69 results on '"Yoriko, Nomura"'
Search Results
2. Surgical outcomes of laparoscopic versus open hepatectomy for left hepatocellular carcinoma: Propensity score analyses using retrospective Japanese and Korean individual patient data
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Masaki Kaibori, Kengo Yoshii, Yuzo Umeda, Takahito Yagi, Takehiro Okabayashi, Kenta Sui, Akira Mori, Yuhei Hamaguchi, Kiyoshi Kajiyama, Daisuke Hokuto, Kazuteru Monden, Tomoharu Yoshizumi, Yoriko Nomura, Kan Toriguchi, Jong Man Kim, Gi Hong Choi, Je Ho Ryu, Yangseok Koh, Koo Jeong Kang, Young Kyoung You, Kwang-Sik Chun, Young Seok Han, Chan Woo Cho, Young Il Choi, Dong-Sik Kim, Jae Do Yang, Keita Mori, Atsushi Hiraoka, Hiroki Yamaue, Masafumi Nakamura, Masakazu Yamamoto, and Itaru Endo
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Introduction: This study aimed to compare the prognostic impact of laparoscopic left hepatectomy (LLH) with that of open left hepatectomy (OLH) on patient survival after resection of left hepatocellular carcinoma (HCC). Methods: Among the 953 patients who received initial treatment for primary HCC that was resectable by either LLH or OLH from 2013 to 2017 in Japan and Korea, 146 patients underwent LLH and 807 underwent OLH. The inverse probability of treatment weighting approach based on propensity scoring was used to address the potential selection bias inherent in the recurrence and survival outcomes between the LLH and OLH groups. Results: The occurrence rate of postoperative complications and hepatic decompensation was significantly lower in the LLH group than in the OLH group. Recurrence-free survival (RFS) was better in the LLH group than in the OLH group (hazard ratio, 1.33; 95% confidence interval, 1.03–1.71; p = 0.029), whereas overall survival (OS) were not significantly different. Subgroup analyses of RFS and OS revealed an almost consistent trend in favor of LLH over OLH. In patients with tumor sizes of ≥4.0 cm or those with single tumors, both RFS and OS were significantly better in the LLH group than in the OLH group. Conclusions: LLH decreases the risk of tumor recurrence and improves OS in patients with primary HCC located in the left liver.
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- 2022
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3. Laparoscopic left hepatectomy for a patient with intrahepatic cholangiocarcinoma metastasis in the falciform ligament: a case report
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Yoriko Nomura, Hisamune Sakai, Jun Akiba, Toru Hisaka, Toshihiro Sato, Yuichi Goto, Masanori Akashi, Shogo Fukutomi, Daisuke Muroya, Hiroki Kanno, Shusuke Okamura, Yuta Yano, Hirohisa Yano, Yoshito Akagi, and Koji Okuda
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Falciform ligament ,Hematogenous metastases ,Intrahepatic cholangiocarcinoma ,Liver ,Segment IV ,Surgery ,RD1-811 - Abstract
Abstract Background Intrahepatic cholangiocarcinoma (ICC) is primary cancer of the liver with poor prognosis because of its high potential for recurrence and metastasis. We experienced a rare case of ICC with hematogenous metastasis to the falciform ligament. We aimed to clarify the route of metastasis to the mesentery by increasing the accuracy of preoperative imaging and establish a hepatectomy to control cancer. Case presentation An 85-year-old woman was referred to our hospital for a detailed study of progressively increasing liver tumors. She had no subjective symptoms. Her medical history showed hypertension, aneurysm clipping for cerebral hemorrhage, and gallstones. A detailed physical examination and laboratory data evaluation included tumor markers but did not demonstrate any abnormalities. On computed tomography scan, contrast-enhanced ultrasound, and magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid, the tumor appeared to be located in liver segment IV, protruding outside the liver. It appeared to contain two distinct components; we suspected ICC in the intrahepatic tumor component. Laparoscopic observation revealed that the extrahepatic lesion was an intra-falciform ligament mass; laparoscopic left hepatectomy was performed. Microscopically, the main tumor in segment IV was 15 mm in diameter and was diagnosed as moderately and poorly differentiated ICC. The tumor of the intra-falciform ligament was not continuous with the main intrahepatic nodule and was also diagnosed as ICC with extensive necrosis. There were no infiltrates in the round ligament of the liver, and several tumor thrombi were found in the small veins of the falciform ligament. Conclusions To date, there have been a few reports of metastases of primary liver cancer to the falciform ligament. At the time of preoperative imaging and pathological diagnosis, this case was suggestive of considering that the malignant liver tumor might be suspected of metastasizing to the falciform ligament. Our case improves awareness of this pathology, which can be useful in the future when encountered by hepatic specialists and surgeons.
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- 2021
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4. Hepatic Epithelioid Hemangioendothelioma Presenting Synchronously with Hepatocellular Carcinoma
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Hiroki Kanno, Toshihiro Sato, Ryuta Midorikawa, Satoki Kojima, Shogo Fukutomi, Yuichi Goto, Yoriko Nomura, Munehiro Yoshitomi, Ryuichi Kawahara, Hisamune Sakai, Toru Hisaka, Yoshito Akagi, and Koji Okuda
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epithelioid hemangioendothelioma ,hepatocellular carcinoma ,liver ,Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant tumor with unknown pathogenesis. Herein, we report a case of a hepatic EHE presenting synchronously with a hepatocellular carcinoma (HCC). To the best of our knowledge, this is the second case report of synchronous hepatic EHE and HCC. An 84-year-old man presented with back pain. During examination, a tumor in liver segment 3 was coincidentally detected. Tumor marker (carbohydrate antigen 19-9, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II) levels were elevated. Contrast-enhanced computed tomography revealed perinodular enhancement in the arterial and portal phases. Another tumor was detected in liver segment 2, which was homogeneously enhanced in the arterial phase, followed by washout in the portal and late phases. Based on these imaging findings, we diagnosed the tumor in segment 3 as a solitary cholangiocellular carcinoma and the tumor in segment 2 as a solitary HCC. Lateral sectionectomy of the liver was performed. Microscopically, spindle-shaped and epithelioid cells were present in the tumor in segment 3. On immunohistochemistry, the tumor cells were positive for CD31 and CD34, focally positive for D2-40, and negative for AE1/AE3. Therefore, the tumor in segment 3 was ultimately diagnosed as an EHE and the tumor in segment 2 as a well-differentiated HCC. Preoperative diagnosis of EHE is difficult owing to the lack of specific findings. Intratumoral calcification, halo sign, and lollipop sign are occasionally found in EHE and are useful imaging findings for diagnosis. Clinical behavior is unpredictable, ranging from indolent growth to rapid progression. Clinical or pathological predictors of the course of EHE are urgently required.
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- 2021
- Full Text
- View/download PDF
5. Successful nonoperative management by endoscopic and percutaneous drainage for penetrating pancreatic duct injury: a case report
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Hiroki Kanno, Yusuke Hirakawa, Masafumi Yasunaga, Ryuta Midorikawa, Shinichi Taniwaki, Yoshihiro Uchino, Shin Sasaki, Satoki Kojima, Yoriko Nomura, Goichi Nakayama, Yuichi Goto, Toshihiro Sato, Ryuichi Kawahara, Hisamune Sakai, Hiroto Ishikawa, Toru Hisaka, and Koji Okuda
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Penetrating pancreatic trauma ,Duct injury ,Nonoperative management ,Medicine - Abstract
Abstract Background Pancreatic trauma is a rare condition with a wide presentation, ranging from hematoma or laceration without main pancreatic duct involvement, to massive destruction of the pancreatic head. The optimal diagnosis of pancreatic trauma and its management approaches are still under debate. The East Association of Surgery for Trauma (EAST) guidelines recommend operative management for high-grade pancreatic trauma; however, several reports have reported successful outcomes with nonoperative management (NOM) for grade III/IV pancreatic injuries. Herein, we report a case of grade IV pancreatic injury that was nonoperatively managed through endoscopic and percutaneous drainage. Case presentation A 47-year-old Japanese man was stabbed in the back with a knife; upon blood examination, both serum amylase and lipase levels were within normal limits. Contrast-enhanced computed tomography (CT) showed extravasation of the contrast medium around the pancreatic head and a hematoma behind the pancreas. Abdominal arterial angiography revealed a pseudo aneurysm in the inferior pancreatoduodenal artery, as well as extravasation of the contrast medium in that artery; coil embolization was thus performed. On day 12, CT revealed a wedge-shaped, low-density area in the pancreatic head, as well as consecutive pseudocysts behind the pancreas; thereafter, percutaneous drainage was performed via the stab wound. On day 22, contrast radiography through the percutaneous drain revealed the proximal and distal parts of the main pancreatic duct. The injury was thus diagnosed as a grade IV pancreatic injury based on the American Association for the Surgery of Trauma guidelines. On day 26, an endoscopic nasopancreatic drainage tube was inserted across the disruption; on day 38, contrast-enhanced CT showed a marked reduction in the fluid collection. Finally, on day 61, the patient was discharged. Conclusions Although the EAST guidelines recommend operative treatment for high-grade pancreatic trauma, NOM with appropriate drainage by endoscopic and/or percutaneous approaches may be a promising treatment for grade III or IV trauma.
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- 2021
- Full Text
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6. A case of reactive lymphoid hyperplasia of the liver in a patient with autoimmune hepatitis
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Hiroki Kanno, Hisamune Sakai, Toru Hisaka, Satoki Kojima, Ryuta Midorikawa, Shogo Fukutomi, Yoriko Nomura, Yuichi Goto, Toshihiro Sato, Munehiro Yoshitomi, Ryuichi Kawahara, and Koji Okuda
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Reactive lymphoid hyperplasia ,Liver ,Autoimmune hepatitis ,Surgery ,RD1-811 - Abstract
Abstract Background Reactive lymphoid hyperplasia (RLH) of the liver is a benign disorder. It is usually observed in the skin, orbit, thyroid, lung, breast, or gastrointestinal tract, but rarely in the liver. Since the first report of RLH of the liver in 1981, only 75 cases have been described in the past literature. Herein, we report a case of RLH of the liver in a patient with autoimmune hepatitis (AIH), which was misdiagnosed as hepatocellular carcinoma (HCC) preoperatively and resected laparoscopically. Case presentation A 43-year-old Japanese woman with autoimmune hepatitis was followed up for 5 years. During her medical checkup, a hypoechoic nodule in segment 6 of the liver was detected. The nodule had been gradually increasing in size for 4 years. Abdominal ultrasound (US) revealed a round, hypoechoic nodule, 12 mm in diameter. Contrast-enhanced computed tomography (CT) demonstrated that the nodule was slightly enhanced in the arterial dominant phase, followed by perinodular enhancement in the portal and late phases. A magnetic resonance imaging (MRI) scan showed low signal intensity on the T1-weighted image (T1WI) and slightly high signal intensity on the T2-weighted image (T2WI). The findings of the Gd-EOB-DTPA-enhanced MRI were similar to those of contrast-enhanced CT. Tumor markers were all within the normal range. The preoperative diagnosis was HCC and a laparoscopic right posterior sectionectomy was performed. Pathological examination revealed that the nodular lesion was infiltrated by small lymphocytes and plasma cells, and germinal centers were present. Immunohistochemistry was positive for B cell and T cell markers, indicating polyclonality. The final diagnosis was RLH of the liver. Conclusions The pathogenesis of RLH of the liver remains unknown, and a definitive diagnosis based on imaging findings is extremely difficult. If a small, solitary nodule is found in female patients with AIH, the possibility of RLH of the liver should be considered.
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- 2020
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7. Intrabiliary growth type of metastasis from colon cancer, 12 years after curative colectomy: a case report
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Shin Sasaki, Yoriko Nomura, Shogo Fukutomi, Nobuhisa Shirahama, Hironori Kusano, Jun Akiba, Hisamune Sakai, Toru Hisaka, Osamu Nakashima, Hirohisa Yano, Yoshito Akagi, Hiroyuki Tanaka, and Koji Okuda
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Intrabiliary growth type of metastasis ,IGM ,Metastasis ,Colorectal cancer ,Hepatectomy ,Liver ,Surgery ,RD1-811 - Abstract
Abstract Background Liver is a common location of colorectal metastasis, but intrabiliary growth of liver metastasis is not well recognized. Furthermore, intrabiliary metastasis that discovered over 10 years after excision has rarely been described. Case presentation An 80-year-old man was admitted due to the presence of a liver mass in segment 5 (S5) concomitant with elevated carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19–9. He underwent right hemicolectomy for colon cancer 12 years prior. Enhanced computed tomography (CT) showed dilated bile ducts with periductal enhancement in S5; hence, cholangiocarcinoma was suspected. Upon anterior segmentectomy, we observed that the cut surface of the specimen exhibited a yellowish-white tumor within the bile ducts. Histologically, the tumor formed within the papillary process, extended along the lumen, and replaced the normal bile duct epithelium. Immunohistochemical studies showed that the liver tumor and primary colon cancer were negative for cytokeratin (CK) 7 and positive for CK20 and Caudal-type homeobox transcription factor 2 (CDX-2). In addition, both tumors showed a same KRAS mutation. We diagnosed the liver tumor as liver metastasis recurrence from colon cancer. Conclusion Intrabiliary growth type of metastasis (IGM) is difficult to distinguish from cholangiocarcinoma, and sometimes develops long after surgery; thus, careful examination of a patient’s history is needed in such cases.
