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Vanigli N, Melotti L, Dussias N, Sanna Passino A, Mazzotta E, De Molo C, Gentilini L, Poggioli G, Gionchetti P, Rizzello F. The contribution of ultrasound in the diagnostic pathway of a symptomatic hepatocellular adenoma arising from ectopic liver. J Ultrasound 2024:10.1007/s40477-024-00872-1. [PMID: 38393453 DOI: 10.1007/s40477-024-00872-1] [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: 11/18/2023] [Accepted: 01/08/2024] [Indexed: 02/25/2024] Open
Abstract
Ectopic liver (EL) is a rare congenital anomaly characterized by the presence of a mass composed of hepatic tissue localized in a different anatomical location with no connection to the native liver. Usually an incidental finding, EL can rarely cause symptoms such as abdominal pain due to torsion, intraperitoneal bleeding, compression, obstruction, or neoplastic transformation, both benign and malignant. EL is often suspected after instrumental investigations such as ultrasound, CT and MRI, however a definitive diagnosis is necessarily bioptic. Here we report a case of a 22-year-old Italian female patient with acute abdominal pain, who underwent abdominal ultrasound, CEUS with Sonovue®, CT scan and ultrasound-guided biopsy which raised the suspicion of hepatocellular adenoma (H-HCA). After a laparoscopic excision of the lesion a diagnosis of H-HCA was formulated.
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Affiliation(s)
- Nicholas Vanigli
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy.
| | - Laura Melotti
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy
| | - Nikolas Dussias
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy
| | - Amalia Sanna Passino
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy
| | - Elena Mazzotta
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy
| | - Chiara De Molo
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy
| | - Lorenzo Gentilini
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy
| | - Gilberto Poggioli
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy
| | - Paolo Gionchetti
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy
| | - Fernando Rizzello
- University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, IRCCS Azienda Ospedaliero, Universitaria Di Bologna Policlinico Di Sant'Orsola, Bologna, Italy
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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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Kim JW, Kim KA, Sim KC, Lee J, Park BN, Song MJ, Park YS, Lee J, Choi JW, Lee CH. Ectopic lesions in the abdomen and pelvis: a multimodality pictorial review. Abdom Radiol (NY) 2022; 47:2254-2276. [PMID: 35441342 DOI: 10.1007/s00261-022-03520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
Various ectopic lesions occur in the abdomen and pelvis and affect multiple organs including liver, gallbladder, pancreas, spleen, and organs of the genitourinary system. Ectopic organs may be present outside their normal positions, or ectopic tissues may develop while the original organ exists in its normal position. Both benign and malignant lesions can occur in ectopic organs and tissues. Owing to their unusual location, they can often be misdiagnosed as other lesions or even malignant lesions, such as metastasis or seeding. This multimodality pictorial review provides various cases of ectopic lesions in the abdomen and pelvis, which will help narrow the differential diagnosis and guide clinical decision-making.
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Affiliation(s)
- Jeong Woo Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea.
