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Primary malignant fibrous histiocytoma (MFH) of the liver is reported in a 79-year-old man. The tumor, measuring 8.0 x 8.0 x 6.0 cm, was located in the left lobe of the liver and consisted of spindle cells in a storiform pattern intermingled with bizarre giant cells. Immunohistochemically, most of the tumor cells expressed vimentin. Cytoplasmic immunoreactivity for alpha 1-antichymotrypsin was documented in the giant cells. However, epithelial expression could not be demonstrated.

Rous and Larimore reported that ligation of a branch of the portal vein in rabbits resulted in atrophy of the corresponding hepatic lobe together with hypertrophy of the other lobe. Hirono, one of my collaborators, observed that experimentally produced carcinoma of the liver regressed more or less after ligation of a branch of the portal vein supplying the tumor-bearing area. Kozaka also demonstrated experimentally that occlusion of the portal blood supply to the area destined to be resected caused no serious impairment on the animals even those with liver damage. The principle of this operative procedure is ligation of the right or left branch of the portal vein supplying the affected hepatic lobe. Ligation of one branch was used for tumors confined to one hepatic lobe, and right portal branch ligation combined with lateral segmentectomy was used for multiple tumors, sparing only the middle hepatic lobe. The operation was performed in twenty patients with carcinoma of the liver. An average survival after operation is 13.6 months in 12 patients with primary carcinoma and 10.6 months in 7 patients with metastatic one excluding one patient now living over 16 years after surgery.

Portal branch ligation, a new surgical treatment for unresectable carcinoma of the liver, was performed in twenty patients. All the patients tolerated the procedure, and morbidity and mortality were minimal, even in patients in poor general condition. The responses to ligation differed considerably, but significant palliation was attained in some patients and one survived six years. The effect of portal branch ligation on the tumor appears to be closely related to the degree of tumor vascularity, tumor malignancy, and portal circulatory disturbances such as cirrhosis, portal hypertension, or portal thrombosis. We believe that the present procedure can be recommended for clinical application in some patients with unresectable carcinoma of the liver.

Effects of chemotherapy on twenty-nine histologically proved and alpha-fetoprotein (AFP) -positive hepatomas were evaluated by changes in serum AFP levels according to the criteria of our previous report. By transfemoral local infusion of mitomycin C, six of eight patients showed more than 50 per cent decrease of AFP levels and regression of the tumor, and the others showed fair effects. By single shot infusion, 50 per cent decrease of serum AFP levels and tumor regression were noted only in three of thirteen patients, and chemotherapy by systemic infusion in eight patients was much less effective. As evaluated by AFP levels, histologically well or moderately differentiated hepatocellular carcinomas responded better to chemotherapy than poorly differentiated ones.

Quantitative determinations of serum alpha-fetoprotein (AFP) in 96 patients with hepatomas have demonstrated three main groups based on changes in the serial levels: 1) patients with more than 10 000 ng/ml during most of their clinical course, and with an increase of 10 000 ng/ml or more in a week (Group A); 2) patients with levels varying from 200 to 10 000 ng/ml and with an increase of 1000 ng/ml in three to four months (Group B); and 3) patients with serum AFP level below 200 ng/ml during most of their clinical course (Group C). The patients in Group A had a mean survival time of 7.62 +/- 3.97 months, and those in Group B, 16.18 +/- 12.18 months. The patients in Group C were subdivided into two groups according to whether survival time was long (33.92 +/- 28.22 months) or short (3.75 +/- 0.87 months). Histologic findings revealed poorly differentiated carcinoma in patients in Group A, moderately differentiated carcinoma in those in Group B, and well differentiated carcinoma in those with long survival in Group C and anaplastic carcinoma in those with short survival in Group C.