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- 2019
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8. Atherosclerosis of the right posterior hepatic artery in a patient with hilar cholangiocarcinoma undergoing left trisectionectomy: a case report of a therapeutic pitfall
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Yuichi Goto, Satoki Kojima, Yoriko Nomura, Daisuke Muroya, Syoichiro Arai, Hisamune Sakai, Ryuichi Kawahara, Toru Hisaka, Yoshito Akagi, Hiroyuki Tanaka, and Koji Okuda
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Hepatic artery ,Stenosis ,Atherosclerosis ,Hilar cholangiocarcinoma ,Pyogenic liver abscess ,Surgery ,RD1-811 - Abstract
Abstract Background We experienced a rare case of benign arterial stricture of the right posterior hepatic artery (RPHA) caused by atherosclerosis in a patient with hilar cholangiocarcinoma. Case presentation A 75-year-old man was referred to our hospital for the detailed investigation of serum hepatobiliary enzyme elevation. The patient had a history of hypertension, type 2 diabetes mellitus, and an operative history of coronary artery bypass grafting 10 years before. Endoscopic retrograde cholangiography found strictures of the right and left hepatic ducts with involvement of right anterior and posterior bile ducts. Adenocarcinoma was evident by brush cytology. We diagnosed these findings as hilar cholangiocarcinoma and planned left trisectionectomy including bile duct reconstruction. Although the tumor and RPHA were not adjacent, preoperative multidetector computed tomography revealed a stricture of the RPHA that was 5.6 mm in length. We suspected that atherosclerosis caused the stricture, and we performed digital subtraction angiography and intravascular ultrasonography that showed stricture of the RPHA accompanied by thick plaques in the arterial wall. We placed a bare-metal stent in the RPHA and then performed left trisectionectomy. Since this patient developed bile leakage postoperatively, percutaneous drainage was performed. The bile leakage was successfully controlled, and the patient was discharged 3 months after surgery. Unfortunately, 4 months after hepatectomy, he was re-hospitalized with multiple pyogenic liver abscesses. We performed intensive multimodal treatment for the liver abscesses and stabilized the disease; however, we eventually lost this patient due to liver failure 14 months after surgery. Conclusion To the best of our knowledge, there is no previous literature on atherosclerosis of the RPHA, which was evident preoperatively in our case. Because arterial complications may lead to critical biliary complications in patients who undergo left trisectionectomy, we first performed prophylactic arterial stent placement. We speculate that existing chronic microscopic injury of the peribiliary plexus might have caused the liver abscesses. We successfully diagnosed atherosclerosis of the RPHA preoperatively. However, further investigation of patients is warranted to determine if left trisectionectomy is contraindicated in these patients.
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- 2018
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9. Hematogenous Dissemination of Tumor Cells in Hepatocellular Carcinoma: Comparing Anterior and Non-anterior Approach Hepatectomy
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Shin, Sasaki, Yoriko, Nomura, Tomoya, Sudo, Hisamune, Sakai, Toru, Hisaka, Jun, Akiba, Osamu, Nakashima, Hirohisa, Yano, Masayoshi, Kage, Yoshito, Akagi, and Koji, Okuda
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Cancer Research ,Carcinoma, Hepatocellular ,Oncology ,Liver Neoplasms ,Hepatectomy ,Humans ,General Medicine ,Epithelial Cell Adhesion Molecule ,Neoplastic Cells, Circulating - Abstract
Studies have indicated that liver mobilization during hepatectomy could cause the dissemination of tumor cells. However, the data are still limited in terms of the relationship between circulating tumor cells (CTCs) and surgical procedures.Fifteen patients who underwent hepatectomy for primary hepatocellular carcinoma (HCC) were included in the study. Blood samples were collected from the portal vein, central vein, and peripheral artery at three time points, namely, before mobilization (BM) of the liver, during transection (DT) of parenchyma, and after resection (AR) of the tumor. To detect CTCs, a real-time PCR assay was performed using primers for the epithelial cell adhesion molecule, cytokeratin 18, and glypican 3. Patients were divided into anterior approach (AA) and non-AA (NA) groups. In the AA group, patients underwent an initial hilar vascular dissection followed by a liver hanging maneuver during transection.Seven patients were allocated to the AA group, and eight to the NA group. In the NA group, CTC levels in the portal vein were significantly increased at DT and AR compared to BM. In cases with large HCC (70 mm), CTC levels in central venous blood were significantly increased at DT and AR in the NA group.The AA liver resection technique may minimize CTC dissemination, improving the prognosis of patients with HCC.
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- 2022
10. Fatty Liver Does Not Increase the Risk of Postoperative Liver Damage Following Hepatectomy
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Yoriko, Nomura, Jun, Akiba, Hirohisa, Yano, Yoshito, Akagi, and Toru, Hisaka
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Cancer Research ,Postoperative Complications ,Liver ,Oncology ,Non-alcoholic Fatty Liver Disease ,Hepatectomy ,Humans ,Alanine Transaminase ,Bilirubin ,Aspartate Aminotransferases ,General Medicine - Abstract
The number of patients with fatty liver due to alcohol consumption, metabolic syndrome, non-alcoholic fatty liver disease, and non-alcoholic steatohepatitis is increasing. Since there is no consensus on the risk of hepatectomy for patients with fatty liver, this study examined the clinical outcomes of hepatectomy for fatty liver patients via evaluation of transaminase.Patients (n=164) who underwent hepatectomy for primary liver tumors from January 2014 to March 2019 were included in the study. Patients were divided into steatohepatitis (n=19), steatosis (n=20), and control (n=30) groups. Serum values of aspartate aminotransferase (AST), alanine transaminase (ALT), total bilirubin (TB), prothrombin time (PT), white blood cells, and platelets were compared before and immediately after surgery, and on postoperative days 1-5, 7, and 10. And their rates of change were compared using the preoperative value as a reference value.Overall, AST and ALT elevation rates were higher in the control group than in the steatosis and steatohepatitis groups from postoperative days 2-7. There was no difference in postoperative hepatic dysfunction between the steatosis and steatohepatitis groups. Univariate analysis revealed significant differences in liver stiffness, operative time, mobilization, and Pringle time. Multivariate analysis indicated low liver stiffness and longer Pringle time as independent risk factors. Postoperative change in TB, PT, and albumin levels did not differ between the groups. There was no difference in postoperative complications and hospital stay between the groups.Fatty liver does not increase the risk of postoperative liver damage following hepatectomy.
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- 2022
11. Prognostic Factors for Distal Bile Duct Carcinoma After Surgery
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RYUICHI KAWAHARA, RYUUTA MIDORIKAWA, SHINICHI TANIWAKI, SATOKI KOJIMA, HIROKI KANNO, MUNEHIRO YOSHITOMI, YORIKO NOMURA, YUICHI GOTO, TOSHIHIRO SATOU, HISAMUNE SAKAI, HIROTO ISHIKAWA, TORU HISAKA, MASAFUMI YASUNAGA, TAKAHIKO SAKAUE, TOMOYUKI USHIJIMA, MAKIKO YASUMOTO, YOSHINOBU OKABE, MASAHIKO TANIGAWA, YOSHIKI NAITOU, HIROHISA YANO, and KOJI OKUDA
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General Medicine - Published
- 2023
12. Impact of Interferon on the Prognosis of Hepatitis C Virus-Related Hepatocellular Carcinoma Patients with a Sustained Virological Response –An Additional Comparison Between Preoperative and Postoperative Sustained Virological Response
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DAISUKE MUROYA, TARO NISHIMURA, HIROKI KANNO, SATOKI KOJIMA, SHOGO FUKUTOMI, MASANORI AKASHI, YORIKO NOMURA, YUICHI GOTO, TOSHIHIRO SATO, HISAMUNE SAKAI, TORU HISAKA, YOSHITO AKAGI, and KOJI OKUDA
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General Medicine - Published
- 2021
13. Hepatic Epithelioid Hemangioendothelioma Presenting Synchronously with Hepatocellular Carcinoma
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Munehiro Yoshitomi, Yoriko Nomura, Toru Hisaka, Yuichi Goto, Hiroki Kanno, Hisamune Sakai, Ryuichi Kawahara, Toshihiro Sato, Ryuta Midorikawa, Koji Okuda, Satoki Kojima, Yoshito Akagi, and Shogo Fukutomi
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CD31 ,Pathology ,medicine.medical_specialty ,Hepatocellular carcinoma ,Single Case ,CD34 ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Epithelioid hemangioendothelioma ,lcsh:RC799-869 ,Halo sign ,Tumor marker ,business.industry ,Gastroenterology ,medicine.disease ,Liver ,030220 oncology & carcinogenesis ,lcsh:Diseases of the digestive system. Gastroenterology ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Epithelioid cell ,Calcification - Abstract
Hepatic epithelioid hemangioendothelioma (EHE) is a rare malignant tumor with unknown pathogenesis. Herein, we report a case of a hepatic EHE presenting synchronously with a hepatocellular carcinoma (HCC). To the best of our knowledge, this is the second case report of synchronous hepatic EHE and HCC. An 84-year-old man presented with back pain. During examination, a tumor in liver segment 3 was coincidentally detected. Tumor marker (carbohydrate antigen 19-9, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II) levels were elevated. Contrast-enhanced computed tomography revealed perinodular enhancement in the arterial and portal phases. Another tumor was detected in liver segment 2, which was homogeneously enhanced in the arterial phase, followed by washout in the portal and late phases. Based on these imaging findings, we diagnosed the tumor in segment 3 as a solitary cholangiocellular carcinoma and the tumor in segment 2 as a solitary HCC. Lateral sectionectomy of the liver was performed. Microscopically, spindle-shaped and epithelioid cells were present in the tumor in segment 3. On immunohistochemistry, the tumor cells were positive for CD31 and CD34, focally positive for D2-40, and negative for AE1/AE3. Therefore, the tumor in segment 3 was ultimately diagnosed as an EHE and the tumor in segment 2 as a well-differentiated HCC. Preoperative diagnosis of EHE is difficult owing to the lack of specific findings. Intratumoral calcification, halo sign, and lollipop sign are occasionally found in EHE and are useful imaging findings for diagnosis. Clinical behavior is unpredictable, ranging from indolent growth to rapid progression. Clinical or pathological predictors of the course of EHE are urgently required.
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- 2021
14. Successful nonoperative management by endoscopic and percutaneous drainage for penetrating pancreatic duct injury: a case report
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Yoshihiro Uchino, Hisamune Sakai, Ryuichi Kawahara, Shin Sasaki, Hiroki Kanno, Koji Okuda, Ryuta Midorikawa, Toshihiro Sato, Masafumi Yasunaga, Yusuke Hirakawa, Satoki Kojima, Goichi Nakayama, Shinichi Taniwaki, Yuichi Goto, Yoriko Nomura, Toru Hisaka, and Hiroto Ishikawa
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Male ,medicine.medical_specialty ,Percutaneous ,Nonoperative management ,Thoracic Injuries ,lcsh:Medicine ,Case Report ,Abdominal Injuries ,Wounds, Nonpenetrating ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,medicine ,Humans ,Stab wound ,Pancreas ,Retrospective Studies ,Pancreatic duct ,medicine.diagnostic_test ,business.industry ,lcsh:R ,Pancreatic Ducts ,030208 emergency & critical care medicine ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Contrast medium ,medicine.anatomical_structure ,Angiography ,Duct injury ,Drainage ,Pancreatic injury ,business ,030217 neurology & neurosurgery ,Penetrating pancreatic trauma - Abstract
Background Pancreatic trauma is a rare condition with a wide presentation, ranging from hematoma or laceration without main pancreatic duct involvement, to massive destruction of the pancreatic head. The optimal diagnosis of pancreatic trauma and its management approaches are still under debate. The East Association of Surgery for Trauma (EAST) guidelines recommend operative management for high-grade pancreatic trauma; however, several reports have reported successful outcomes with nonoperative management (NOM) for grade III/IV pancreatic injuries. Herein, we report a case of grade IV pancreatic injury that was nonoperatively managed through endoscopic and percutaneous drainage. Case presentation A 47-year-old Japanese man was stabbed in the back with a knife; upon blood examination, both serum amylase and lipase levels were within normal limits. Contrast-enhanced computed tomography (CT) showed extravasation of the contrast medium around the pancreatic head and a hematoma behind the pancreas. Abdominal arterial angiography revealed a pseudo aneurysm in the inferior pancreatoduodenal artery, as well as extravasation of the contrast medium in that artery; coil embolization was thus performed. On day 12, CT revealed a wedge-shaped, low-density area in the pancreatic head, as well as consecutive pseudocysts behind the pancreas; thereafter, percutaneous drainage was performed via the stab wound. On day 22, contrast radiography through the percutaneous drain revealed the proximal and distal parts of the main pancreatic duct. The injury was thus diagnosed as a grade IV pancreatic injury based on the American Association for the Surgery of Trauma guidelines. On day 26, an endoscopic nasopancreatic drainage tube was inserted across the disruption; on day 38, contrast-enhanced CT showed a marked reduction in the fluid collection. Finally, on day 61, the patient was discharged. Conclusions Although the EAST guidelines recommend operative treatment for high-grade pancreatic trauma, NOM with appropriate drainage by endoscopic and/or percutaneous approaches may be a promising treatment for grade III or IV trauma.
