C 型肝炎患者に対するインターフェロン療法後の肝発癌についての検討

目的：C型慢性肝炎患者に対するインターフェロン(IFN)療法後の肝発癌について検討した．方法：C型慢性肝炎に対してIFN療法が施行された180例を対象とした．非発癌群と発癌群の間で，治療前の背景因子と半年後のウイルス学的著効(SVR24)の有無，治療後のALT，AFPについて比較した．また，それぞれの因子別に発癌曲線を作成して発癌率を比較した．結果：IFN治療によるSVR24の達成率は68.9％(124/180)であり，36.3ヶ月の観察期間で全体の発癌率は2.3％(5/180)であった．発癌群では非発癌群に比べ，高齢者，男性，SVR24非達成例，ALT高値例が多い傾向にあった．治療後のALT高値，AFP高値例は発癌が多かったが，特にAFPでは統計学的な有意差を認めた．結論：IFN治療前の線維化進展例と高齢者，男性，治療後ALT高値，AFP高値は肝発癌率が高い傾向にある．特に治療後AFP高値は肝発癌予測因子になる

Infliximab 治療中のクローン病にStreptococcus intermedius による肝膿瘍と膿胸を合併した1例

症例は31歳女性．クローン病再燃に対して抗TNF-α抗体製剤であるInfliximab治療中に，Streptococcus intermediusによる肝膿瘍と膿胸を発症し，治療に難渋するも抗菌薬治療，経皮経肝膿瘍ドレナージにて軽快した．Infliximab投与は，易感染性により様々な感染症を合併する可能性があるが，肝膿瘍の合併は非常にまれながら診断・治療の遅れが重篤になりやすく注意が必要である

A Case of Hemangiosarcoma of the Liver which led to a Diagnosis with Hemoptysis

Angiosarcoma is a vascular endothelium-derived malignant tumor that arises in blood vessel walls, accounting for only 2.3% of soft tissue sarcomas in adults. Primary hepatic angiosarcoma(PHA)is rare, comprising< 5% of all angiosarcomas. We report a case of PHA in a 61-year-old man evaluated by another clinic around our hospital for a chief complaint of hemoptysis in May 2012. Chest computed tomography(CT) showed abnormal shadows in bilateral lung fields, so he was referred to Department of Respiratory Medicine at our hospital in late July. However, no definitive diagnosis was not made, even after bronchoscopy. In mid-August, he presented to the outpatient clinic of the respiratory department with a chief complaint of right-sided abdominal pain. Abdominal CT showed a liver lesion, and he was urgently admitted to our department. Initial physical examination was unremarkable except for palpable liver in the right hypochondrium. Tumor markers for liver and biliary cancers were all within normal limits, and negative results were obtained for hepatitis B and C virus. CT, ultrasonography, and(MRI)identified a large lesion replacing the right hepatic lobe and medial segment of the left hepatic lobe. Hemangioma or hepatic angiosarcoma was suspected, accompanied by intraperitoneal rupture. Transcatheter arterial embolization was attempted, but had to be discontinued, and the patient died from hemorrhagic shock due to tumor rupture after onset of abdominal pain. The PHA which assumes hemoptysis primary symptom is extremely rare, and by reports for the past ten years searched using PubMed, this is the second report in the world