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Tsalikidis C, Mitsala A, Pappas-Gogos G, Romanidis K, Tsaroucha AK, Pitiakoudis M. Pedunculated Focal Nodular Hyperplasia: When in Doubt, Should We Cut It Out? J Clin Med 2023; 12:6034. [PMID: 37762973 PMCID: PMC10532121 DOI: 10.3390/jcm12186034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Focal nodular hyperplasia (FNH) is the second most common benign hepatic tumor and can rarely present as an exophytic solitary mass attached to the liver by a stalk. Most FNH cases are usually detected as incidental findings during surgery, imaging or physical examination and have a high female predominance. However, the pedunculated forms of FNH are particularly rare and commonly associated with severe complications and diagnostic challenges. Hence, our study aims to provide a comprehensive summary of the available data on the pedunculated FNH cases among adults and children. Furthermore, we will highlight the role of different therapeutic options in treating this clinical entity. The use of imaging techniques is considered a significant addition to the diagnostic toolbox. Regarding the optimal treatment strategy, the main indications for surgery were the presence of symptoms, diagnostic uncertainty and increased risk of complications, based on the current literature. Herein, we also propose a management algorithm for patients with suspected FNH lesions. Therefore, a high index of suspicion and awareness of this pathology and its life-threatening complications, as an uncommon etiology of acute abdomen, is of utmost importance in order to achieve better clinical outcomes.
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Affiliation(s)
- Christos Tsalikidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Athanasia Mitsala
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - George Pappas-Gogos
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Konstantinos Romanidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
| | - Alexandra K. Tsaroucha
- Laboratory of Experimental Surgery & Surgical Research, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece
| | - Michail Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.); (G.P.-G.); (K.R.); (M.P.)
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Parmeggiani A, Baldazzi M, Carfagnini F, Vivacqua D, Golfieri R, Lovato L, Greco L. Extensive solitary lymphatic malformation of the liver in a child: a case report and literature review. Radiol Case Rep 2022; 17:427-433. [PMID: 34917222 PMCID: PMC8666449 DOI: 10.1016/j.radcr.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
Intrabdominal lymphatic malformations are rare benign congenital vascular anomalies that account for less than 5% of benign masses in childhood, with an extremely variable clinical presentation. For this reason, although their radiological appearance is usually typical, diagnosis can be challenging and not always immediate. This report describes a unique case of extensive solitary hepatic lymphatic malformation in a 10-year-old boy with both extra- and intraparenchymal development with no associated symptoms. A literature review of reported cases of solitary hepatic lymphatic malformation is also included.
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Affiliation(s)
- Anna Parmeggiani
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Michelangelo Baldazzi
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Filomena Carfagnini
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Donatella Vivacqua
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Luigi Lovato
- Cardio-Thoracic Radiology Unit, Cardio-Thoracic-Vascular Department, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Laura Greco
- Pediatric Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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3
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Long X, Zhang L, Cheng Q, Chen Q, Chen XP. Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review. World J Clin Cases 2020; 8:4633-4643. [PMID: 33083428 PMCID: PMC7559670 DOI: 10.12998/wjcc.v8.i19.4633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/03/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatic lymphangioma, a malformation of the liver lymphatic system, is a rare benign neoplasm and usually coexists with other visceral lymphangiomas. Solitary hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as malignancy.
CASE SUMMARY A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with, including Schistosome japonicum infection and jaundice, and also together with imaging results, which showed the mass enhanced quickly in the arterial phase and faded fast in the venous phase. The patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for operation. Finally, the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the operation. The pathological examination indicated the mass as hepatic lymphangioma. The patient has been followed up for 30 mo without recurrence. To raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future, we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms, imaging presentation, operative techniques, histology features and prognosis.
CONCLUSION Solitary hepatic lymphangioma mimicking malignancy makes diagnosis difficult. Complete surgical resection is the first choice to treat solitary hepatic lymphangioma.