- Published
- 2021
15. Quercetin Suppresses Proliferation of Liver Cancer Cell Lines In Vitro
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Yoriko Nomura, Toru Hisaka, Sachiko Ogasawara, Koji Okuda, Yoshito Akagi, Osamu Nakashima, Tomoaki Mizobe, Kouta Nakashima, Yoshiki Naito, Masahiko Tanigawa, Yuichi Goto, Hirohisa Yano, Fumihiko Fujita, Toshihiro Sato, Shogo Fukutomi, Hisamune Sakai, and Jun Akiba
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Cancer Research ,Cell cycle checkpoint ,medicine.diagnostic_test ,Cell growth ,Chemistry ,General Medicine ,Cell cycle ,Flow cytometry ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Apoptosis ,Cell culture ,030220 oncology & carcinogenesis ,medicine ,Cancer research ,heterocyclic compounds ,MTT assay ,Viability assay - Abstract
Background/aim We investigated the anti-proliferative effect of quercetin on liver cancer cell lines. Materials and methods Thirteen liver cancer cell lines were cultured followed by treatment with varying concentrations of quercetin (0-100 μM) or quercetin and 5-FU, and the cell viability was analysed by the MTT assay. Flow cytometry was also used to examine cell cycle progression after treatment with quercetin. Results The addition of quercetin resulted in a dose- and time-dependent suppression of cell proliferation. In some cell lines, treatment with quercetin and 5-FU caused an additional or synergistic effect. Most cell lines displayed cell cycle arrest at different phases of the cell cycle. Conclusion Quercetin inhibits the proliferation of liver cancer cells via induction of apoptosis and cell cycle arrest.
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- 2020
16. Differences in the immunosurveillance pattern associated with DNA mismatch repair status between right‐sided and left‐sided colorectal cancer
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Hiroaki Miyoshi, Yoriko Nomura, Toru Hisaka, Yoshito Akagi, Koichi Ohshima, Kazutaka Nakashima, Naohiro Yoshida, Masao Seto, Hiroyuki Tanaka, Hiroki Kanno, Mai Takeuchi, Koji Okuda, and Tomoya Sudo
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Male ,0301 basic medicine ,Oncology ,Cancer Research ,CD3 Complex ,Colorectal cancer ,tumor‐infiltrating lymphocyte ,DNA Mismatch Repair ,B7-H1 Antigen ,0302 clinical medicine ,Pathology ,Immunologic Surveillance ,Aged, 80 and over ,Hazard ratio ,FOXP3 ,Forkhead Transcription Factors ,General Medicine ,Middle Aged ,Immunosurveillance ,mismatch repair ,030220 oncology & carcinogenesis ,Original Article ,Female ,DNA mismatch repair ,Colorectal Neoplasms ,immune‐checkpoint molecule ,Adult ,medicine.medical_specialty ,Colon ,CD8 Antigens ,colorectal cancer ,Human leukocyte antigen ,Disease-Free Survival ,03 medical and health sciences ,Internal medicine ,Biomarkers, Tumor ,medicine ,Humans ,tumor location ,Aged ,business.industry ,Tumor-infiltrating lymphocytes ,Rectum ,Cancer ,Original Articles ,medicine.disease ,T-Cell Intracellular Antigen-1 ,030104 developmental biology ,business - Abstract
Tumor location and immunity play important roles in the progression of colorectal cancer (CRC). This study aimed to investigate the differences in the immunosurveillance pattern between right‐ and left‐sided CRC and analyze their association with clinicopathologic features, including mismatch repair (MMR) status. We included surgically resected stage II/III CRC cases and evaluated the immunohistochemical findings of HLA class I, HLA class II, programmed cell death‐ligand 1 (PD‐L1), PD‐1, CTLA‐4, CD3, CD4, CD8, TIA‐1, T‐bet, GATA3, RORγT, Foxp3, and CD163. A total of 117 patients were included in the analyses; of these, 30 and 87 had right‐ and left‐sided cancer, respectively. Tumor immunity varied according to the tumor location in the overall cohort. Analysis of the tumors excluding those with DNA mismatch repair (MMR) deficiency also revealed that tumor immunity differed according to the tumor location. In right‐sided colon cancer (CC), high expression of Foxp3 (P = .0055) and TIA‐1 (P = .0396) were associated with significantly better disease‐free survival (DFS). High CD8 (P = .0808) and CD3 (P = .0863) expression tended to have better DFS. Furthermore, in left‐sided CRC, only high PD‐L1 expression in the stroma (P = .0426) was associated with better DFS. In multivariate analysis, high Foxp3 expression in right‐sided CC was an independent prognostic factor for DFS (hazard ratio, 7.6445; 95% confidence interval, 1.2091‐150.35; P = .0284). In conclusion, the immunosurveillance pattern differs between right‐ and left‐sided CRC, even after adjusting for MMR deficiency., Comparison of Kaplan‐Meier curves of disease‐free survival (DFS) in each tumor location excluding DNA mismatch repair deficiency. In right‐sided colon cancer, high Foxp3 (P = .0055) and TIA‐1 expression (P = .0396) were associated with significantly better DFS. High CD8 (P = .0808) and CD3 (0.0863) expression showed a tendency towards better DFS. In left‐sided colorectal cancer, only high sPD‐L1 expression (P = .0426) was associated with better DFS.
- Published
- 2020
17. [Laparoscopic Extirpation of Peritoneal Dissemination of Hepatocellular Carcinoma Using ICG Imaging]
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Hisamune, Sakai, Yuichi, Goto, Shogo, Fukutomi, Masanori, Akashi, Toshihiro, Sato, Yoriko, Nomura, Shoichiro, Arai, Hiroki, Kanno, Kazuaki, Hashimoto, Jun, Akiba, Toru, Hisaka, Yoshito, Akagi, and Koji, Okuda
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Indocyanine Green ,Male ,Carcinoma, Hepatocellular ,Liver Neoplasms ,Hepatectomy ,Humans ,Female ,Laparoscopy ,Aged - Abstract
A 71-year-old man who underwent laparoscopic partial liver resection for local recurrence hepatocellular carcinoma (HCC)in segment 4 one year after percutaneous radiofrequency ablation(RFA)for HCC. About 3 years after treatment, the patient showed elevation of serum level of tumor marker and a mass lesion in the round ligament on CT and EOB-MRI. We made a diagnosis of peritoneal dissemination of HCC. Laparoscopic extirpation of peritoneal dissemination using indocyanine green(ICG)imaging was performed and no other tumors were observed in the peritoneal cavity. A lesion was diagnosed as peritoneal dissemination of HCC, and postoperative course was uneventful. This patient underwent repeated RFA and partial resection for recurrence of HCC. The patient was died for intrahepatic multiple recurrence of HCC without peritoneal dissemination 25 months after extirpation of peritoneal dissemination. In the field of hepatobiliary surgery, ICG imaging can be used for the intraoperative real-time visualization of hepatic malignancies. The ICG imaging is restricted to detection of fluorescence for liver tumors 5-10 mm from the liver surface. In the detection of peritoneal dissemination, however, there are no such limitations. Laparoscopic extirpation using ICG imaging is useful for the detection of peritoneal dissemination of HCC and may improve the prognosis in selected patients.
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- 2022
18. Cholangitis after Hemobilia: A Brief Overview
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Daisuke, Muroya, primary, Koji, Okuda, additional, Shoichiro, Arai, additional, Masanori, Akashi, additional, Yoriko, Nomura, additional, Yuichi, Goto, additional, Toshihiro, Sato, additional, Hisamune, Sakai, additional, Yoshinobu, Okabe, additional, Toru, Hisaka, additional, Yoshito, Akagi, additional, Satoshi, Taniwaki, additional, Hironobu, Sou, additional, and Tetsuo, Imamura, additional
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- 2021
- Full Text
- View/download PDF
19. Des-γ-carboxyprothrombin (DCP) and NX-DCP expressions and their relationship with clinicopathological features in hepatocellular carcinoma.
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Akiko Sumi, Jun Akiba, Sachiko Ogasawara, Masamichi Nakayama, Yoriko Nomura, Makiko Yasumoto, Sakiko Sanada, Osamu Nakashima, Toshi Abe, and Hirohisa Yano
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Medicine ,Science - Abstract
Des-γ-carboxyprothrombin (DCP) has been used as a tumor marker for hepatocellular carcinoma (HCC). Recently the DCP/NX-DCP ratio, calculated by dividing DCP by NX-DCP, has been reported useful in detecting HCC. The purpose of this study is to clarify the significance of DCP and NX-DCP expression in HCC tissues.HCC and non-HCC tissue samples were obtained from 157 patients and were immunohistochemically examined for DCP and NX-DCP expression using anti-DCP antibody and anti-NX-DCP antibody. DCP and NX-DCP expression scores were calculated by multiplying staining intensity grade by percentage of stained area. Serum DCP and NX-DCP levels were determined in 89 patients. We evaluated the relationship between tumor expression, serum level, and pathomorphological findings.Intrahepatic metastasis (im) was significantly more frequent in cases with high DCP expression than in cases with low DCP expression. High NX-DCP expression was associated with significantly lower histological grade, and less frequent im or portal vein invasion (vp) than low NX-DCP expression. Serum DCP was correlated with DCP expression, but serum NX-DCP was not correlated with NX-DCP expression. DCP-positive (≥40 mAU/L), NX-DCP-positive (≥90 mAU/L), and DCP/NX-DCP ratio-positive (≥1.5) cases were associated with significantly larger tumor size and more frequent vp than negative cases. DCP was rarely expressed, but NX-DCP was frequently expressed in non-cancerous liver tissues. Patients with NX-DCP expression-negative tumors showed a lower survival rate than those with NX-DCP expression-positive tumors (p = 0.04), whereas the survival in serum NX-DCP-positive cases was lower than that of serum negative cases (p = 0.02).DCP and NX-DCP were produced in HCC tissues, but differed in expression level and biological properties. DCP expression, serum DCP or NX-DCP level, and DCP/NX-DCP ratio were closely related to malignant properties of HCC.
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- 2015
- Full Text
- View/download PDF
20. Fatty Liver Does Not Increase the Risk of Postoperative Liver Damage Following Hepatectomy
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Koji Okuda, Hisamune Sakai, Hirohisa Yano, Jun Akiba, Yoriko Nomura, Toru Hisaka, and Yoshito Akagi
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medicine.medical_specialty ,Text mining ,business.industry ,Internal medicine ,medicine.medical_treatment ,Fatty liver ,medicine ,Liver damage ,Hepatectomy ,business ,medicine.disease ,Gastroenterology - Abstract
Background The number of patients with fatty liver due to alcohol consumption, the metabolic syndrome, non-alcoholic fatty liver disease, and non-alcoholic steatohepatitis is increasing. Because there is no consensus on the risk of hepatectomy in patients with fatty liver, this study examined the clinical outcomes of hepatectomy in fatty liver patients by evaluation their transaminase levels. Methods Patients (n = 164) who underwent hepatectomy for primary liver tumors from January 2014 to March 2019 were included in the study. They were divided into the steatohepatitis (n = 19), steatosis (n = 20), and viral hepatitis (n = 30) groups. Serum values of aspartate aminotransferase (AST), alanine transaminase (ALT), total bilirubin (TB), white blood cells, and platelets level and the prothrombin time (PT) were compared before and immediately after surgery, and on postoperative days 1–5, 7, and 10. Results Overall, the AST and ALT elevation rates were higher in the control group than in the steatosis and steatohepatitis groups during postoperative days 2–7. There was no difference in postoperative hepatic dysfunction between the steatosis and steatohepatitis groups. Univariate analysis revealed significant differences in liver stiffness, operative time, mobilization, and the Pringle time. Multivariate analysis indicated low liver stiffness and a longer Pringle time as independent risk factors. Postoperative changes in the TB and albumin levels and the PT did not differ between the groups. There was no difference in the postoperative complications and hospital stay length between the groups. Conclusions Fatty liver does not increase the risk of postoperative liver damage following hepatectomy.
