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ABSTRACT: We describe six patients with non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC). From 1990 to 2001, we treated 82 patients with NASH and observed six patients (three men and three women, aged 56-72 years) in this group who were referred with HCC or developed the complication during follow-up. In five of these six patients, NASH was associated with obesity (cases 3, 4 and 5), hyperlipidemia (case 5), or diabetes mellitus (cases 1, 3 and 6). We confirmed the presence of HCC by ultrasonography-guided tumor biopsy or surgery except in case 3 where we diagnosed the tumor by ultrasonography, computed tomography and selective hepatic arteriography. The carcinomas measured 1.5-6.0 cm in diameter and three were well differentiated. When HCC was diagnosed, cirrhosis was present in all instances. Four of the six tumor patients also had esophageal varices but only one patient had a history of variceal bleeding and ascites. Treatment of HCC consisted of surgery (cases 1 and 5), transcatheter arterial embolization or infusion and/or percutaneous ethanol injection (cases 2, 3, 4, and 6). In patients with NASH cirrhosis, the development of treatable HCC is sufficiently common to warrant regular screening for this grave complication.
Journal of Hepatology 08/2002; 37(1):154-60. · 9.26 Impact Factor
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ABSTRACT: We describe the recurrence of primary biliary cirrhosis (PBC) in recipients of living liver transplants. We are not aware of similar previous reports. Because most donors for living liver transplantation (LLT) are blood relatives with close HLA matches, the recurrence of PBC in transplant recipients might offer additional insights in the pathogenesis of the condition. We studied 6 women (age, 29 to 61 years) with PBC who survived LLT for at least 1 year. Tests for antimitochondrial autoantibody (AMA), antipyruvate dehydrogenase complex-E2, immunoglobulin G (IgG) anti-M2, and IgM anti-M2 had confirmed the diagnosis. Donors were blood relatives in 5 instances, and one donor who was not a blood relative still had multiple HLA matches with the recipient. After LLT, we observed a decrease in AMA titers, but within 1 year, these titers increased again in 5 of the 6 patients to pre-LLT levels or greater. Immunoblotting analysis of the anti-M2 protein profile failed to show loss of bands and showed new bands in 3 of 6 patients. Histologically, strong evidence of recurrent PBC was found in 2 patients, and findings compatible with PBC were present in 1 additional patient. All 6 patients are doing well, without symptoms of recurrent PBC (median time post-LLT, 35.5 months; range, 12 to 50 months).
Liver Transplantation 06/2001; 7(7):588 - 595. · 3.39 Impact Factor
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ABSTRACT: We describe a 23-year-old man with protein-losing enterop-athy, iron deficiency anemia, and recurrent gastrointestinal bleeding. The patient eventually developed disseminated intra-vascular coagulation, portal vein thrombosis, and extensive small bowel infarction. The autopsy showed multiple telangiectases in the intestines, mesentery, liver, gallbladder, renal pelves, and diaphragm. In addition, lymphangiectases were found in the retroperitoneal space, intestines, and liver. These lesions appeared to have been the cause of the gastrointestinal bleeding and the protein-losing enteropathy. The case most likely represents Osier-Weber-Rendu disease without the usual manifestations in the skin and oral-nasal cavities.
(C) Lippincott-Raven Publishers.
Journal of Clinical Gastroenterology 08/1995; 21(2). · 3.16 Impact Factor
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ABSTRACT: A 3-yr-old child underwent biopsy of a nonresectable liver cell adenoma. She was well thereafter, but at the age of 22 yr, she underwent orthotopic liver transplantation because the lesion had grown. The -fetoprotein level was 4,300. The specimen showed poorly differentiated hepatocellular carcinoma in a noncirrhotic liver. At this writing, the patient is well 32 mo after transplantation. (HEPATOLOGY 1993;17:583–585.)
Hepatology 03/1993; 17(4):583 - 585. · 11.66 Impact Factor
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ABSTRACT: A 51-year-old woman underwent orthotopic liver transplantation because of a small-duct primary sclerosing cholangitis associated with chronic ulcerative colitis and a hepatoportal arteriovenous fistula. Arteriograms before liver transplantation and specimen arteriograms revealed a convolution of arteries in the right hepatic lobe which communicated with a massively dilated and partly thrombosed portal vein branch. The lesion was probably the result of a previous liver biopsy. Microscopic examination of the fistula and of specimens taken at a distance from the fistula showed prominent intimal fibroplasia of portal vein branches. The vascular changes were so severe that hepatic artery and portal vein branches closely resembled each other on routine sections. We are unaware of such a finding in other conditions and therefore believe that recognition of the described vascular abnormalities in liver biopsy specimens should lead pathologists to comment that an arterioportal fistula might be present.
Human Pathlogy 08/1989; · 2.88 Impact Factor
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ABSTRACT: Of 187 patients with severe chronic active hepatitis, 37 (20%) had antimitochondrial antibodies, usually of low titer (140). To assess the significance of this finding and to identify differentiating features from primary biliary cirrhosis, 24 of these patients were compared to two groups of matched counterparts of which one lacked antimitochondrial antibodies and one had the antibodies together with typical primary biliary cirrhosis. Higher serum levels of alkaline phosphatase and an increased frequency of stainable hepatic copper were the only features that distinguished these patients from those without antimitochondrial antibodies. The response to corticosteroids was not influenced by antibody status. Histologic interpretation differentiated primary biliary cirrhosis from antibody-positive chronic active hepatitis in 91% of instances. High antibody levels (1160), immunoglobulin M concentrations (6.0 mg/ml), alkaline phosphatase activity (fourfold normal), and cholesterol elevations (300 mg/dl) separated the syndromes in 82% of instances. Patients with laboratory features of primary biliary cirrhosis but histologic findings of chronic active hepatitis responded to corticosteroids. We conclude that low titers of antimitochondrial antibodies are common in chronic active hepatitis, and the presence of these antibodies does not preclude a satisfactory response to corticosteroids. Histologic features are more reliable than biochemical findings in differentiating the syndromes and should be the basis for diagnosis and treatment.
Digestive Diseases and Sciences 06/1986; 31(7):705-711. · 2.12 Impact Factor
