Taehan Kan Hakhoe chi = The Korean journal of hepatology最新文献

Primary hepatic leiomyosarcoma is a very rare malignant tumor of the liver and rather slowly progressing disease. When the tumor is solitary or even multiple but located in one lobe, the treatment of choice is an operation. We report a case of huge leiomyosarcoma in a 58-year old female patient treated by surgical resection.

Hepatocellular carcinoma is one of the most common causes of death in Koreans. Most cases of hepatocellular carcinoma are beyond the stage of curative resection at the time of diagnosis due to extrahepatic metastasis as well as wide distribution of tumor in the liver. The lung is the most common site of extrahepatic metastasis but metastasis to gingiva is very rare in hepatocellular carcinoma. We report a case hepatocellular carcinoma with gingival metastasis in a 59 year old male patient.

Background/aims: Long-term lamivudine therapy can induce the emergence of lamivudine resistant hepatitis B virus (HBV) mutants. Clinically emergence of the mutant is expressed by the reappearance of disappeared HBV DNA in serum. Continued lamivudine treatment has been usually recommended in cases of viral breakthrough. However, the clinical outcome in patients with viral breakthrough is not clear. The aim of this study was to investigate the clinical course of chronic hepatitis B patients after viral breakthrough during lamivudine therapy.

Methods: A total of 74 patients with chronic hepatitis B who showed viral breakthrough after at least 6 months of lamivudine treatment were included in this study. They had positive HBeAg and HBV DNA before treatment. The median follow-up duration after breakthrough was 13 months.

Results: After viral breakthrough, only 8 patients (11%) maintained normal ALT levels and 66 patients (89%) showed elevation of ALT. 30 patients (41%) showed acute exacerbation of hepatitis (ALT increase over five-times upper normal limit). These acute exacerbations occurred within three months after breakthrough in 19 patients (63%). In the cases of acute exacerbation, 6 patients showed decompensated progression such as elevation of serum total bilirubin. One of them died of hepatic failure. A predictive factor for acute exacerbation was not found. HBeAg seroconversion occurred in 8 patients after viral breakthrough but their clinical course was highly variable.

Conclusions: Chronic hepatitis B patients who had viral breakthrough during lamivudine therapy should be followed carefully and regularly in mind of potential clinical deterioration. New strategies are needed to manage the cases of acute exacerbation after viral breakthrough.

Background/aims: [18F]FDG-PET is a functional imaging modality reflecting cellular glucose metabolism. In most malignant cells, accumulation and trapping of [18F]FDG allows the visualization of increased uptake compared with normal cells. The aim of this study was to assess the value of PET in differentiating benign from malignant hepatic lesions and to determine in which types of hepatic tumors PET can help evaluate stage, monitor response to therapy, and detect recurrence.

Methods: Eighty patients with liver lesions were enrolled (hepatocellular carcinoma 34, cholangiocarcinoma 8, metastatic liver cancer 25, hemangioma 6, liver abscess 7). Liver metastases were 22 adenocarcinoma, 2 lymphoma, 2 squamous cell carcinoma. The PET images of these patients were analyzed. SUV and lesion-to-normal liver background SUV ratio were obtained and compared among the disease groups.

Results: All liver metastases and all cholangiocarcinomas had increased uptake value, with SUV ratios greater than 2. Hepatocellular carcinoma had SUV ratios greater than 2 in 20 of 34 patients (59%). All hemangiomas had poor uptake, a SUV ratio of less than 2. All liver abscesses showed definite uptake.

Conclusions: The PET technique using FDG static imaging was useful in differentiating malignant from benign lesions of the liver in limited situations. Limitations included false negative results in some patients with hepatocellular carcinoma. Liver abscesses raised problems in differential diagnosis from malignant liver tumors. The findings of this study suggest that the PET technique might be applied in tumor staging and the detection of recurrence, as well as monitoring responses to therapy for all adenocarcinomas and some hepatocellular carcinomas.

Nodular hepatic involvement of multiple myeloma is very rare. We report a case of nodular hepatic involvement of multiple myeloma, mimicking hypervascular hepatocellular carcinoma.

Background/aims: Apolipoprotein E (Apo E) is important in plasma lipid metabolism and is a component of several plasma lipoprotein-lipid particles. Three major Apo E isoforms are encoded by three common allelic forms, epsilon2, epsilon3, and epsilon4 at the APO E locus. The goal of this study was to examine the association between polymorphisms in the apolipoprotein E gene (APOE) and fatty liver disease.

Methods: We examined the distribution of APOE alleles from 116 fatty liver patients and 50 controls in Korea.

Results: The frequencies of APOE alleles in fatty liver patients were 6.5% in epsilon2, 85.7% in epsilon3 and 7.8% in epsilon4. The corresponding frequencies in control subjects were 4.0% in epsilon2, 91.0% in epsilon3 and 5.0% in epsilon4. There were no significant differences in the distribution of APOE genotypes between fatty liver patients and controls. APOE epsilon2 and epsilon4 allele frequencies in fatty liver patients were more than those in controls. However, there was no significant differences in APOE epsilon2 and epsilon4 allele frequencies.

Conclusions: These results suggest that APOE alleles seem not to be directly associated with the pathogenesis of fatty liver disease.

Background/aims: Hepatitis B virus (HBV) is the etiological factor for hepatocellular carcinoma (HCC). Numerous evidence has indicated a link between chronic infection with HBV and the development of HCC. Among the four proteins encoded by HBV, Hepatitis B virus X gene(HBx), best characterized as a transcriptional transactivator, gained attention owing to its presumptive role in oncogenesis. Further, HBx has been shown to stimulate signal transduction pathways such as Ras-MAPK pathway, NF-kappa B, and Src kinase. The pleiotropic events caused by HBx may be the key to understanding the HBV-mediated oncogenicity. However, the specific roles of HBx in oncogenesis remain largely elusive. To explore the role of HBx in hepatocarcinogenesis, we examined the deregulation of host genes induced by HBx expression.