| | - Ki Choon Sim
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jisun Lee
- Department of Radiology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Bit Na Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Mi Jin Song
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Jae Woong Choi
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
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Ko J, Hwang J, Yoon H, Eom K, Kim J. Case Report: Multimodal Imaging Features of Pedunculated Liver Masses in Seven Dogs. Front Vet Sci 2020; 7:581922. [PMID: 33330705 PMCID: PMC7732477 DOI: 10.3389/fvets.2020.581922] [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: 07/10/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022] Open
Abstract
This study describes the multimodal imaging characteristics of pedunculated liver masses in seven dogs [Cocker Spaniel (n = 2), Maltese (n = 1), Shih-Tzu (n = 2), and Schnauzer (n = 2)]. These masses are anatomic variants of hepatic masses in which the center of the mass lies outside the liver contour. Prior to referral, only one dog had been diagnosed with a hepatic mass, four had been diagnosed with mid-abdominal masses of unknown origin, and two had been misdiagnosed with splenic head and pancreatic masses. Using radiographs, the mass locations were classified as cranioventral (n = 3), mid-abdominal (n = 2), or craniodorsal (n = 2). The gastric axis was deviated in various directions in four cases. Based on computed tomography (CT) findings, the masses were noted to originate from every liver lobe (two from the left lateral lobe) and to possess parenchymal (n = 6) or vascular (n = 1) pedicles. The histopathological results showed that three masses were benign [hepatic adenoma (n = 1) and nodular hyperplasia (n = 2)] and four were malignant [hepatocellular carcinoma (n = 3) and cholangiocarcinoma (n = 1)]. For three dogs, triple-phase CT maximum intensity projection images in the arterial phase clearly showed that the masses were connected to the hepatic artery. We propose that a pedunculated liver mass should be considered as a differential diagnosis when a mass is located in the mid-abdomen, even if it is separated from the liver and with the gastric axis deviated in various directions. We consider CT imaging to be a useful tool for diagnosis, evaluation, and surgical planning in dogs with a pedunculated liver mass.
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Affiliation(s)
- Jaeeun Ko
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jeongyeon Hwang
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Kidong Eom
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | - Jaehwan Kim
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
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Su N, Chen C, Dai Q, Wang L, Yang M, Xia Y, Jiang Y, Lv K. Focal nodular hyperplasia on an accessory liver lobe: A case report and literature review. Medicine (Baltimore) 2020; 99:e21357. [PMID: 32791740 PMCID: PMC7386996 DOI: 10.1097/md.0000000000021357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Accessory liver lobe (ALL), an autonomous island of normal liver parenchyma, is a rare congenital anomaly that is difficult for preoperative diagnosis and often identified incidentally. It can also be accompanied with benign or malignant diseases, which is extremely rare. There are only 3 cases of focal nodular hyperplasia (FNH) detected on ALL reported by previous literature. PATIENT CONCERNS A 33-year-old woman was incidentally diagnosed with a mass in left upper quadrant abdomen by a routine ultrasound examination. Doppler ultrasound revealed that the mass was attached to left liver lobe with a vascular pedicle. A spoke-wheel artery with diffuse enhancement during hepatic arterial phase was visualized on contrast-enhanced ultrasound, and the mass was continuously hyper-enhanced with a hypo-enhanced intralesional scar during the portal and delayed phase. And contrast-enhanced computed tomography showed a similar enhancement mode of the mass. DIAGNOSIS The mass was resected and postoperative histopathologic result of the lesion revealed a nodular hyperplastic parenchyma with a central fibrous scar, without tumor cells. And a final diagnosis of FNH on ALL was determined accordingly. INTERVENTIONS Mass resection was conducted according to patient's demand. OUTCOME After general postoperative administration, the patient was discharged. Then, she had been undergoing regular serological tests and imaging examinations in our hospital for 24 months. CONCLUSION The finding of a mass connecting with liver by a stalk should alert the clinician of the possibility of ALL, as well as benign or malignancies on an ALL. This is the first case of FNH on ALL preoperatively confirmed by contrast-enhanced ultrasound. We suggest that an integrated radiologic approach is crucial to evaluate an incidentally detected, asymptomatic abdominal focal mass.
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Taj H, Comba I, Kumar S, Lakhinder B. Extracapsular Hepatocellular Adenoma: A Diagnostic Dilemma. Cureus 2020; 12:e8928. [PMID: 32760628 PMCID: PMC7392356 DOI: 10.7759/cureus.8928] [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: 02/29/2020] [Accepted: 06/22/2020] [Indexed: 11/07/2022] Open
Abstract
Hepatocellular adenoma (HCA) is a benign neoplasm of the hepatic parenchyma. The use of oral contraceptives (OCP) in women is the most well-established risk for the development of HCA. HCA commonly presents as an intracapsular mass of the liver but there are very few cases of extracapsular HCA. This is a case of a middle-aged female who presented to the emergency department with left shoulder pain and epigastric tenderness on physical exam. Subsequent imaging of the abdomen revealed a mass arising from the anterior wall of the stomach, with evidence of surrounding hemorrhage. The patient underwent exploratory laparotomy that revealed free blood in the peritoneum and a hemorrhagic mass arising from the stomach wall. The mass was successfully removed with no postoperative complications. Histopathological examination of the mass was consistent with an infarcted inflammatory HCA. This case illustrates this unusual presentation of a rare diagnosis.