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- 2021
21. Sarcomatous Component in Pancreatic Adenosquamous Carcinoma: A Clinicopathological Series of 7 Cases
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Yuichi Goto, Hirohisa Yano, Yoshiki Naito, Shinichi Taniwaki, Hisamune Sakai, Ryuichi Kawahara, Masafumi Yasunaga, Hiroto Ishikawa, Jun Akiba, Hiroyuki Tanaka, Yoriko Nomura, Toru Hisaka, Yoshito Akagi, and Koji Okuda
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Male ,Cancer Research ,Poor prognosis ,Pathology ,medicine.medical_specialty ,Vimentin ,Pancreatic Adenosquamous Carcinoma ,Malignancy ,Metastasis ,Carcinoma, Adenosquamous ,medicine ,Humans ,Aged ,biology ,business.industry ,General Medicine ,Middle Aged ,Cadherins ,Prognosis ,medicine.disease ,Sarcomatous Component ,Squamous carcinoma ,Gene Expression Regulation, Neoplastic ,Pancreatic Neoplasms ,Oncology ,biology.protein ,Adenocarcinoma ,Female ,business - Abstract
Background/aim The aim of this study was to examine the clinicopathological features of pancreatic adenosquamous carcinoma (PASC). Patients and methods Our study included seven patients who underwent resection of PASC. Results PASC is characterized by large tumors and strong infiltration into the major blood vessels and other organs, forcing many patients to undergo extended resections. In addition, all patients experienced liver metastasis recurrence following surgery, with a very poor prognosis. Histopathologically, a poorly differentiated sarcomatous component existed in all patients in addition to an adenocarcinoma component and squamous carcinoma component. Although P40 staining for the sarcomatous component was positive along with squamous carcinoma, E-cadherin expression disappeared while vimentin was expressed. It has been suggested that it is highly likely that these sarcomatous components are derived from squamous carcinoma and have an impact on prognosis. Conclusion The sarcomatous component may be related to the biological malignancy of PASC.
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- 2019
22. Sinusoidal Obstruction Syndrome and Postoperative Complications Resulting from Preoperative Chemotherapy for Colorectal Cancer Liver Metastasis
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Masahiko Tanigawa, Hirohisa Yano, Yuichi Goto, Masaru Fukahori, Koji Okuda, Jun Akiba, Hiroto Ishikawa, Yoriko Nomura, Hisamune Sakai, Ryuichi Kawahara, Toru Hisaka, Yoshito Akagi, Tomoaki Mizobe, Yoshiki Naito, Masafumi Yasunaga, Hiroyuki Tanaka, Fumihiko Fujita, Osamu Nakashima, Tetsushi Kinugasa, and Keisuke Miwa
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Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Bevacizumab ,Colorectal cancer ,medicine.medical_treatment ,Hepatic Veno-Occlusive Disease ,Leucovorin ,Hemodynamics ,Gastroenterology ,Disease-Free Survival ,Metastasis ,Postoperative Complications ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Hepatectomy ,Humans ,Panitumumab ,Neoplasm Metastasis ,Aged ,Chemotherapy ,Cetuximab ,business.industry ,Liver Neoplasms ,General Medicine ,Middle Aged ,medicine.disease ,Chemotherapy regimen ,Oncology ,Preoperative Period ,Female ,Fluorouracil ,Colorectal Neoplasms ,business ,medicine.drug - Abstract
Background/aim The aim of this study was to investigate the effects of preoperative chemotherapy on the healthy, metastasis-free part of the liver in colorectal cancer patients with liver metastasis, and the relationship between chemotherapy and postoperative complications. Patients and methods Our study included 90 cases of colorectal cancer liver metastasis resected after preoperative chemotherapy. The patients were divided into three groups according to the received chemotherapy regimen: 20 cases received mFOLFOX6, 54 cases a combination of mFOLFOX6 with bevacizumab, and 16 cases a combination of mFOLFOX6 and cetuximab or panitumumab. Results The mean numbers of sinusoidal injuries for each chemotherapy type were compared. The group treated with the combination of mFOLFOX6 and bevacizumab showed a lower extent of sinusoidal injury relative to other groups; this intergroup difference became increasingly remarkable as the number of chemotherapy cycles increased. Complications of various extents were found in all three groups, but no significant differences were observed between the three groups. Conclusion In cases where preoperative chemotherapy was extended over a long period, combined use of bevacizumab was thought to be effective because of stabilization of disturbed liver hemodynamics resulting from sinusoidal injury suppression effects, allowing effective distribution of anti-cancer agents to tumors.
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- 2019
23. Laparoscopic left hepatectomy for a patient with intrahepatic cholangiocarcinoma metastasis in the falciform ligament: a case report
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Toshihiro Sato, Shusuke Okamura, Yuichi Goto, Hirohisa Yano, Shogo Fukutomi, Yuta Yano, Hisamune Sakai, Koji Okuda, Masanori Akashi, Jun Akiba, Hiroki Kanno, Daisuke Muroya, Yoriko Nomura, Toru Hisaka, and Yoshito Akagi
- Subjects
medicine.medical_specialty ,Liver tumor ,Hematogenous metastases ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,030218 nuclear medicine & medical imaging ,Metastasis ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Falciform ligament ,medicine ,Hepatectomy ,Humans ,Intrahepatic Cholangiocarcinoma ,Intrahepatic cholangiocarcinoma ,Aged, 80 and over ,Ligaments ,Round Ligament ,business.industry ,Liver Neoplasms ,Cancer ,lcsh:RD1-811 ,General Medicine ,Segment IV ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Liver ,030220 oncology & carcinogenesis ,Ligament ,Female ,Laparoscopy ,Radiology ,business - Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is primary cancer of the liver with poor prognosis because of its high potential for recurrence and metastasis. We experienced a rare case of ICC with hematogenous metastasis to the falciform ligament. We aimed to clarify the route of metastasis to the mesentery by increasing the accuracy of preoperative imaging and establish a hepatectomy to control cancer. Case presentation An 85-year-old woman was referred to our hospital for a detailed study of progressively increasing liver tumors. She had no subjective symptoms. Her medical history showed hypertension, aneurysm clipping for cerebral hemorrhage, and gallstones. A detailed physical examination and laboratory data evaluation included tumor markers but did not demonstrate any abnormalities. On computed tomography scan, contrast-enhanced ultrasound, and magnetic resonance imaging with gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid, the tumor appeared to be located in liver segment IV, protruding outside the liver. It appeared to contain two distinct components; we suspected ICC in the intrahepatic tumor component. Laparoscopic observation revealed that the extrahepatic lesion was an intra-falciform ligament mass; laparoscopic left hepatectomy was performed. Microscopically, the main tumor in segment IV was 15 mm in diameter and was diagnosed as moderately and poorly differentiated ICC. The tumor of the intra-falciform ligament was not continuous with the main intrahepatic nodule and was also diagnosed as ICC with extensive necrosis. There were no infiltrates in the round ligament of the liver, and several tumor thrombi were found in the small veins of the falciform ligament. Conclusions To date, there have been a few reports of metastases of primary liver cancer to the falciform ligament. At the time of preoperative imaging and pathological diagnosis, this case was suggestive of considering that the malignant liver tumor might be suspected of metastasizing to the falciform ligament. Our case improves awareness of this pathology, which can be useful in the future when encountered by hepatic specialists and surgeons.
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- 2021
24. [A Case Report of Duodenal Ampullary Carcinoma with Annular Pancreas]
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Toshihiro, Sato, Hisamune, Sakai, Daisuke, Muroya, Hiroki, Kanno, Satoki, Kojima, Syogo, Fukutomi, Masanori, Akashi, Yoriko, Nomura, Yuichi, Goto, Hiroto, Ishikawa, Toru, Hisaka, Yoshito, Akagi, and Koji, Okuda
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Ampulla of Vater ,Duodenal Neoplasms ,Humans ,Pancreatic Diseases ,Female ,Pancreas ,Aged - Abstract
Annular pancreas is a rare congenital anomaly that rarely occurs in parallel with malignancy. We herein report a case of annular pancreas with carcinoma of the papilla of Vater. A 76-year-old woman presented with abdominal pain and was referred to us after gastroduodenal endoscopy showed a tumor of the papilla. Preoperative computed tomography confirmed the presence of an ampullary tumor. During surgery, we found an anomaly consisting of a ring-like band of pancreatic tissue encircling the second part of the duodenum. Transduodenal papillectomy with preservation of the annular pancreas was subsequently performed. The patient was discharged without any postoperative morbidity.
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- 2021
25. Laparoscopic Liver Resection Using a Silicone Band Retraction Method (With Video)
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Yoriko Nomura, Toru Hisaka, Yoshito Akagi, Toshihiro Sato, Koji Okuda, Yuichi Goto, and Hisamune Sakai
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medicine.medical_specialty ,Technical Reports ,Silicones ,silicone band retraction method ,silicone band uplift technique ,Resection ,chemistry.chemical_compound ,Silicone ,Blood loss ,Medicine ,Hepatectomy ,Humans ,Major complication ,Retrospective Studies ,posterosuperior segment ,one-surgeon technique ,business.industry ,Liver Neoplasms ,technology, industry, and agriculture ,laparoscopic liver resection ,Length of Stay ,Surgery ,chemistry ,ComputingMethodologies_DOCUMENTANDTEXTPROCESSING ,Operative time ,Laparoscopy ,business ,Hospital stay - Abstract
Supplemental Digital Content is available in the text., Background: The success of laparoscopic liver resection (LLR) depends on stable and full exposure of the parenchymal transection plane. We evaluated the efficacy of LLR using a silicone band retraction method for lesions in the anterolateral and posterosuperior segments. Methods: We retrospectively analyzed 189 consecutive patients who had undergone LLR in our hospital between July 2010 and July 2020. They were divided into 2 groups according to whether LLR was performed before (conventional group; n=64) or after (silicone band group; n=125) the introduction of the silicone band retraction method. Results: The silicone band group demonstrated significantly less blood loss than that by the conventional group. The mean operative time and the hospital stay in the silicone band group were obviously shorter than that in the conventional group. The open conversion rate and the major complication rate were significantly lower in the silicone band group than that in the conventional group. Conclusion: The silicone band retraction method is a useful approach that results in a safe LLR.
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- 2020
26. Assessing the incidence of complications and malignancies in the long-term management of benign biliary strictures with a percutaneous transhepatic drain
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Munehiro, Yoshitomi, Ryuichi, Kawahara, Shinichi, Taniwaki, Ryuta, Midorikawa, Satoki, Kojima, Daisuke, Muroya, Shoichiro, Arai, Takahisa, Shirahama, Hiroki, Kanno, Shogo, Fukutomi, Yuichi, Goto, Yoriko, Nomura, Masanori, Akashi, Toshihiro, Sato, Hisamune, Sakai, Toru, Hisaka, and Yoshito, Akagi
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Aged, 80 and over ,Male ,Cholestasis ,Incidence ,Constriction, Pathologic ,General Medicine ,Middle Aged ,Postoperative Complications ,Treatment Outcome ,Drainage ,Humans ,Female ,Neoplasm Recurrence, Local ,Aged ,Retrospective Studies - Abstract
Percutaneous drainage catheters (PDCs) are required for the management of benign biliary strictures refractory to first-line endoscopic treatment. While biliary patency after PDC placement exceeds 75%, long-term catheterization is occasionally necessary. In this article, we assess the outcomes of patients at our institution who required long-term PDC placement.A single-institution retrospective analysis was performed on patients who required a PDC for 10 years or longer for the management of a benign biliary stricture. The primary outcome was uncomplicated drain management without infection or complication. Drain replacement was performed every 4 to 12 weeks as an outpatient procedure.Nine patients (three males and six females; age range of 48-96 years) required a long-term PDC; eight patients required the long-term PDC for an anastomotic stricture and one for iatrogenic bile duct stenosis. A long-term PDC was required for residual stenosis or patient refusal. Drain placement ranged from 157 to 408 months. In seven patients, intrahepatic stones developed, while in one patient each, intrahepatic cholangiocarcinoma or hepatocellular carcinoma occurred.Long-term PDC has a high rate of complications; therefore, to avoid the need for using long-term placement, careful observation or early surgical interventions are required.