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Affiliation(s)
- Xin Long
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Qi Cheng
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Qian Chen
- Endoscopic Unit, Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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4
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Badea R, Meszaros M, Al Hajjar N, Rusu I, Chiorean L. Benign nodular hyperplasia of the liver-pedunculated form: diagnostic contributions of ultrasonography and consideration of exophytic liver tumors. J Med Ultrason (2001) 2014; 42:97-102. [PMID: 26578496 DOI: 10.1007/s10396-014-0564-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/03/2014] [Indexed: 12/12/2022]
Abstract
Focal nodular hyperplasia (FNH) is an asymptomatic benign liver tumor that may be detected accidentally during an abdominal ultrasound examination; it is associated with unspecific complaints, sometimes painful. Diagnosis can be precise using imaging techniques like ultrasonography. The diagnostic criteria are represented by the spatial display of the tumoral vessels and their hemodynamic characteristics. Sometimes differential diagnostic issues occur with other benign or malignant liver tumors. We present the case of a young female patient without a personal pathological history, who complained of intense, diffuse, intermittent, non-systematic abdominal pain and who underwent ultrasound examination, followed by contrast-enhanced ultrasound. With this technique, we evidenced a solid extrahepatic tumor, which was mobile at the patient's change of position and had the hemodynamic features of FNH. The article also tackles the problem of intra-abdominal pedunculated tumors.
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Affiliation(s)
- Radu Badea
- Department of Ultrasonography, Medical Clinic 3, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Magdalena Meszaros
- Department of Gastroenterology, Medical Clinic 3, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, Cluj Napoca, Romania.
| | - Nadim Al Hajjar
- Department of Surgery, Medical Clinic 3, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, Str. Croitorilor 19-21, 400 162, Cluj Napoca, Romania
| | - Ioana Rusu
- Department of Pathology, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, Cluj Napoca, Romania
| | - Liliana Chiorean
- Department of Ultrasonography, Medical Clinic 3, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
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Liu Q, Sui CJ, Li BS, Gao A, Lu JY, Yang JM. Solitary hepatic lymphangioma: a one-case report. SPRINGERPLUS 2014; 3:314. [PMID: 25279280 PMCID: PMC4169228 DOI: 10.1186/2193-1801-3-314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 06/17/2014] [Indexed: 02/07/2023]
Abstract
Hepatic lymphangiomas, malformations of the liver lymphatic system, are extremely rare conditions in adults. A 41-year-old man presented with right upper abdominal pain for 6 months was introduced in this report. Ultrasound (US) and computed tomography (CT) scan demonstrated a giant cystictumor with a pedunculatedextrahepatic growth pattern. Due to diagnostic uncertainty, a partial hepatectomy was performed and pathological results confirmed the diagnosis of solitary hepatic lymphangioma. In this article, we reviewed the clinical and pathology features, preoperative diagnostic challenges, and treatments of hepaticlymphangiomas.
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Affiliation(s)
- Qu Liu
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China ; Department of Hepatobiliary Surgery, People's Republic of China No. 254 Hospital, Tianjin, 300142 China
| | - Cheng-Jun Sui
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China
| | - Bao-Shan Li
- Department of Hepatobiliary Surgery, People's Republic of China No. 254 Hospital, Tianjin, 300142 China
| | - Ang Gao
- Department of Hepatobiliary Surgery, People's Republic of China No. 254 Hospital, Tianjin, 300142 China
| | - Jian-Yue Lu
- Department of Hepatobiliary Surgery, People's Republic of China No. 254 Hospital, Tianjin, 300142 China
| | - Jia-Mei Yang
- Department of Special Treatment, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China
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Choi WJ, Jeong WK, Kim Y, Kim J, Pyo JY, Oh YH. MR imaging of hepatic lymphangioma. THE KOREAN JOURNAL OF HEPATOLOGY 2012; 18:101-4. [PMID: 22511911 PMCID: PMC3326998 DOI: 10.3350/kjhep.2012.18.1.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Woo Jung Choi
