遠藤 和洋

INTRODUCTION: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. While curative resection offers the best chance for long-term survival, the high postoperative recurrence rate suggests a persistent need for effective perioperative therapies. We investigated a multimodal approach, combining sequential lenvatinib with transarterial chemoembolization (TACE), as a presurgical treatment (PST) for resectable HCC. METHODS: This retrospective study included 19 patients with technically resectable HCC who underwent the PST protocol followed by surgery between March 2022 and September 2024. The protocol involved four phases: Pre-TACE lenvatinib administration (Pre-LEN), TACE, Post-TACE lenvatinib administration, and surgery. We assessed the feasibility, safety, and pathological response of the protocol. Liver function was evaluated using the albumin-bilirubin (ALBI) score, modified ALBI (mALBI) grade, and tumor response was assessed using the Response Evaluation Criteria in Cancer of the Liver (RECICL). RESULTS: The PST protocol demonstrated high efficacy and safety. The median tumor reduction rate was 22.9%, and the median pathological tumor necrosis rate was 95%. The preoperative overall RECICL response was a complete response in 84.2% of patients. With a median follow-up of 22 months, the 2-year recurrence-free survival rate was 84.6%, and the overall survival rate was 100%. A significant association was found between mALBI grade and the decision to proceed with surgery at two time points: Pre-LEN (p = 0.023) and before surgery (p = 0.006). CONCLUSION: Presurgical sequential lenvatinib-TACE therapy is a feasible and safe strategy for resectable HCC. This protocol achieved a high pathological response and favorable survival outcomes, suggesting that it may mitigate the risk of early recurrence. Our findings highlight the importance of mALBI grade monitoring for patient selection and provide a rationale for larger, prospective studies.

INTRODUCTION: Acinar cell carcinomas are rare pancreatic neoplasms, accounting for approximately 1% of all exocrine pancreatic tumors. We describe a case of a cystic variant with intracystic hemorrhaging that was difficult to differentiate from a pseudocyst due to its morphology. CASE PRESENTATION: A 54-year-old man was admitted with severe left upper quadrant abdominal pain. Imaging studies showed a 7.0-cm internal heterogeneous cystic lesion with a splenic artery pseudoaneurysm near the lesion. Transarterial embolization of the splenic artery was performed, but rebleeding occurred 1 month later. Distal pancreatectomy with partial resection of the stomach revealed internal nodular lesions on the resected specimen. Microscopically, the cystic mass was composed of neoplastic tissue with papillary and tubular structures. The tumor was diagnosed as acinar cell carcinoma since immunohistochemical examination showed tumor cells positive for BCL10, lipase, and trypsin. The patient experienced local recurrence 6 months postoperatively, received chemotherapy with gemcitabine followed by S-1, underwent a 2nd resection at 18 months, and has remained recurrence-free for 15 years. CONCLUSIONS: Acinar cell carcinoma rarely presents with a cystic structure and may be accompanied by a pseudoaneurysm, which can complicate differentiation from a pancreatic pseudocyst, highlighting the importance of careful differential diagnosis for appropriate treatment.