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- 2022
27. Quercetin Suppresses Proliferation of Liver Cancer Cell Lines
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Toru, Hisaka, Hisamune, Sakai, Toshihiro, Sato, Yuichi, Goto, Yoriko, Nomura, Shogo, Fukutomi, Fumihiko, Fujita, Tomoaki, Mizobe, Osamu, Nakashima, Masahiko, Tanigawa, Yoshiki, Naito, Jun, Akiba, Sachiko, Ogasawara, Kouta, Nakashima, Yoshito, Akagi, Koji, Okuda, and Hirohisa, Yano
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Cell Survival ,Cell Line, Tumor ,Liver Neoplasms ,Humans ,Apoptosis ,Quercetin ,Cell Cycle Checkpoints ,Cell Division ,Cell Proliferation - Abstract
We investigated the anti-proliferative effect of quercetin on liver cancer cell lines.Thirteen liver cancer cell lines were cultured followed by treatment with varying concentrations of quercetin (0-100 μM) or quercetin and 5-FU, and the cell viability was analysed by the MTT assay. Flow cytometry was also used to examine cell cycle progression after treatment with quercetin.The addition of quercetin resulted in a dose- and time-dependent suppression of cell proliferation. In some cell lines, treatment with quercetin and 5-FU caused an additional or synergistic effect. Most cell lines displayed cell cycle arrest at different phases of the cell cycle.Quercetin inhibits the proliferation of liver cancer cells via induction of apoptosis and cell cycle arrest.
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- 2020
28. [A Case of Pancreatoduodenectomy for Pancreatic Head Cancer with Invasion to the Hepatic Artery from the Pancreatic Arcade]
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Toshihiro, Sato, Hisamune, Sakai, Yuichi, Goto, Hiroki, Kanno, Ryuta, Midorikawa, Satoki, Kojima, Syougo, Fukutomi, Yoriko, Nomura, Ryuichi, Kawahara, Hiroto, Ishikawa, Toru, Hisaka, Masafumi, Yasunaga, and Kouji, Okuda
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Male ,Pancreatic Neoplasms ,Hepatic Artery ,Portal Vein ,Humans ,Middle Aged ,Pancreas ,Pancreaticoduodenectomy - Abstract
This case pertained a 53-year-old man who underwent nab-PTX plus GEM therapy for BR-A pancreatic head cancer. He achieved a partial response and underwent pancreatoduodenectomy. Dynamic CT showed blockage of the original common hepatic artery branching from the celiac artery. Hepatic blood flow was maintained by a pancreatic arcade branching from the superior mesenteric artery which ran along the ventral side of the pancreatic head. The cancer had invaded the same location; therefore, the hepatic artery and portal vein were both resected and reconstructed. The patient had no complications, such as postoperative pancreatic fistula, and was discharged 45 days postoperatively. Currently(5 months postoperatively), postoperative S-1-based adjuvant chemotherapy is being administered, and the patient had a recurrence-free survival.
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- 2020
29. Complete spontaneous necrosis of hepatocellular carcinoma accompanied by portal vein tumor thrombosis: A case report
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Nobuhisa Shirahama, Koji Okuda, Hiroyuki Tanaka, Shin Sasaki, Yuichi Goto, Yoshihiro Uchino, Jun Akiba, Hiroto Ishikawa, Yoriko Nomura, and Yoshito Akagi
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CECT, contrast-enhanced computed tomography ,medicine.medical_specialty ,Pathology ,Necrosis ,PV, portal vein ,Hepatocellular carcinoma ,medicine.medical_treatment ,Article ,03 medical and health sciences ,0302 clinical medicine ,PVL, portal vein ligation ,medicine ,PVTT, portal vein tumor thrombosis ,Thrombus ,Portal vein ligation ,Spontaneous regression ,AFP, alpha-fetoprotein ,US, ultrasonography ,business.industry ,Portal vein tumor thrombosis ,medicine.disease ,Thrombosis ,digestive system diseases ,Posterior segment of eyeball ,AFP-L3, Lens culinaris agglutinin-reactive AFP isoform 3 ,HCC, hepatocellular carcinomaPIVKA-II – proteins induced by vitamin K absence or antagonist-II ,Complete spontaneous necrosis ,030220 oncology & carcinogenesis ,Cancer cell ,030211 gastroenterology & hepatology ,Surgery ,Histopathology ,medicine.symptom ,Hepatectomy ,business - Abstract
Highlights • We present an rare case of complete spontaneous necrosis of HCC with gross PVTT. • Immune response was thought to be the main cause of total necrosis of our case. • Surgery should be considered for patients with suspected tumor necrosis., Introduction We report a rare case of complete spontaneous necrosis of a hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombosis (PVTT), as confirmed by resection. Case presentation A 64-year-old man was referred to our hospital for suspected HCC. Contrast-enhanced computed tomography (CECT) findings before admission revealed a 53-mm tumor in the posterior segment of the liver and were suspicious for PVTT in the right posterior PV. Both alpha-fetoprotein (AFP) and proteins induced by vitamin K absence or antagonist-II (PIVKA-II) were elevated at 17,562 ng/mL and 153 mAU/mL, respectively. We diagnosed the findings as HCC with PVTT. Seven days after the first CECT scan, we performed CECT volumetry, which revealed that the tumor had regressed to 30 mm, along with regression of the PVTT. We performed portal vein ligation (PVL), and 10 days later, CECT revealed that the tumor had shrunk to 20 mm. AFP and PIVKA-II levels were 643 ng/mL and 14 mAU/mL, respectively. We suspected spontaneous regression of the patient’s HCC, but performed a hepatectomy. Histopathology revealed a 22-mm tumor with a thin fibrous capsule and a tumor thrombus in the PV. Trabecular and pseudoglandular structures consisting of denucleated HCC epithelial cells made up both the tumor and thrombus, and the finding confirmed the spontaneous necrosis of HCC. Conclusions We present an extremely rare case of complete spontaneous necrosis of HCC with PVTT. When spontaneous necrosis is suspected, surgery should be considered because of the potential risk of residual viable cancer cells.
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- 2018
30. Surgically treated diaphragmatic perforation after radiofrequency ablation for hepatocellular carcinoma
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Ryoko Kuromatsu, Koji Okuda, Sachiko Nagasu, Takuji Torimura, Yoriko Nomura, and Yoshito Akagi
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medicine.medical_specialty ,Diaphragmatic hernia ,Radiofrequency ablation ,Hepatocellular carcinoma ,medicine.medical_treatment ,Perforation (oil well) ,Diaphragmatic breathing ,Case Report ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Laparotomy ,Medicine ,business.industry ,Diaphragmatic perforation ,medicine.disease ,Surgery ,Diaphragm (structural system) ,surgical procedures, operative ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,Complication - Abstract
We review 6 cases of diaphragmatic perforation, with and without herniation, treated in our institution. All patients with diaphragmatic perforation underwent radiofrequency ablation (RFA) treatments for hepatocellular carcinoma (HCC) performed at Kurume University Hospital and Tobata Kyoritsu Hospital. We investigated the clinical profiles of the 6 patients between January 2003 and December 2013. We further describe the clinical presentation, diagnosis, and treatment of diaphragmatic perforation. The change in the volume of liver and the change in the Child-Pugh score from just after the RFA to the onset of perforation was evaluated using a paired t-test. At the time of perforation, 4 patients had herniation of the viscera, while the other 2 patients had no herniation. The majority of ablated tumors were located adjacent to the diaphragm, in segments 4, 6, and 8. The average interval from RFA to the onset of perforation was 12.8 mo (range, 6-21 mo). The median Child-Pugh score at the onset of perforation (8.2) was significantly higher compared to the median Child-Pugh score just after RFA (6.5) (P = 0.031). All patients underwent laparotomy and direct suture of the diaphragm defect, with uneventful post-surgical recovery. Diaphragmatic perforation after RFA is not a matter that can be ignored. Clinicians should carefully address this complication by performing RFA for HCC adjacent to diaphragm.
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- 2017
31. A Case of Hepatic Angiomyolipoma With Peritumoral Hyperplasia Difficult to Differentiate From Hepatocellular Carcinoma Preoperatively
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Shogo Fukutomi, Tsutomu Kumabe, Osamu Nakashima, Nobuhisa Shirahama, Hirohisa Yano, Koji Okuda, Yoriko Nomura, Yoshito Akagi, and Hiroyuki Tanaka
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Pathology ,medicine.medical_specialty ,Unusual case ,Angiomyolipoma ,Hepatic Angiomyolipoma ,business.industry ,General Medicine ,Hyperplasia ,medicine.disease ,Benign tumor ,Hepatocellular carcinoma ,medicine ,business ,Pathological ,Preoperative imaging - Abstract
Angiomyolipoma of the liver is a well-known benign tumor, but preoperative imaging diagnosis is often difficult because of variation in the proportions of its 3 components. We report an unusual case of angiomyolipoma with the imaging and pathological findings. In a 63-year-old woman, abdomin
- Published
- 2017
32. Histological changes in patients who developed hepatocellular carcinoma after hepatitis�C virus eradication by interferon‑based therapy
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Keisuke Amano, Reiichiro Kondo, Reiichiro Kuwahara, Toshihiro Kawaguchi, Jun Akiba, Koichi Ohshima, Yoriko Nomura, Takuji Torimura, Tatsuya Ide, Hirohisa Yano, Tomoya Sano, and Teruko Hino
- Subjects
0301 basic medicine ,Cancer Research ,medicine.medical_specialty ,Hepatitis C virus ,Chronic liver disease ,medicine.disease_cause ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Immunology and Microbiology (miscellaneous) ,Interferon ,Fibrosis ,Internal medicine ,forkhead box P3 ,medicine ,chronic hepatitis C ,CD20 ,biology ,business.industry ,Cancer ,Articles ,hepatocellular carcinoma ,General Medicine ,medicine.disease ,Molecular medicine ,digestive system diseases ,030104 developmental biology ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,biology.protein ,sustained virological response ,business ,histological inflammation ,medicine.drug - Abstract
Although the incidence of hepatocellular carcinoma (HCC) occurring after hepatitis C virus (HCV) eradication has decreased, there are still reports of hepatocarcinogenesis. The present study investigated the histological changes of non-cancerous liver tissue obtained prior to interferon (IFN) therapy and after HCC development. A total of 669 HCV-infected Japanese patients who achieved sustained virological response (SVR) by IFN-based therapy were retrospectively enrolled. Of these, the present study investigated 18 patients who developed HCC after IFN-based SVR. Specimens from 9 of 18 patients were available for histological comparisons prior to IFN therapy and following HCC development. Of these 9 patients, the specimens of 5 individuals were compared via immunohistochemical staining [CD3, CD4, CD8, CD20, forkhead box P3 (FOXP3), transforming growth factor-β1 and granzyme B]. The current study included 6 control patients with HCV-associated chronic liver disease who subsequently developed HCC (non-SVR-HCC group). Mann-Whitney and Wilcoxon tests were used to compare groups. Bonferroni correction was used for multiple comparisons. P
- Published
- 2019
33. [A Case of Laparoscopic Hepatectomy and Combined Resection of Lymph Nodes and Ureter for Liver Metastasis after Colorectal Cancer Surgery, with Local Lymph Node Recurrence and Bilateral Hydronephrosis]
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Toshihiro, Sato, Hisamune, Sakai, Yuuichi, Goto, Satoki, Kojima, Yoriko, Nomura, Goichi, Nakayama, Yuusuke, Hirakawa, Kazuhiro, Mikagi, Ryuuichi, Kawahara, Hiroto, Ishikawa, Toru, Hisaka, Masafumi, Yasunaga, Hiroyuki, Tanaka, Yoshito, Akagi, and Kouji, Okuda
- Subjects
Male ,Liver Neoplasms ,Hepatectomy ,Humans ,Lymph Node Excision ,Laparoscopy ,Hydronephrosis ,Lymph Nodes ,Neoplasm Recurrence, Local ,Ureter ,Colorectal Neoplasms ,Aged - Abstract
A 65-year-old man with sigmoid colon cancer underwent sigmoidectomy, followed by 8 courses of oral S-1 as postoperative adjuvant chemotherapy. Three years and 3 months after surgery, the patient developed liver metastasis, lymphadenopathy at the root of the inferior mesenteric artery, and bilateral hydronephrosis. The left hydronephrosis was believed to be due to invasion by lymph node metastasis at the root ofthe inferior mesenteric artery. The patient underwent laparoscopic partial resection ofsegment 5 ofthe liver, excision ofthe lymph nodes at the root ofthe inferior mesenteric artery(combined resection ofthe left ureter), bilateral ureteral stent placement, and left ureteral reconstruction. The postoperative course was without complications, and he was discharged 12 days after surgery. Follow-up observation without postoperative adjuvant chemotherapy was planned, according to the patient's wishes.