- Department of Radiology, Hanyang University Guri Hospital, Hanyang Univeristy College of Medicine, Guri, Korea
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Gonidec S, Guibal A, Pilleul F. [Solitary hepatic lymphangioma of the adult: MRI findings]. JOURNAL DE RADIOLOGIE 2011; 92:729-31. [PMID: 21819916 DOI: 10.1016/j.jradio.2010.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 08/28/2010] [Accepted: 08/31/2010] [Indexed: 01/18/2023]
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Matsumoto T, Ojima H, Akishima-Fukasawa Y, Hiraoka N, Onaya H, Shimada K, Mizuguchi Y, Sakurai S, Ishii T, Kosuge T, Kanai Y. Solitary hepatic lymphangioma: report of a case. Surg Today 2010. [PMID: 20740355 DOI: 10.1007/s00595-010-4255.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A 52-year-old woman presented with upper abdominal pain. Abdominal ultrasonography showed a 4-cm well-defined mass containing solid and cystic components in segment IV of the liver, and contrast-enhanced T1-weighted magnetic resonance imaging revealed heterogeneous enhancement within the tumor, indicating a solid or fibrous component. There were no cystic lesions in any other organs. A partial hepatectomy was performed, based on a preoperative diagnosis of sclerosing hemangioma and biliary cystadenoma or cystadenocarcinoma. Pathologically, the tumor appeared to be a multilocular and cystic lesion lined by attenuated endothelial- like cells with no atypia. Immunohistochemistry demonstrated the endothelial-like cells to be positive for the lymphatic-specific markers D2-40, LYVE-1, and Prox-1, which proved helpful for confirming the diagnosis as solitary hepatic lymphangioma. This case is presented with details of the pathologic and radiologic findings, because solitary hepatic lymphangioma is an extremely rare tumor and no previous reports have provided details of the immunohistochemical characteristics.
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Affiliation(s)
- Takuya Matsumoto
- Pathology Division, National Cancer Center Hospital, Tokyo, Japan
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9
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Solitary hepatic lymphangioma: report of a case. Surg Today 2010; 40:883-9. [PMID: 20740355 DOI: 10.1007/s00595-010-4255-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 01/12/2010] [Indexed: 12/16/2022]
Abstract
A 52-year-old woman presented with upper abdominal pain. Abdominal ultrasonography showed a 4-cm well-defined mass containing solid and cystic components in segment IV of the liver, and contrast-enhanced T1-weighted magnetic resonance imaging revealed heterogeneous enhancement within the tumor, indicating a solid or fibrous component. There were no cystic lesions in any other organs. A partial hepatectomy was performed, based on a preoperative diagnosis of sclerosing hemangioma and biliary cystadenoma or cystadenocarcinoma. Pathologically, the tumor appeared to be a multilocular and cystic lesion lined by attenuated endothelial- like cells with no atypia. Immunohistochemistry demonstrated the endothelial-like cells to be positive for the lymphatic-specific markers D2-40, LYVE-1, and Prox-1, which proved helpful for confirming the diagnosis as solitary hepatic lymphangioma. This case is presented with details of the pathologic and radiologic findings, because solitary hepatic lymphangioma is an extremely rare tumor and no previous reports have provided details of the immunohistochemical characteristics.
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10
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Shahi KS, Geeta B, Rajput P. Solitary hepatic lymphangioma in a 22-day-old infant. J Pediatr Surg 2009; 44:E9-11. [PMID: 19635291 DOI: 10.1016/j.jpedsurg.2009.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 04/02/2009] [Accepted: 04/04/2009] [Indexed: 01/22/2023]
Abstract
Lymphangiomas are congenital malformations of the lymphatic system composed of dilated endothelial lined spaces of varying sizes containing lymph. Hepatic lymphangioma is a rare finding, exclusively present in children and adolescents. Most reported cases occur as part of diffuse lymphangiomatosis. Solitary lymphangioma of the liver in infants is extremely rare. This report describes a case of unilocular, solitary hepatic lymphangioma in a 22-day-old infant.
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Affiliation(s)
- Kedar Singh Shahi
- Department of Surgery, U.F.H.T. Medical College, Haldwani (Nainital), India.
