD)and caudal MPD dilatation and subsequent pancreatic juice cytology using endoscopic retrograde cholangiopancreatography(ERCP).We experienced a case of high-grade PanIN with an unclear MPD over a 20-mm range,but without caudal MPD dilatation on magnetic resonance cholangiopancreatography(MRCP).CASE SUMMARY A 60-year-old female patient underwent computed tomography for a follow-up of uterine cancer post-excision,which revealed pancreatic *** revealed an unclear MPD of the pancreatic body at a 20-mm length without caudal MPD ***,course observation was *** 24 mo,MRCP revealed an increased caudal MPD caliber and a larger pancreatic *** performed ERCP and detected atypical cells suspected of adenocarcinoma by serial pancreatic juice aspiration cytology *** performed a distal pancreatectomy and obtained a histopathological diagnosis of high-grade *** parenchyma invasion was not observed,and curative resection was *** High-grade Pan-IN may cause MPD narrowing in a long range without caudal MPD dilatation.

关键词： Pancreatic cancer Pancreatic intraepithelial neoplasm High-grade pancreatic intraepithelial neoplasm Magnetic resonance cholangiopancreatography Carcinoma in situ Case report

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