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Affiliation(s)
- Hiffsa Taj
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Isin Comba
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Sundeep Kumar
- Cardiovascular Disease, Saint Louis University Hospital, St. Louis, USA
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
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Galimov OV, Khanov VO, Rudakov DM, Sagitdinov RR. [Ectopic liver tissue in gallbladder's wall]. Khirurgiia (Mosk) 2019:95-96. [PMID: 28514391 DOI: 10.17116/hirurgia2017595-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- O V Galimov
- Chair of Surgical Diseases and New Technologies, Bashkir State Medical University, Ministry of Health of Russia, Ufa
| | - V O Khanov
- Chair of Surgical Diseases and New Technologies, Bashkir State Medical University, Ministry of Health of Russia, Ufa
| | - D M Rudakov
- Chair of Surgical Diseases and New Technologies, Bashkir State Medical University, Ministry of Health of Russia, Ufa
| | - R R Sagitdinov
- Chair of Surgical Diseases and New Technologies, Bashkir State Medical University, Ministry of Health of Russia, Ufa
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A First Report of Synchronous Intracapsular and Extracapsular Hepatic Adenoma. Case Rep Surg 2018; 2017:9053568. [PMID: 29410930 PMCID: PMC5749273 DOI: 10.1155/2017/9053568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/20/2017] [Indexed: 01/01/2023] Open
Abstract
Although the gallbladder is the most common site of ectopic liver, it has been reported in many other organs, such as kidney, adrenal glands, pancreas, omentum, stomach, esophagus, mediastinum, lungs, and heart. Hepatocytes in an ectopic liver behave like normal hepatocytes; furthermore, they can be associated with the same pathological findings as those in the main liver. Ectopic liver in the gallbladder can undergo fatty change, hemosiderosis, cholestasis, cirrhosis, hemangioma, focal nodular hyperplasia, adenoma, and even carcinogenesis. The incidence of extracapsular hepatic adenoma is not known, but only two cases have been reported. Here, we provide the first case report of synchronous multiple intracapsular and extracapsular hepatic adenomas. A 60-year-old woman with multiple hepatic adenomas and one 7 × 5 × 5 cm ectopic hepatic adenoma attached to the gallbladder fundus complicated with abdominal pain is presented.
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9
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Cholecystectomy of an Intrahepatic Gallbladder in an Ectopic Pelvic Liver: A Case Report and Review of the Literature. Case Rep Surg 2017; 2017:3568768. [PMID: 29225990 PMCID: PMC5684543 DOI: 10.1155/2017/3568768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 10/03/2017] [Indexed: 12/29/2022] Open
Abstract
Introduction Ectopic pelvic liver is an exceedingly rare condition usually resulting after repair of congenital abdominal wall defects. Intrahepatic gallbladder is another rare condition predisposing patients to cholelithiasis and its sequelae. We describe a cholecystectomy in a patient with an intrahepatic gallbladder in a pelvic ectopic liver. Presentation of Case A 33-year-old woman with a history of omphalocele repair as an infant presented with signs and symptoms of symptomatic cholelithiasis and chronic cholecystitis, however, in an unusual location. After extensive workup and symptomatic treatment, cholecystectomy was recommended and performed via laparotomy and hepatotomy using microwave technology for parenchymal hepatic transection. Discussion Given the rare combination of an intrahepatic gallbladder and an ectopic pelvic liver, advanced surgical techniques must be employed for cholecystectomies, in addition to involvement of hepatobiliary experienced surgeons due to the distortion of the biliary and hepatic vascular anatomy. Conclusion Cholecystectomy by experienced hepatobiliary surgeons is a safe and effective treatment for cholecystitis in patients with intrahepatic gallbladders in ectopic pelvic livers.