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12
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Abstract
AIM Liver cysts in children are uncommon. Many are simple and solitary and do not require intervention. However, this series demonstrates a broad range of potential pathologies, some of which are life-threatening. METHODS All children referred to our unit during an 8-year period (1998-2005) and found to have a solitary liver cyst were prospectively recorded. Clinical, radiologic, and pathologic features were analyzed. Children with an isolated extrahepatic choledochal cyst and polycystic disease were excluded. RESULTS Twenty-one children with a liver cyst were identified. Two had undergone unsuccessful surgical intervention before referral. There were 11 prenatally detected cysts. Median gestational age at detection was 22 weeks (19-35 weeks); only 1 was specifically characterized as a liver cyst prenatally. Six of these required surgery: 2 large simple cysts, 2 intrahepatic choledochal cysts, 1 giant complex biliary cyst causing respiratory distress, and 1 ciliated hepatic foregut cyst. Of the 5 cysts remaining under ultrasound surveillance, 4 decreased in size or resolved. In 10 children presenting between birth and 15.8 years, a liver cyst was diagnosed postnatally: 3 huge cystic mesenchymal hamartomas, 1 type V choledochal cyst, 1 hydatid cyst, and 5 simple cysts. Four of these required surgical resection. Simple cysts tended to be small and could be distinguished from other pathologies using a combination of imaging techniques (ultrasound, magnetic resonance imaging/magnetic resonance cholangiopancreatography [MRCP], radionuclide scan). Only 2 of 12 children with "simple" cysts required surgery for symptoms. However, a wide range of other cyst pathologies were found in 9 children, and although none was malignant, some were life-threatening and 7 required resection. CONCLUSIONS Simple solitary nonparasitic liver cysts rarely cause symptoms or require surgery, but the pediatric surgeon should be aware of the wide range of other types of liver cyst in children to ensure appropriate treatment.
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Affiliation(s)
- Tim N Rogers
- Children's Liver and GI Unit, Gledhow Wing, St. James's University Hospital, LS9 7TF Leeds, UK
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Allen JG, Riall TS, Cameron JL, Askin FB, Hruban RH, Campbell KA. Abdominal lymphangiomas in adults. J Gastrointest Surg 2006; 10:746-51. [PMID: 16713549 DOI: 10.1016/j.gassur.2005.10.015] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 10/19/2005] [Indexed: 01/31/2023]
Abstract
Abdominal lymphangiomas are rare benign cystic tumors that can become locally invasive and often require resection. They arise in all ages and have a variable presentation. We performed a retrospective review of a single institution surgical experience with this lesion in adults. The pathology prospective database was reviewed to identify patients with surgically resected abdominal lymphangiomas from January 1986 to May 2004. Retrospective review and follow-up was performed for each patient. The six patients with abdominal lymphangiomas ranged in age from 38 to 66 years. They presented with a variety of signs and symptoms. All underwent CT scan that demonstrated a cystic lesion, but in only one third was the diagnosis made preoperatively. Tumors were located in the retroperitoneum, small bowel mesentery, liver, and pancreas. Five of the six tumors were completely resected. Two of the six required resection of adjacent or involved organs. Follow-up ranged between 6 months and 18 years. All had symptomatic relief after resection, and no patient showed evidence of recurrence in this time period. Abdominal lymphangiomas are rare. The correct diagnosis often remains elusive until tissue is obtained. The treatment of choice is complete surgical resection. When completely resected, these lesions seem not to recur, and the overall prognosis is excellent.
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Affiliation(s)
- J Geoff Allen
- Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA
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Abstract
Hepatic lymphangioma is an extremely rare benign neoplasm that is usually associated with lymphangiomas of other viscera. We report a patient with huge, solitary hepatic lymphangioma involving only the liver. The clinical features and computed tomography findings of this case are described.
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Affiliation(s)
- S C Chan
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, Taiwan
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Abstract
A rare case of a lymphangioma of the falciform ligament in a child is described. He presented with abdominal pain and was found to have an unusual intraabdominal mass. Resection was curative.
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Affiliation(s)
- Katherine Morgan
- Division of Pediatric Surgery, Emory University, Atlanta, GA, USA
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Affiliation(s)
- Julian E Losanoff
- Department of Surgery, School of Medicine, University of Missouri-Columbia, One Hospital Drive, Columbia, MO 65212, USA
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