1.Spontaneous Neoplastic Remission of Hepatocellular Carcinoma.
Sung Bae KIM ; Wonseok KANG ; Seung Hwan SHIN ; Hee Seung LEE ; Sang Hoon LEE ; Gi Hong CHOI ; Jun Yong PARK
The Korean Journal of Gastroenterology 2015;65(5):312-315
We report on a case of a 57-year-old male who underwent a curative resection for hepatocellular carcinoma (HCC) with histological confirmation of a spontaneously necrotized tumor. Initial serum AFP level was 4,778 ng/mL. A 3.7 cm hyperechoic mass in segment 6 of the liver was observed on ultrasonography and dynamic contrast-enhanced liver MRI showed a 3.7x3.1 cm sized HCC. He was scheduled to undergo curative surgical resection under the clinical diagnosis of an early stage HCC (Barcelona Clinic Liver Cancer stage A). Without treatment, the serum AFP level declined rapidly to 50 ng/mL over five weeks. He underwent curative wedge resection of segment 6 of the liver. Histology revealed complete necrosis of the mass rimmed by inflamed fibrous capsule on a background of HBV-related cirrhosis with infiltration of lymphoplasma cells. Exact pathophysiology underlying this event is unknown. Among the proposed mechanisms of spontaneous neoplastic remission of HCC, circulatory disturbance and activation of host immune response offer the most scientific explanation for the complete histologic necrosis of HCC in the resected mass seen in our patient.
Carcinoma, Hepatocellular/*diagnosis/diagnostic imaging/pathology
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Hepatitis B/complications/diagnosis
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Humans
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Liver/diagnostic imaging/pathology
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Liver Cirrhosis/etiology
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Liver Neoplasms/*diagnosis/diagnostic imaging/pathology
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Magnetic Resonance Imaging
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Male
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Middle Aged
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Necrosis
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Radiography
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Remission, Spontaneous
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Ultrasonography
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alpha-Fetoproteins/analysis
2.Portal vein flow rate used as a early predictor of portal vein thrombosis after periesophagastric devascularization.
Yu ZHANG ; Tian-Fu WEN ; Zhe-Yu CHEN ; Lü-Nan YAN ; Guan-Lin LIANG ; Guo LI ; Xian-Hua ZHANG ; Shun RAN ; Zhi-Xua LIAO
Chinese Journal of Surgery 2009;47(11):825-828
OBJECTIVETo evaluate the predictive value of portal vein flow rate preoperative for portal vein thrombosis (PVT) after periesophagastric devascularization in hepatitis B cirrhosis-related portal hypertension.
METHODSFrom January 2007 to July 2008, 45 patients with portal hypertension caused by hepatitis B cirrhosis were performed splenectomy with peri-esophagogastric devascularization in the same medical group in West China Hospital of Sichuan University. The portal vein flow rate and the diameter of portal vein were measured with doppler sonography respectively before and after the operation. At the same time, the level of PT and PLT were detected. The weight of spleens were measured after operation.
RESULTSThirteen cases suffered from PVT postoperatively. Portal vein flow rate was significantly lower in patients with PVT postoperation than that in patients without PVT (P < 0.01). In patients with PVT (n = 13) postoperation, the preoperative portal vein flow rate was (19.5 +/- 5.3) cm/s. Among the 13 cases, there were 12 cases whose flow rate were lower than 25 cm/s, and 1 case whose flow rate was 32. 3 cm/s; In patients without PVT (n = 32), the preoperative portal vein flow rate was (9.6 +/- 8.0) cm/s. In patients with lower rate (n = 17), the incidence rate of PVT was 70.6%; in patients with higher rate (n = 28), the incidence rate of PVT was 3.6%. The incidence rate of PVT in patients with lower rate was significantly lower than patients with higher rate (P < 0.01). The diameter of portal vein in patients with PVT was significantly wider than patients without PVT. The diameter of portal vein was negative correlative with the portal vein flow rate. The value 25 cm/s was of diagnostic efficiency, the sensitivity was 92.3%, and specificity was 70.6%.