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- 2019
34. Expression of Matrix Metalloproteinases in Intraductal Papillary Mucinous Neoplasm of the Pancreas
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Hisamune Sakai, Ryuichi Kawahara, Koji Okuda, Masanori Akashi, Yoriko Nomura, Toru Hisaka, Yoshito Akagi, Hirohisa Yano, Masafumi Yasunaga, Yoshiki Naito, Hiroyuki Tanaka, Jun Akiba, Hiroto Ishikawa, Fumihiko Fujita, Masahiko Tanigawa, and Yuichi Goto
- Subjects
Male ,Cancer Research ,Pathology ,medicine.medical_specialty ,Poor prognosis ,endocrine system diseases ,Pancreatic Intraductal Neoplasms ,Matrix metalloproteinase ,Disease-Free Survival ,medicine ,Humans ,Pancreas ,Aged ,Intraductal papillary mucinous neoplasm ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Optimal management ,Staining ,Gene Expression Regulation, Neoplastic ,medicine.anatomical_structure ,Oncology ,Matrix Metalloproteinase 9 ,Tumor progression ,Matrix Metalloproteinase 7 ,Immunohistochemistry ,Matrix Metalloproteinase 2 ,Female ,Matrix Metalloproteinase 1 ,business - Abstract
Background/aim Intraductal papillary mucinous neoplasm (IPMN) has a variety of histological and morphological appearances. Matrix metalloproteinases (MMPs) have been considered to be associated with tumor progression or poor prognosis. The aim of this study was to elucidate the molecular basis of IPMN variation in different types of lesions. Materials and methods The expression of MMP-1,2,7,9 in 51 cases of IPMN were investigated. The MMP score was calculated as the sum of the score of staining distribution and the score of the intensity staining. Results MMP scores were correlated with histological grade, histological subtype, and type of invasion. MMP high expression groups (MMP score ≥5) had worse prognosis than low-expression groups. Conclusion MMP expression varied between different types of IPMN, a result supporting differences in molecular basis of malignancies. These considerations may be helpful for optimal management or treatment according to various types of IPMN.
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- 2019
35. Clinical and Prognostic Significance of Neoplastic Spindle Cells in Gallbladder Cancer
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Yoshiki Naito, Hisamune Sakai, Ryuichi Kawahara, Hirohisa Yano, Ryuta Midorikawa, Masahiko Tanigawa, Jun Akiba, Hiroto Ishikawa, Yuichi Goto, Koji Okuda, Yoriko Nomura, Toru Hisaka, Yoshito Akagi, Fumihiko Fujita, Hiroyuki Tanaka, Toshihiro Sato, and Masafumi Yasunaga
- Subjects
Oncology ,Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Poor prognosis ,Surgical margin ,Epithelial-Mesenchymal Transition ,CA-19-9 Antigen ,Lymphovascular invasion ,Perineural invasion ,Kaplan-Meier Estimate ,Metastasis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Biomarkers, Tumor ,Medicine ,Humans ,Neoplasm Invasiveness ,Gallbladder cancer ,reproductive and urinary physiology ,Aged ,Tumor size ,business.industry ,Cancer ,Margins of Excision ,Epithelial Cells ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,nervous system diseases ,nervous system ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Female ,Gallbladder Neoplasms ,biological phenomena, cell phenomena, and immunity ,business - Abstract
Background/aim Neoplastic spindle cells (NSCs) are believed to play a role in cancer invasion and metastasis, as well as in poor prognosis. The clinicopathological characteristics and prognostic relevance of NSCs was investigated in gallbladder cancer. Materials and methods Specimens were obtained from 62 patients with gallbladder cancer who underwent surgery. The emergence of NSCs and their correlation with clinicopathological factors, prognosis, and EMT markers was evaluated. Results The NSC grade correlated with tumor size, preoperative CA19-9, surgical margin, the degree of differentiation, the depth of invasion, lymph node metastasis, lymphatic invasion, vascular invasion, and perineural invasion. Multivariate analysis of overall survival showed that NSCs were an independent prognostic factor. A correlation between NSCs and EMT was also suggested. Conclusion NSCs are an independent prognostic factor for patients with postoperative gallbladder cancer, which also suggests a correlation between NSCs and EMT.
- Published
- 2019
36. Intrabiliary growth type of metastasis from colon cancer, 12 years after curative colectomy: a case report
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Koji Okuda, Hisamune Sakai, Hironori Kusano, Hiroyuki Tanaka, Yoriko Nomura, Hirohisa Yano, Toru Hisaka, Osamu Nakashima, Yoshito Akagi, Nobuhisa Shirahama, Shin Sasaki, Jun Akiba, and Shogo Fukutomi
- Subjects
Male ,medicine.medical_specialty ,Pathology ,Liver tumor ,Bile Duct Epithelium ,Colorectal cancer ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,Intrabiliary growth type of metastasis ,Metastasis ,Cholangiocarcinoma ,03 medical and health sciences ,Cytokeratin ,0302 clinical medicine ,Carcinoembryonic antigen ,medicine ,Hepatectomy ,Humans ,CDX2 Transcription Factor ,Colectomy ,Aged, 80 and over ,IGM ,biology ,business.industry ,Liver Neoplasms ,lcsh:RD1-811 ,General Medicine ,medicine.disease ,Surgery ,Bile Ducts, Intrahepatic ,Liver ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,biology.protein ,030211 gastroenterology & hepatology ,business ,Tomography, X-Ray Computed - Abstract
Background Liver is a common location of colorectal metastasis, but intrabiliary growth of liver metastasis is not well recognized. Furthermore, intrabiliary metastasis that discovered over 10 years after excision has rarely been described. Case presentation An 80-year-old man was admitted due to the presence of a liver mass in segment 5 (S5) concomitant with elevated carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19–9. He underwent right hemicolectomy for colon cancer 12 years prior. Enhanced computed tomography (CT) showed dilated bile ducts with periductal enhancement in S5; hence, cholangiocarcinoma was suspected. Upon anterior segmentectomy, we observed that the cut surface of the specimen exhibited a yellowish-white tumor within the bile ducts. Histologically, the tumor formed within the papillary process, extended along the lumen, and replaced the normal bile duct epithelium. Immunohistochemical studies showed that the liver tumor and primary colon cancer were negative for cytokeratin (CK) 7 and positive for CK20 and Caudal-type homeobox transcription factor 2 (CDX-2). In addition, both tumors showed a same KRAS mutation. We diagnosed the liver tumor as liver metastasis recurrence from colon cancer. Conclusion Intrabiliary growth type of metastasis (IGM) is difficult to distinguish from cholangiocarcinoma, and sometimes develops long after surgery; thus, careful examination of a patient’s history is needed in such cases.
- Published
- 2019
37. Atherosclerosis of the right posterior hepatic artery in a patient with hilar cholangiocarcinoma undergoing left trisectionectomy: a case report of a therapeutic pitfall
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Yoriko Nomura, Toru Hisaka, Hisamune Sakai, Ryuichi Kawahara, Yoshito Akagi, Daisuke Muroya, Satoki Kojima, Syoichiro Arai, Yuichi Goto, Hiroyuki Tanaka, and Koji Okuda
- Subjects
Male ,medicine.medical_specialty ,lcsh:Surgery ,03 medical and health sciences ,0302 clinical medicine ,Hepatic Artery ,Rare case ,Multidetector Computed Tomography ,medicine ,Hepatectomy ,Humans ,Aged ,Pyogenic liver abscess ,Stenosis ,business.industry ,Arterial stricture ,General Medicine ,lcsh:RD1-811 ,Hilar cholangiocarcinoma ,medicine.disease ,Atherosclerosis ,digestive system diseases ,Surgery ,medicine.anatomical_structure ,Bile Ducts, Intrahepatic ,Bile Duct Neoplasms ,Diabetes Mellitus, Type 2 ,030220 oncology & carcinogenesis ,Right posterior ,Drainage ,030211 gastroenterology & hepatology ,Stents ,business ,Cholangiography ,Artery ,Klatskin Tumor - Abstract
Background We experienced a rare case of benign arterial stricture of the right posterior hepatic artery (RPHA) caused by atherosclerosis in a patient with hilar cholangiocarcinoma. Case presentation A 75-year-old man was referred to our hospital for the detailed investigation of serum hepatobiliary enzyme elevation. The patient had a history of hypertension, type 2 diabetes mellitus, and an operative history of coronary artery bypass grafting 10 years before. Endoscopic retrograde cholangiography found strictures of the right and left hepatic ducts with involvement of right anterior and posterior bile ducts. Adenocarcinoma was evident by brush cytology. We diagnosed these findings as hilar cholangiocarcinoma and planned left trisectionectomy including bile duct reconstruction. Although the tumor and RPHA were not adjacent, preoperative multidetector computed tomography revealed a stricture of the RPHA that was 5.6 mm in length. We suspected that atherosclerosis caused the stricture, and we performed digital subtraction angiography and intravascular ultrasonography that showed stricture of the RPHA accompanied by thick plaques in the arterial wall. We placed a bare-metal stent in the RPHA and then performed left trisectionectomy. Since this patient developed bile leakage postoperatively, percutaneous drainage was performed. The bile leakage was successfully controlled, and the patient was discharged 3 months after surgery. Unfortunately, 4 months after hepatectomy, he was re-hospitalized with multiple pyogenic liver abscesses. We performed intensive multimodal treatment for the liver abscesses and stabilized the disease; however, we eventually lost this patient due to liver failure 14 months after surgery. Conclusion To the best of our knowledge, there is no previous literature on atherosclerosis of the RPHA, which was evident preoperatively in our case. Because arterial complications may lead to critical biliary complications in patients who undergo left trisectionectomy, we first performed prophylactic arterial stent placement. We speculate that existing chronic microscopic injury of the peribiliary plexus might have caused the liver abscesses. We successfully diagnosed atherosclerosis of the RPHA preoperatively. However, further investigation of patients is warranted to determine if left trisectionectomy is contraindicated in these patients.
- Published
- 2018
38. Evaluation of Surgical Procedures for T2 Gallbladder Cancer in Terms of Recurrence and Prognosis
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Nobuhisa Shirahama, Yuichi Goto, Koji Okuda, Masanori Akashi, Hiroyuki Tanaka, Yuichirou Maruyama, Daisuke Muroya, Takahisa Shirahama, Shogo Fukutomi, Hiroyuki Horiuchi, Shyoichirou Arai, Hisamune Sakai, Ryuichi Kawahara, Hiroto Ishikawa, Masafumi Yasunaga, Yoriko Nomura, Toru Hisaka, Yoshito Akagi, and Katsuaki Takagi
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Cholecystectomy ,Neoplasm Invasiveness ,Gallbladder cancer ,Neoplasm Metastasis ,Survival rate ,Aged ,Retrospective Studies ,Gallbladder Fundus ,business.industry ,Bile duct ,Gallbladder ,Therapeutic effect ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Liver ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Resection margin ,Lymph Node Excision ,030211 gastroenterology & hepatology ,Female ,Gallbladder Neoplasms ,Bile Ducts ,Neoplasm Recurrence, Local ,business - Abstract
T2 (tumor invades perimuscular connective tissue; no extension beyond serosa or into liver) gallbladder cancer has generally been treated by S4aS5 subsegmentectomy (S4aS5 HR). We investigated the therapeutic effect of full-thickness cholecystectomy (FC) and gallbladder bed resection (GBR), in terms of tumor location and resection margin (distance from the tumor). At our department we employ the following protocol to determine the extent of resection needed to achieve R0 status: (1) A tumor located in the gallbladder fundus (Gf) or body (Gb) and only on the free peritoneal side was classified as P-type, for which full-thickness cholecystectomy and regional lymph node dissection were performed. (2) A tumor located in Gf or Gb and in contact with the liver bed was classified as H-type, for which gallbladder bed resection and regional lymph node dissection were performed. (3) A tumor located in the gallbladder neck (Gn) was classified as N-type, for which gallbladder bed resection, bile duct resection, and regional lymph node dissection were performed. Twenty-two patients admitted to our department between January 2000 and December 2014 with pT2gallbladder cancers were included in our study. Surgical procedures performed were compared with those specified in our protocol, and patients in whom the extent of resection was greater than that specified in our strategy were evaluated clinicopathologically and in terms of recurrence and the prognosis. Six (27.2%), 7 (31.8%), and 9 (40.9%) patients underwent limited, standard, and extended surgery, respectively. Ten (66.7%) of 15 patients with tumors close to the liver bed underwent cholecystectomy or extended surgery, 7 (85.7%) of 8 patients with tumors close to the bile duct underwent bile duct resection, and 16 (72.7%) of 22 patients underwent regional lymph node dissection. Recurrence at the bile duct resection margin, para-aortic lymph node metastasis, and hepatic metastasis occurred in 2, 1, and 3 patients, respectively. The 3-year survival rates (for patients including those dying of noncancer causes) were 50, 100, and 75% after limited, standard, and extended surgery, respectively. There was a significant difference in the survival rate of patients who underwent standard or extended surgery (P=0.0273). Favorable results were obtained in T2 gallbladder cancer patients without performing S4aS5 subsegmentectomy. Depending on the tumor location, neither full-thickness cholecystectomy nor gallbladder bed resection appeared to pose problems regarding recurrence or prognosis. In conclusion, surgical treatment based on our protocol, which aims to achieve the condition of R0, may result in a sufficient therapeutic effect.
