Liver cell adenoma in a young man with elevated serum PIVKA-II level.

A 21-year-old man was referred to our hospital because of a liver mass lesion detected by abdominal ultrasonography. He had received no hormonal treatment. Physical examinations revealed no abnormalities, and laboratory data, including hepatic function test results, were within normal ranges, with the exception of elevated levels of serum protein induced by vitamin K absence or antagonist (PIVKA)-II (2.2 AU/ml). Abdominal ultrasonography revealed a hyperechoic mass lesion measuring 10 x 10 cm, with hypoechoic areas located in the right posterior segment of the liver. A low-density area and a hypervascular area were detected in the right posterior segment of the liver by computed tomography and celiac angiography, respectively. As hepatocellular carcinoma could not be completely excluded, the tumor was resected. The tissue consisted of sheets of tumor cells with eosinophilic cytoplasm and round nuclei showing a thin trabecular pattern, and these histological findings indicated liver cell adenoma. After resection of the tumor, serum PIVKA-II returned to the normal level.

Retinal complications during interferon therapy for chronic hepatitis C.

OBJECTIVES: Various side effects of interferon (IFN) therapy have been reported. In this study, we examined retinal change during IFN therapy. METHODS: We performed ophthalmological examinations before, during, and after therapy on 63 patients with chronic hepatitis C who were receiving either natural IFA-alpha or recombinant IFN-alpha 2a or 2b. RESULTS: No retinal lesion was detected before IFN therapy, but, during therapy, retinal abnormality or retinopathy developed in 36 (57.1%) of 63 patients, including retinal hemorrhage in 25 patients and cotton-wool spots in 28 patients. They were noted early in the course of IFN therapy, within the first 4 wk in 67% (24/36) and within 8 wk in 86% (31/36). The incidence was not influenced by the type of IFN but was higher among diabetic (11/12, 92%, p < 0.05) or hypertensive patients (4/5, 80%, not significant) than among patients without either diabetes or hypertension (24/49, 49%). There was no relation between the incidence of retinopathy and the level of ALT activity or white blood cell or platelet counts. However, retinopathy occurred in most patients receiving IFN therapy after white blood cell count and platelet count reached a nadir. The levels of LDL-cholesterol and the atherosclerotic index in patients with retinopathy were slightly higher than those in the patients without retinopathy. CONCLUSIONS: These results suggest that retinopathy often occurs in patients with chronic hepatitis C who are receiving IFN and that we should closely monitor patients for retinal complications during IFN therapy.

[Interferon-induced retinal changes].

Fifty patients treated with interferon for chronic type C hepatitis, chronic type B hepatitis and renal cell carcinoma were examined for retinal complications. Retinal hemorrhages or cotton wool spots were observed in 23 (46%) of the patients. Retinal hemorrhages without cotton wool spots were found in 14 patients, cotton wool spots without retinal hemorrhages in 5 patients, and both hemorrhages and cotton wool spots in four patients. These findings were potentially reversible. There was one case of branch retinal artery occlusion and one case with microaneurysm. Red blood cell count decreased significantly in the patients with retinopathy compared with those without retinopathy (p < 0.05%). Patients with diabetes, hypertension, retinal arterial sclerosis, and anemia were at risk for retinopathy.

[Therapy of hepatocellular carcinoma with UFT--clinical evaluation of its effect in the combination therapy with transcatheter arterial embolization or one shot therapy].

In 55 hepatocellular carcinoma patients treated with transcatheter arterial embolization or one shot therapy, the prognosis of patients treated with UFT (group A; n = 23) were historically compared with those of patients treated without UFT (group B; n=32). In group A, survival rate was 91.3% at 6 month; 67.5% at 1-year, 24.3% at 2-year, 24.3% at 3 year, in group B, 59.4% at 6-month, 37.5% at 1 year, 16.1% at 2-year. In these comparison, group A revealed significantly higher survival rate than group B. These results indicated that UFT was effective as maintenance therapy after transcatheter arterial embolization or one shot therapy with hepatocellular carcinoma.

[A case of primary hepatoma with marked reduction of the tumor after oral administration of tegafur].

A 57-year-old male complaining mainly of pain in the right terminal rib area was admitted to hospital for hepatic tumor examination. Primary hepatoma with infiltration of the inferior vena cava was diagnosed by various imaging techniques and the subject was started on a program of daily oral administrations of 800 mg of tegafur. Prior to commencing drug administration the hepatic tumor measured 112 x 80 mm; after four months of treatment the tumor was reduced to 56 x 48 mm and the infiltration in the inferior vena cava had disappeared. The tumor continued to decrease in size thereafter, and today measures 32 x 28 mm after three years of tegafur administration. The subject continues to be monitored as an outpatient. A marked reduction in the size of a hepatic tumor was observed in this case, and the administration of tegafur has proved effective in prolonging life for over three years.

[Almost complete disappearance of metastatic pulmonary tumor and reduction of the main hepatic mass in a case of hepatocellular carcinoma treated with UFT].

A 61-year-old female patient with a low density area indicated by abdominal CT was admitted to hospital. Several circular shadows 5-20-mm in diameter were visible on the chest photos. Primary hepatocellular carcinoma complicated by compensatory cirrhosis accompanying pulmonary metastasis was diagnosed from blood biochemistry tests, a high AFP value (390,000 ng/ml) and angiogram findings. After two months of daily administration of 400 mg of UFT as ftorafur, both reduced AFP (46,000 ng/ml) and a reduction of the primary nidus were observed; after four months, the circular shadows were almost completely eliminated on chest photos. Although UFT administration was discontinued (total FT dose 33.6g) due to jaundice, in the eight months after discontinuation no enlargement of the primary nidus, recurrent shadows on chest photos, or recurrent rise of AFP were observed. This case is considered to suggest the effectiveness of UFT against primary hepatocellular carcinoma with accompanying pulmonary metastasis.