CONCLUSIONSThe portal vein flow rate preoperative can be used as an early predictor of portal vein thrombosis after periesophagastric devascularization in hepatitis B cirrhosis-related portal hypertension to give a guide to clinical work.
Adult ; Aged ; Blood Flow Velocity ; Female ; Humans ; Hypertension, Portal ; etiology ; physiopathology ; surgery ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Portal Vein ; diagnostic imaging ; physiopathology ; Postoperative Complications ; diagnosis ; etiology ; Preoperative Care ; Risk Factors ; Splenectomy ; Ultrasonography ; Venous Thrombosis ; diagnosis ; etiology
3.Comparison of Transient Elastography and Hepatic Fibrosis Assessed by Histology in Chronic Liver Disease.
Min Kyu JUNG ; Han Jin CHO ; Ho Chul LEE ; Kwan Sik PARK ; Eun Hee SEO ; Sung Woo JEON ; Chang Min CHO ; Won Young TAK ; Sung Kook KIM ; Yong Hwan CHOI ; Young Oh KWEON
The Korean Journal of Gastroenterology 2008;51(4):241-247
BACKGROUND/AIMS: Transient elastography (Fibroscan, Echosens, France) is a new, simple, and non-invasive method to assess the degree of hepatic fibrosis by measuring liver stiffness. Recent reports have shown that liver stiffness measurement using Fibroscan allowed accurate prediction of hepatic fibrosis in patient with chronic hepatitis C. The aim of this study was to evaluate accuracy of Fibroscan for the detection of hepatic fibrosis in Korea with various etiologies of chronic liver disease by comparison with fibrosis assessed by histologic examination. METHODS: Fifty-four patients with chronic liver diseases, which were histologically confirmed within recent 6 months were enrolled. Etiologies were HBV, HCV infection, autoimmune hepatitis, and non alcoholic steatohepatitis. Hepatic fibrosis was graded on the basis of standard guideline proposed by the Korean Study Group for the Pathology of Digestive Diseases. RESULTS: Fibroscan values were significantly higher in F3 (16.96 kPa) and F4 (19.86 kPa) than others (p=0.003). Liver stiffness measurement was significantly correlated to the fibrosis stage (r=0.614, p<0.0001). CONCLUSIONS: Liver stiffness measurement by Fibroscan is a promising method for the assessment of hepatic fibrosis in chronic liver disease because it accompanies no complication.
Adult
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Aged
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Biological Markers/blood
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Chronic Disease
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Elasticity
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Elasticity Imaging Techniques/*methods
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Humans
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Liver Cirrhosis/diagnosis/etiology/*ultrasonography
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Liver Diseases/complications/pathology/*ultrasonography
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Male
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Middle Aged
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Predictive Value of Tests
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ROC Curve
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Regression Analysis
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Sensitivity and Specificity
4.A Case of Breast Cancer in a Male Patient with Cryptogenic Cirrhosis.
Su Rin SHIN ; Myung Seok LEE ; Sang Hoon PARK ; Jong Soo CHOI ; Kyung Min LEE ; Jin Bae KIM ; Hyeong Su KIM ; Jeong Won KIM
The Korean Journal of Gastroenterology 2012;60(3):182-185
Breast cancer is a rare disease in men. We report a case of 53-year-old obese male, with known cryptogenic cirrhosis and hepatocellular carcinoma, presenting a tender mass on left breast. He was diagnosed with invasive intraductal carcinoma, which was consistent with a sporadic lesion. On the basis of previous literatures, obesity can be regarded as a cause for breast cancer even in men. However, there has been inconsistent data about link between liver cirrhosis and male breast cancer, which can be due to heterogenity in the etiology of cirrhosis. Through this case, it can be postulated that the risk for male breast cancer may vary according to the etiology of cirrhosis.
Breast Neoplasms, Male/*etiology/secondary/ultrasonography
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Carcinoma, Hepatocellular/diagnosis/pathology
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Humans
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Immunohistochemistry
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Liver Cirrhosis/complications/*diagnosis/pathology
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Liver Neoplasms/diagnosis/pathology
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Male
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Middle Aged
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Receptors, Estrogen/metabolism
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Tomography, X-Ray Computed
5.Elevated red cell distribution width is associated with advanced fibrosis in NAFLD.