Methods: HBx was ectopically expressed in HepG2 cells using a recombinant adenovirus to transiently express HBx. Gene expression profiling of HBx was conducted on cDNA microarrays that contained 1,028 cDNAs.

Results: A number of oncogenes and genes that are involved in cell growth, DNA repair, cell cycle regulation, and cell motility were deregulated by HBx.

Conclusions: Theses results suggest that HBx regulates transcription in a way that contributes to the proliferation of hepatocytes, a probable early event of HCC.

Background/aims: Long-term efficacy and the rate of viral breakthrough in patients with HBeAg- negative chronic hepatitis B receiving lamivudine therapy is uncertain. This study was conducted to determine the rate of viral breakthrough according to the HBeAg status and the relation of viral breakthrough with YMDD mutants.

Methods: Two hundred and five patients with HBeAg-positive and 49 patients with HBeAg-negative chronic hepatitis B, who had received lamivudine for at least 9 months, were included. The mean durations of the lamivudine treatment were 176 months and 155 months in HBeAg-positive and negative patients, respectively. Analysis of HBV genome for YMDD mutations was performed by restriction-fragment-length polymorphism assay and direct sequencing.

Results: While the cumulative rates of viral breakthrough at 12th and 24th months of the lamivudine therapy were 0% and 7% in the HBeAg-negative group, they were 12% and 39% in the HBeAg-positive group. The cumulative rate of viral breakthrough in the HBeAg-negative group was significantly lower than in the HBeAg-positive group (p<0.01). In multivariate analysis, the only significant factor related to viral breakthrough was the HBeAg status (p<0.05). The YMDD mutants were detected in all patients with viral breakthrough irrespective of HBeAg status. However, in patients without viral breakthrough, the rate of YMDD mutants was significantly higher in the HBeAg-negative group than in the HBeAg-positive group (13.3% vs 5.1%; p<0.01).

Conclusions: Lamivudine is expected to be more persistently effective in HBeAg-negative chronic hepatitis B because of a lower viral breakthrough rate than in HBeAg-positive chronic hepatitis B in spite of the emergence of YMDD mutants.

Background/aims: The first episode of variceal bleeding is one of the most frequent causes of death in patients with liver cirrhosis. The Child-Pugh(CP) scoring system has been widely accepted for prognostic assessment. Recently, MELD has been known to be better than the CP scoring system for predicting mortality in patients with end-stage liver diseases. The Rockall risk scoring system was developed to predict the outcome of upper GI bleeding including variceal bleeding. The aim of this study was to investigate the mortality rate of first variceal bleeding and the predictability of each scoring system.

Methods: We evaluated the 6-week mortality rate, rebleeding rate, and 1-year mortality rate of all the 136 patients with acute variceal bleeding without previous episode of hemorrhage between January 1, 1998 and December 31, 2000. The CP score, MELD score, and Rockall score were estimated and analyzed.

Results: Among 136 patients, 35 patients with hepatoma and 8 patients with follow-up loss were excluded. Six-week mortality rate, 1-year mortality rate, and rebleeding rate of first variceal bleeding were 24.7%, 35.5%, and 12.9%, respectively. The c-statistics of CP, MELD, and Rockall score for predicting 6-week mortality rate were 0.809 (p<0.001, 95% CI, 0.720-0.898), 0.804 (p<0.001, 95% CI, 0.696-0.911), 0.787 (p<0.001, 95% CI, 0.683-0.890), respectively. For 1-year mortality rate, c-statistics were 0.765 (p<0.005, 95% CI, 0.665-0.865), 0.780 (p<0.005, 95% CI, 0.676-0.883), 0.730 (p<0.01, 95% CI, 0.627-0.834), respectively.

Conclusion: The CP, MELD, and Rockall scores were reliable measures of mortality risk in patients with first variceal bleeding. The CP classification is useful in its easy applicability.

Background/aims: Protein induced by vitamin K absence or antagonist II (PIVKA-II) appears to be a useful tumor marker for the evaluation of patients with hepatocellular carcinoma (HCC). But the usefulness of PIVKA-II was not yet clear in Korea where hepatitis B-virus is endemic. We investigated the usefulness of PIVKA-II in the diagnosis and follow-up after treatment of HCC.

Methods: We studied patients with HCC which was pathologically confirmed. PIVKA-II was measured by enzyme immunoassay. PIVKA- levels before and after treatment, in correlation with imaging studies, were analyzed for the comparison of treatment responses. Kappa index was obtained.

Results: A total of 129 patients were included. 93 patients (72%) were HBsAg positive. 86 patients (67%) were PIVKA-II >40 mAU/mL. 52 patients (40%) were AFP >20 ng/mL and 77 patients (60%) were AFP < or = 20 ng/mL. Of 77 patients, 40 patients (52%) showed PIVKA-II >40 mAU/mL. 68 of 129 patients were evaluated treatment response. On the basis of radiologic response, CR was 33, PR 17, SD 12, and PD 6. Of the 33 radiologic CR patients, 30 patients were CR and 3 patients were PR by means of PIVKA-II response. Of the 17 radiologic PR patients, 6 patients were CR and 7 patients were PR. Therefore, tumor responses by radiologic and PIVKA-II were well correlated (Kappa index was 0.59).

Conclusions: PIVKA-II can be used as a useful tumor marker for patients with HCC, especially those with low levels of AFP, before and after treatment in Korea.