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- 2017
39. Evaluation of hepatocellular carcinoma spread via the portal system by 3-dimensional mapping
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Osamu Nakashima, Koji Okuda, Hiroyuki Tanaka, Shogo Fukutomi, Hirohisa Yano, Yoriko Nomura, and Yoshito Akagi
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Male ,Patient-Specific Modeling ,Pathology ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,3d mapping ,Imaging, Three-Dimensional ,Cell Movement ,Predictive Value of Tests ,Multidetector Computed Tomography ,medicine ,Carcinoma ,Hepatectomy ,Humans ,In patient ,Neoplasm Invasiveness ,Aged ,Aged, 80 and over ,Hepatology ,Tumor size ,business.industry ,Liver Neoplasms ,Gastroenterology ,Middle Aged ,medicine.disease ,Portal System ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Cancer cell ,Radiographic Image Interpretation, Computer-Assisted ,030211 gastroenterology & hepatology ,Female ,medicine.symptom ,business - Abstract
The pattern of tumor cell spread via the portal system has not been fully clarified in patients with hepatocellular carcinoma (HCC). This study aimed to evaluate the intrahepatic distribution of cancer cells derived from the main tumor by assessing histological portal invasion and/or intrahepatic metastasis (vp/im).In 14 patients who underwent anatomical resection of primary solitary HCC ≤ 50 mm in diameter, vp/im were examined pathologically, and the sites of the lesions were reproduced on preoperative 3D-CT images. The number of vp/im and the distance of each lesion from the tumor margin were also determined.The tumor diameter was30 mm in seven patients (smaller HCCs) and 30-50 mm in seven patients (larger HCCs). 3D mapping revealed that almost all vp/im were localized to the peritumoral area within one cm of the tumor margin in smaller HCCs, whereas vp/im seemed to spread extensively to the feeding 3rd level portal branches in larger HCCs. The number of vp/im was greater in patients with larger HCCs than in those with smaller HCCs.3D mapping suggested tumor cells of HCC spread via the portal vein extensively in several cases.
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- 2017
40. Clinicopathologic analysis of the simple nodular type of well-differentiated hepatocellular carcinoma with extensive peliotic change
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Osamu Nakashima, Jun Akiba, Sachiko Ogasawara, Tsutomu Kumabe, Masayoshi Kage, Kinoshita Hisafumi, Yoriko Nomura, and Hirohisa Yano
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Pathology ,medicine.medical_specialty ,Hepatology ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Gastroenterology ,CD34 ,Magnetic resonance imaging ,HCCS ,medicine.disease ,digestive system diseases ,Hepatocellular carcinoma ,medicine ,Carcinoma ,Immunohistochemistry ,Hepatectomy ,business ,Well Differentiated Hepatocellular Carcinoma - Abstract
Background and Aim Peliosis hepatis-like blood-filled cavities are frequently observed in hepatocellular carcinoma (HCC). Peliotic change (PC) is commonly seen in moderately differentiated HCCs and rarely in well-differentiated HCCs. We conducted clinicopathological analysis of well-differentiated HCC with PC (PHCC). Methods A total of 1225 patients underwent hepatectomy at Kurume University Hospital between 1992 and 2010. Of these, 101 cases were diagnosed as well-differentiated HCC. Immunohistochemical double staining of CD34 and α smooth muscle actin was performed to examine the number and diameter of arterial blood vessels and drainage veins around tumors. We compared the clinical manifestations, histopathological features, and imaging findings of these cases. Results Seven cases of 101 well-differentiated HCCs had PC. Almost of PHCCs were macroscopically classified as the simple nodular type with a fibrous capsule, and microscopically showed thin trabecular arrangement of tumor cells and extensive dilated sinusoid-like structures filled with red blood cells. The number of arteries inside the tumor was significantly higher in PHCCs than in the simple nodular type of well-differentiated HCCs without PC. Furthermore, no significant differences were observed in the ratio of the number of irregularly shaped drainage veins around the tumor to the tumor diameter. Imaging revealed that most of the tumors had capsule-like structures and showed prolonged enhancement in the delayed phase of dynamic study of imagings. Conclusion PC is unusually observed in well-differentiated HCC and the size of PHCC was larger than that of well-differentiated HCC without PC and most are detected as a hypervascular tumor on images.
- Published
- 2014
41. Infantile hemangioma of the liver in an adult: A case report and review of the literature
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Akiko Sumi, Hirohisa Yano, Shuji Nagata, Masafumi Uchida, Toshiro Ogata, Jun Akiba, Masayoshi Kage, Yoriko Nomura, Osamu Nakashima, and Tatsuyuki Tonan
- Subjects
Gadolinium DTPA ,Cancer Research ,Pathology ,medicine.medical_specialty ,Liver tumor ,Contrast Media ,Antigens, CD34 ,Biochemistry ,Infantile hemangioma ,Genetics ,medicine ,Humans ,Vimentin ,Effective diffusion coefficient ,Molecular Biology ,medicine.diagnostic_test ,business.industry ,Liver Neoplasms ,Cancer ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Hyperintensity ,Oncology ,Molecular Medicine ,Female ,Hemangioma ,Tomography, X-Ray Computed ,business ,Liver parenchyma ,Arterial phase - Abstract
Infantile hemangioma (IH), a representative vascular liver tumor, usually occurs in infancy or early childhood but rarely in adults. In this study, we describe a case of IH in a 47-year-old female and we also review the literature. A plain computed tomography (CT) image revealed five hypoattenuating masses in the liver. A dynamic study revealed the masses appeared to be well-enhanced in the arterial phase, and were considered to be high-flow hemangiomas. The tumors appeared as hypointense tumors on the T1-weighted images and as hyperintensities on fat-suppression T2-weighted images. Following the administration of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), tumors appeared to be well-enhanced in the arterial phase. In the portal phase, tumors demonstrated isointensity compared with the surrounding liver parenchyma, and hypointensity in the equilibrium and hepatobiliary phases. The apparent diffusion coefficient (ADC) values ranged from 2.0 to 2.4x10(-3) mm2/sec. Microscopically, the tumors were composed of numerous capillary-like small vessels lined with plump endothelial cells, arranged in a single layer without mitoses, and small bile ducts were trapped and scattered within the tumor. These findings were considered to be characteristic of IH. To the best of our knowledge, this case is the third report on IH in adults.
- Published
- 2013
42. Clinicopathological features of neoplasms with neuroendocrine differentiation occurring in the liver
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Hironori Kusano, Shogo Fukutomi, Rin Yamaguchi, Hirohisa Yano, Osamu Nakashima, Yoriko Nomura, Jun Akiba, Sachiko Ogasawara, Koji Okuda, and Masayoshi Kage
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pathology ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Fluorescent Antibody Technique ,Biology ,Gastroenterology ,Neuroendocrine differentiation ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Poorly Differentiated Hepatocellular Carcinoma ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Pathological ,Aged ,Retrospective Studies ,Liver Neoplasms ,Chromogranin A ,General Medicine ,Middle Aged ,medicine.disease ,Immunohistochemistry ,digestive system diseases ,Tumor Burden ,Neuroendocrine Tumors ,Cell Transformation, Neoplastic ,030220 oncology & carcinogenesis ,biology.protein ,030211 gastroenterology & hepatology ,Female ,Liver cancer ,Immunostaining - Abstract
Background/aimsWe investigated the clinicopathological features of hepatic neuroendocrine tumours (NET) and neuroendocrine carcinoma (NEC), which remain largely unknown.Material and methodsWe examined 1235 tumours from 1048 patients who had undergone curative hepatectomy for liver neoplasms at Kurume University Hospital. Pathological diagnoses were based on the 2010 WHO Classification of Tumours of the Digestive System. We performed immunostaining for hepatocyte markers (eg, hepatocyte paraffin (HepPar)-1), neuroendocrine markers (eg, chromogranin A (CGA)) and the proliferation marker (Ki-67).ResultsThere were four cases of NET G2 (0.38%) and five of hepatic malignant tumours with an NEC component (HNEC) (0.48%). HNEC cases were classified into three types, that is, transitional, intermediate and separate types, according to their histological and immunohistochemical features. In the former two types, the NEC component intermingled with the moderately to poorly differentiated hepatocellular carcinoma (HCC) component or intermediate component consisting of tumour cells showing the colocalisation of CGA and HepPar-1. In the separate type, the NEC and poorly differentiated HCC components were present separately, whereas the sarcomatous HCC component was detected in the vicinity of the NEC component. Ki-67 labelling indices of the NET G2, HCC and NEC components of HNEC were 6.8%, 14.9% and 58.9%, respectively.ConclusionsPrimary hepatic NET and NEC are very rare tumours. The NEC component in HNEC showed high proliferative activity and influenced patient prognoses.
- Published
- 2016
43. Malignant hepatic epithelioid angiomyolipoma with recurrence in the lung 7 years after hepatectomy: a case report and literature review
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Yoshinori Kodama, Masayuki Mano, Mitsumasa Ogawara, Eiji Mita, Mitsugu Sekimoto, Koji Takami, Yoriko Nomura, Shoji Nakamori, Osamu Nakashima, Hideyasu Omiya, Jun Akiba, Hirohisa Yano, Kiyoshi Mori, and Yasunari Fukuda
- Subjects
Pathology ,medicine.medical_specialty ,Malignant potential ,Liver tumor ,Angiomyolipoma ,Lung ,business.industry ,medicine.medical_treatment ,Perivascular epithelioid cell ,Case Report ,medicine.disease ,Perivascular Epithelioid Cell ,HMB-45 ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Medicine ,030211 gastroenterology & hepatology ,Hepatic angiomyolipoma ,Hepatectomy ,business ,Epithelioid cell - Abstract
Angiomyolipoma (AML) arising in the liver is rare and usually benign, but it occasionally has malignant potential. A 58-year-old man with a liver tumor identified by a previous doctor with features suggestive of hepatocellular carcinoma on computed tomography (CT) underwent anterior segmentectomy of the liver in 2006. Microscopically, the tumor was composed of exclusively epithelioid cells that were scatteredly positive for human melanoma black 45 on immunohistochemistry. Accordingly, primary hepatic epithelioid AML (eAML) was diagnosed. The patient was subsequently referred to our hospital for follow-up after hepatectomy. He had event-free survival for nearly 7 years. In 2013, two well-defined round nodules were detected in the right lung field by chest CT, and partial pneumonectomy was performed for diagnosis and treatment. Histological examination of the resected lung tissue showed that it was morphologically and immunohistochemically identical to his primary hepatic eAML, leading to the diagnosis of pulmonary metastasis. This paper demonstrates a rare case of malignant hepatic eAML with late recurrence in the lung after hepatectomy.