Hwa Mok KIM ; Bum Soo KIM ; Yong Kyun CHO ; Byung Ik KIM ; Chong Il SOHN ; Woo Kyu JEON ; Hong Joo KIM ; Dong Il PARK ; Jung Ho PARK ; Kwan Joong JOO ; Chang Joon KIM ; Yong Sung KIM ; Woon Je HEO ; Won Seok CHOI
Clinical and Molecular Hepatology 2013;19(3):258-265
BACKGROUND/AIMS: The red-blood-cell distribution width (RDW) is a newly recognized risk marker in patients with cardiovascular disease, but its role in nonalcoholic fatty liver disease (NAFLD) has not been well defined. The aim of the present study was to determine the association between RDW values and the level of fibrosis in NAFLD according to BARD and FIB-4 scores. METHODS: This study included 24,547 subjects who had been diagnosed with NAFLD based on abdominal ultrasonography and questionnaires about alcohol consumption. The degree of liver fibrosis was determined according to BARD and FIB-4 scores. The association between RDW values and the degree of fibrosis in NAFLD was analyzed retrospectively. RESULTS: After adjusting for age, hemoglobin level, mean corpuscular volume, history of hypertension, history of diabetes, and high-sensitivity C-reactive protein, the RDW values were 12.61+/-0.41% (mean+/-SD), 12.70+/-0.70%, 12.77+/-0.62%, 12.87+/-0.82%, and 13.25+/-0.90% for those with BARD scores of 0, 1, 2, 3, and 4, respectively, and 12.71+/-0.72%, 12.79+/-0.66%, and 13.23+/-1.52% for those with FIB-4 scores of <1.30, 1.31-2.66, and > or =2.67, respectively (P<0.05). The prevalence of advanced fibrosis (BARD score of 24 and FIB-4 score of > or =1.3) increased with the RDW [BARD score: 51.1% in quartile 1 (Q1) vs. 63.6% in Q4; FIB-4 score: 6.9% in Q1 vs. 10.5% in Q4; P<0.001]. After adjustments, the odds ratio of having advanced fibrosis for those in Q4 compared to Q1 were 1.76 (95%CI=1.55-2.00, P<0.001) relative to BARD score and 1.69 (95%CI=1.52-1.98, P<0.001) relative to FIB-4 score. CONCLUSIONS: Elevated RDW is independently associated with advanced fibrosis in NAFLD.
Adult
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Alcohol Drinking
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C-Reactive Protein/analysis
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Diabetes Mellitus/pathology
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Erythrocyte Indices
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Fatty Liver/complications/*diagnosis/ultrasonography
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Female
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Humans
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Hypertension/pathology
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Liver Cirrhosis/*diagnosis/epidemiology/etiology
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Male
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Middle Aged
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Odds Ratio
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Prevalence
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Questionnaires
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Severity of Illness Index
6.Effects of syndrome dependent umbilical sticking with shizhang cataplasm and xuzhang cataplasm in treating Cirrhosis caused ascites.
Cheng-hai LIU ; Ya-li ZHANG ; Nian-ping FENG
Chinese Journal of Integrated Traditional and Western Medicine 2006;26(5):411-414
UNLABELLEDTo investigate the effects of Shizhang Cataplasm (SC) and Xuzhang Cataplasm (XC) in treating liver cirrhosis caused ascites of excessive syndrome (ES) type and deficient syndrome (DS) type respectively.
METHODSAll the 77 patients (37 of ES type and 40 of DS type) enrolled were treated by conventional treatment but with restrictive use of diuretics. SC and XC were given respectively to 26 patients of ES type and 26 of DS type additionally by umbilical sticking, they were regarded as the treated group, and those (11 of ES type and 14 of DS type) not received the cataplasm treatment were regarded as the control group. The changes of symptoms, body weight, abdominal perimeter and amount of urine before and after treatment were observed, and amount of ascites was examined with B-ultrasound to evaluate the efficacy according to comprehensive grading criteria. Also, the toxicity was observed.