- Published
- 2016
44. [A Case of Pancreatic Head Cancer Showing Pathological Complete Response to Neoadjuvant Chemoradiation Therapy]
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Yohei, Nakama, Ryuichi, Kawahara, Yoriko, Nomura, Daisuke, Muroya, Shoichiro, Arai, Hiroto, Ishikawa, Masafumi, Yasunaga, Hiroyuki, Horiuchi, Yoshito, Akagi, Hiroyuki, Tanaka, Makiko, Yasumoto, Yoshinobu, Okabe, Takuji, Torimura, Yoshiki, Naito, and Koji, Okuda
- Subjects
Pancreatic Neoplasms ,Antimetabolites, Antineoplastic ,Drug Combinations ,Oxonic Acid ,Treatment Outcome ,Humans ,Female ,Chemoradiotherapy ,Middle Aged ,Neoadjuvant Therapy ,Pancreaticoduodenectomy ,Tegafur - Abstract
The patient was a 64-year-old woman. She was referred to our institute because of a chief complaint of upper abdominal pain. Abdominal computed tomographic scan revealed a 35 mm hypovascular tumor in the pancreatic head and superior mesenteric vein (SMV), as well as thrombosis. We chose neoadjuvant chemoradiation therapy (NACRT) (S-1/RT, 50.4 Gy/28 Fr) and anticoagulants. After the treatment, the primary lesion showed a partial response, and the SMV thrombosis was reduced. We performed pancreaticoduodenectomy. Histopathological examination revealed no cancer cells in the pancreas. Pathological evaluation revealed grade Ⅳ tumor according to the Evans classification. The patient had had no recurrence for 10 months after the pancreaticoduodenectomy.
- Published
- 2016
45. Common bile duct stricture due to blunt abdominal trauma: report of two cases
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Masaya Tanaka, Satoshi Taniwaki, Hisashi Kurodai, Atsuhiro Hidaka, Ayako Mizoguchi, Akihiro Saruwatari, and Yoriko Nomura
- Subjects
medicine.medical_specialty ,Common bile duct ,medicine.diagnostic_test ,business.industry ,Bile duct ,medicine.medical_treatment ,Interventional radiology ,Hepatoduodenal ligament ,medicine.disease ,Gastroduodenal artery ,Pseudoaneurysm ,medicine.anatomical_structure ,Abdominal trauma ,Cholecystostomy ,medicine.artery ,medicine ,Radiology ,business - Abstract
We treated two cases of common bile duct stricture associated with blunt abdominal trauma. Case 1 was a 72-year-old male who was injured during farm work and he needed emergency surgery due to the intra-abdominal hemorrhage. A complete rupture of the pancreatic body and ecchymoma within the hepatoduodenal ligament were observed. Distal pancreatectomy and an external cholecystostomy were performed. Case 2 was a 62-year-old male who was injured in traffic accident. An abdominal computed tomography revealed an intra-abdominal hemorrhage, and emergency angiography was performed. A pseudoaneurysm was found in the gastroduodenal artery, and it was coiled for hemostasis. Stricture of the common bile duct was detected on Day 13 after the surgery and on Day 12 after interventional radiology respectively. Percutaneous transhepatic biliary drainage were performed and tube stent were kept in place for 6 months. It was speculated that obstruction of the blood flow may cause the bile duct stricture secondarily.
- Published
- 2010
46. Clinicopathologic analysis of the simple nodular type of well-differentiated hepatocellular carcinoma with extensive peliotic change
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Yoriko, Nomura, Osamu, Nakashima, Tsutomu, Kumabe, Jun, Akiba, Sachiko, Ogasawara, Masayoshi, Kage, Hisafumi, Kinoshita, and Hirohisa, Yano
- Subjects
Male ,Carcinoma, Hepatocellular ,Liver Neoplasms ,Humans ,Female ,Peliosis Hepatis ,Middle Aged ,Tomography, X-Ray Computed ,Magnetic Resonance Imaging ,Aged - Published
- 2015
47. Des-γ-carboxyprothrombin (DCP) and NX-DCP expressions and their relationship with clinicopathological features in hepatocellular carcinoma
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Sakiko Sanada, Akiko Sumi, Masamichi Nakayama, Toshi Abe, Hirohisa Yano, Jun Akiba, Sachiko Ogasawara, Makiko Yasumoto, Osamu Nakashima, and Yoriko Nomura
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,lcsh:Medicine ,Metastasis ,medicine ,Humans ,Protein Precursors ,lcsh:Science ,Aged ,Retrospective Studies ,Tumor marker ,Aged, 80 and over ,Multidisciplinary ,biology ,business.industry ,Liver Neoplasms ,lcsh:R ,Cancer ,Histology ,Middle Aged ,medicine.disease ,Molecular biology ,Staining ,Gene Expression Regulation, Neoplastic ,Liver ,Hepatocellular carcinoma ,biology.protein ,Female ,Prothrombin ,lcsh:Q ,Antibody ,business ,1-Carboxyglutamic Acid ,Biomarkers ,Immunostaining ,Research Article - Abstract
Aim: Des-g-carboxyprothrombin (DCP) is an abnormal prothrombin and has been used as a tumor marker of hepatocellular carcinoma (HCC). DCP has several variants based on the number of glutamic acid (Glu) residues and their positions in the γ-carboxyglutamic (Gla) domain. DCP expression in HCC tissues has been identified using MU-3 antibody which reacts strongly to DCP containing less Gla residues. Serum DCP also increases in patients with vitamin K deficiency, in which DCP containing more Gla residues (NX-DCP) elevates and can be detected using P-11 or P-16 antibody. Recently, NX-DCP-R, calculated by dividing DCP by NX-DCP, is reportedly useful for the diagnosis of HCC in such patients as taking warfarin. In this study is, we evaluated tissue DCP and NX-DCP expression in HCC. Materials and Methods: Tissue samples of HCC and non-HCC were obtained from 157 patients and were immunohistochemically examined for tissue DCP and NX-DCP expression using MU-3 antibody and P-16 antibody, respectively. Immunostain of HCC was evaluated according to staining intensity and stained area (0-1) within the tumor. The staining intensity was graded into 4 levels (0, negative; 1, weakly; 2, moderately; 3, strongly). The expression score was calculated by multiplying staining intensity grade by stained area. Additionally, serum DCP level and NX-DCP level were determined in 89 patients. We evaluated the relationship among the tissue expression, serum level, and pathomorphological findings. Additionally, immunostain of noncancerous tissues was evaluated according to the stained area. Results: DCP and NX-DCP expressions were found in 69/157 (44%) cases and 35/157 (22%) cases, respectively, in HCC tissue. The expression score of DCP [0.54 ± 0.82 (mean ± SD)] was higher than that of NX-DCP [0.15 ± 0.39]. The DCP expression score was significantly higher in the cases of non-simple nodular type, moderately-poorly differentiated type, and in the cases without capsule formation, and in those with intrahepatic metastasis (im) or portal vein invasion (vp). On the other hand, NX-DCP expression score was significantly higher in the cases of well-differentiated type, and in the cases without im. There was the correlation between serum DCP level and DCP expression score, but there was no correlation between serum NX-DCP level and NX-DCP expression score. DCP-positive (≥40 AU/L) or NX-DCP-R-positive (≥ 1.5) cases were significantly larger in tumor size, higher in histological grade and more frequent in vp than negative cases. In noncancerous liver tissues, DCP was rarely expressed, but NX-DCP was much more frequently expressed. Conclusion: An increase in tissue DCP expression, serum DCP level, and NX-DCP-R was closely related with malignant properties of HCC. In contrast, NX-DCP is less frequently expressed and showed different biological properties from DCP in HCC. Citation Format: Akiko Sumi, Jun Akiba, Sachiko Ogasawara, Masamichi Nakayama, Yoriko Nomura, Sakiko Sanada, Osamu Nakashima, Takuji Torimura, Toshi Abe, Hirohisa Yano. Des-g-carboxyprothrombin (DCP) and NX-DCP expressions and their relationship with clinicopathological features in hepatocellular carcinoma. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 880. doi:10.1158/1538-7445.AM2014-880
- Published
- 2015
48. Preoperative Computed Tomographic Diagnosis of an Aortocaval Fistula Associated with Aneurysm of the Abdominal Aorta
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Yasuyuki Zaima, Yoriko Nomura, Hiroshi Yasunaga, Takeshi Oda, Yukio Hosokawa, Takemi Kawara, and Takahiro Shojima
- Subjects
Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Aortography ,Fistula ,Aortic Diseases ,Blood Loss, Surgical ,Arteriovenous fistula ,Vena Cava, Inferior ,Preoperative care ,Inferior vena cava ,Blood Vessel Prosthesis Implantation ,Aneurysm ,Predictive Value of Tests ,medicine.artery ,Preoperative Care ,medicine ,Humans ,Aged ,medicine.diagnostic_test ,business.industry ,Abdominal aorta ,Gastroenterology ,Phlebography ,General Medicine ,medicine.disease ,Abdominal aortic aneurysm ,Surgery ,Treatment Outcome ,medicine.vein ,Arteriovenous Fistula ,cardiovascular system ,Radiology ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Aortic Aneurysm, Abdominal - Abstract
Aortocaval fistula is a rare but life-threatening complication of ruptured abdominal aortic aneurysm. We present a case of an aortocaval fistula with acute right heart failure. The condition was accurately diagnosed before operation by physical examination, echo, and especially by computed tomography (CT), thereby enabling proper planning of the operative strategy. At surgery, not only the infrarenal aorta and common iliac arteries on both sides but the inferior vena cava and iliac veins on both sides were also controlled to avoid massive venous bleeding through the fistula. Aortocaval fistula repair was easy, and conventional bifurcated Dacron graft replacement for abdominal aortic aneurysm was successfully performed. Innovative CT images give us prompt preoperative diagnoses and elaborate surgical strategies.
- Published
- 2011
49. Therapeutic efficacy of splenectomy is attenuated by necroinflammation of the liver in patients with liver cirrhosis
- Author
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Osamu Nakashima, Toshiro Ogata, Hirohisa Yano, Yoriko Nomura, Masayoshi Kage, Reiichiro Kondo, and Jun Akiba
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Pathology ,Cirrhosis ,medicine.medical_treatment ,Biopsy ,Splenectomy ,Gastroenterology ,Hypersplenism ,Hepatitis ,Necrosis ,Internal medicine ,medicine ,Humans ,Platelet ,Aged ,Retrospective Studies ,Hepatology ,business.industry ,Hepatitis C ,Middle Aged ,medicine.disease ,Treatment Outcome ,Liver ,Hepatocellular carcinoma ,Immunohistochemistry ,Surgery ,Female ,Hepatectomy ,business ,Complication ,Follow-Up Studies - Abstract
Background Splenectomy is a therapy for thrombocytopenia caused by hypersplenism with liver cirrhosis. However, the determinant of therapeutic outcomes for this complication has not yet been fully clarified. Methods We studied the laboratory findings of 55 patients who underwent splenectomy for hypersplenism with liver cirrhosis. In addition, we examined the histopathological findings of hepatosplenic tissues of nine patients who underwent hepatectomy for hepatocellular carcinoma and splenectomy for hypersplenism with liver cirrhosis on one stage surgery. The locations of platelets in hepatosplenic tissues were identified by immunohistochemistry. We used monoclonal antibody against CD41. Results Among 55 patients, 40 patients had high serum alanine aminotransferase (ALT) level (≧38 IU/l). Blood platelet count after splenectomy of patients with high serum ALT level were significantly lower than those of patients with low serum ALT level (P = 0.02). Histopathologically, platelet area of the liver tissues was positively correlated with hepatic inflammation (P = 0.02). Platelet area of the liver tissues was negatively correlated with blood platelet count after splenectomy (P = 0.03). Conclusions Hepatic inflammation contributes to the accumulation of platelets in liver; therefore, in patients with high serum ALT level, improvement of thrombocytopenia by the elimination of hypersplenism was limited.
- Published
- 2014
50. An autopsy case of refractory vasculo-Behçet's disease
- Author
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Masayoshi Kage, Yoshiaki Zaizen, Hiroaki Ida, Koki Okabe, Tomoaki Hoshino, Takaaki Fukuda, Yoriko Nomura, Seiyo Honda, and Shinjiro Kaieda
- Subjects
Adult ,Lung Diseases ,Male ,medicine.medical_specialty ,Cyclophosphamide ,business.industry ,Behcet Syndrome ,Hemorrhage ,Behcet's disease ,Disease ,medicine.disease ,eye diseases ,Surgery ,stomatognathic diseases ,Rheumatology ,Refractory ,medicine.artery ,Pulmonary artery ,medicine ,Humans ,Pulmonary hemorrhage ,Complication ,business ,Vasculitis ,medicine.drug - Abstract
Pulmonary vascular involvement in Behcet’s disease is a rare complication with a poor prognosis. We present an autopsy case of vasculo-Behcet’s disease complicated by pulmonary hemorrhage, possibly caused by rupture of pulmonary artery aneurysms. The patient was treated with a combination of high-dose steroids and pulse cyclophosphamide, but he died from massive hemoptysis. This case highlights the need for potent new therapies for patients with vasculo-Behcet’s disease refractory to conventional immunosuppressive therapy, such as a combination of steroids and cyclophosphamide.
- Published
- 2014
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