RESULTSSixty-two cases completed the full course, 15 were withdrawn. As compared with the corresponding control group, body weight, abdominal perimeter and amount of ascites decreased, while amount of urine and flatus discharging increased remarkably in the treated group (P < 0.05). The comprehensive efficacy in patients of ES type was better than that in DS type (P < 0.05). The effective rate of grade I/II was 7.1% and 9.1% for patients in the control group of DS type and ES type respectively, while it was 57.2% and 69.2% in the treated group of DS and ES type respectively. Better therapeutic effect was shown in patients of ES type treated with SC.
CONCLUSIONSC and XC showed good assistant effects in treating patients with liver cirrhosis caused ascites of ES and DS type respectively.
Administration, Cutaneous ; Ascites ; diagnostic imaging ; drug therapy ; etiology ; Diagnosis, Differential ; Drugs, Chinese Herbal ; administration & dosage ; Female ; Humans ; Liver Cirrhosis ; complications ; diagnostic imaging ; drug therapy ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Phytotherapy ; Ultrasonography ; Umbilicus
7.Biliary Cast Syndrome in Non-Liver Surgery Patients.
Seung In HA ; Jung Sik CHOI ; Young Hoon KIM ; Hyun Soo JUN ; Yong Gun JO ; Won Hyun LEE ; Seong Gill PARK ; Sang Heon LEE
The Korean Journal of Gastroenterology 2012;60(6):382-385
Biliary cast describes the presence of casts within the biliary tree. It is resultant sequel of cholangitis and hepatocyte damage secondary to bile stasis and bile duct injury. Biliary cast syndrome was first reported in patient undergone liver transplantation. The pathogenesis of biliary cast is not clearly identified, but proposed etiologic factors include post-transplant bile duct damage, ischemia, biliary infection, or post-operative biliary drainage tube. Although biliary casts are uncommon, most of biliary cast syndrome are reported in the liver transplant or hepatic surgery patients. A few reports have been published about non-transplant or non-liver surgery biliary cast. We report two cases of biliary cast syndrome in non-liver surgery patients.
Acute Disease
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Ascariasis/diagnosis
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Bile Duct Diseases/*diagnosis/ultrasonography
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Bile Ducts/ultrasonography
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Cholagogues and Choleretics/therapeutic use
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Cholangiopancreatography, Endoscopic Retrograde/adverse effects
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Female
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Gallstones/diagnosis
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Humans
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Liver Cirrhosis, Biliary/diagnosis/drug therapy
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Male
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Middle Aged
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Pancreatitis/etiology
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Tomography, X-Ray Computed
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Ursodeoxycholic Acid/therapeutic use
8.Regression of esophageal varices during entecavir treatment in patients with hepatitis-B-virus-related liver cirrhosis.
Hye Young JWA ; Yoo Kyung CHO ; Eun Kwang CHOI ; Heung Up KIM ; Hyun Joo SONG ; Soo Young NA ; Sun Jin BOO ; Seung Uk JEONG ; Bong Soo KIM ; Byoung Wook LEE ; Byung Cheol SONG
Clinical and Molecular Hepatology 2016;22(1):183-187
Recent studies suggest that liver cirrhosis is reversible after administering oral nucleos(t)ide analogue therapy to patients with hepatitis B virus (HBV) infection. However, few studies have addressed whether esophageal varices can regress after such therapy. We report a case of complete regression of esophageal varices during entecavir therapy in patients with HBV-related liver cirrhosis, suggesting that complications of liver cirrhosis such as esophageal varices can regress after the long-term suppression of HBV replication.
Abdomen/diagnostic imaging
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Antiviral Agents/*therapeutic use
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DNA, Viral/blood
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Esophageal and Gastric Varices/complications/prevention & control
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Guanine/*analogs & derivatives/therapeutic use
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Hepatitis B virus/genetics
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Hepatitis B, Chronic/complications/*drug therapy/virology
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Humans
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Liver Cirrhosis/*diagnosis/etiology
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Male
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Middle Aged
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Polymerase Chain Reaction
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Ultrasonography