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Barazza G, Adler DG, Factor RE. An unexpected diagnosis of ectopic liver diagnosed by fine needle aspiration. Cytojournal 2017; 13:29. [PMID: 28105065 PMCID: PMC5200975 DOI: 10.4103/1742-6413.196239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/18/2016] [Indexed: 12/15/2022] Open
Abstract
The differential diagnosis of perigastric masses is broad, ranging from benign to malignant entities. Among the benign entities, accessory liver lobes and ectopic liver are unusual and often incidentally discovered. Here, we report a patient with malignant melanoma who was clinically suspected to have a perigastric metastasis or a gastrointestinal stromal tumor but was ultimately diagnosed by fine needle aspiration (FNA) to have benign ectopic liver. A 47-year-old male was diagnosed with malignant melanoma of the scalp in May 2015 at a tertiary care hospital. He was found to have a 2.6 cm enhancing mass adjacent to the fundus of the stomach and below the diaphragm by computed tomography imaging. To exclude metastasis, the patient was referred to endoscopy, and an endoscopic ultrasound-guided FNA was performed with rapid on-site evaluation (ROSE) by a cytopathologist. A relatively new FNA needle (Shark Core) was used, which produced useful core biopsy material. Cytopathology demonstrated flat sheets, single cells, and small clusters of polygonal cells. There was abundant granular cytoplasm, often containing pigment. Cells lacked pleomorphism. The smear findings appeared consistent with hepatocytes. The cell block demonstrated small core fragments of hepatic parenchyma with portal tracts. Immunohistochemistry for arginase-1 confirmed that this was hepatic tissue. ROSE was useful for communicating with the endoscopist that the mass was both far from, and not connected to, the liver. This is the first documented account of perigastric ectopic liver diagnosed by FNA. This entity should be considered in the differential of perigastric masses.
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Affiliation(s)
- Gonzalo Barazza
- Address: Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah, Salt Lake City, Utah, USA
| | - Rachel E Factor
- Address: Department of Pathology, University of Utah, Salt Lake City, Utah, USA
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11
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Lande R, Dvorak L, Gardiner DW, Bahr A. Ectopic Intrathoracic Hepatic Tissue and Accessory Lung Lobe Aplasia in a Dog. J Am Anim Hosp Assoc 2016; 51:342-5. [PMID: 26355587 DOI: 10.5326/jaaha-ms-6229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 6 yr old male Yorkshire terrier was presented for an ~6 yr history of progressive cough and dyspnea. Thoracic radiographs revealed a 6 cm diameter mass within the right caudal thorax. Thoracic ultrasound identified an intrathoracic mass ultrasonographically consistent with liver tissue and a chronic diaphragmatic hernia was suspected. Exploratory laparotomy was performed, but no evidence of a diaphragmatic hernia was identified. Thoracic exploration identified abnormal lung parenchyma. The accessory lung lobe was removed using a stapling devise near its base. The consolidated mass had the gross appearance of liver and was histologically identified as ectopic hepatic tissue. Ectopic hepatic tissue, unlike ectopic splenic and pancreatic tissue, is rare and generally has a subdiaphragmatic distribution. This solitary case report demonstrates that ectopic intrathoracic hepatic tissue should be considered a differential diagnosis for a caudal mediastinal mass.
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Affiliation(s)
- Rachel Lande
- From the PetPB Pet Emergency Clinic, Boynton Beach, FL (R.L.); Carolina Veterinary Specialists, Matthews, NC (R.L., L.D.); IDEXX Reference Laboratory, West Sacramento, CA (D.G.); and Pet Rays, Spring, TX (A.B.)
| | - Laura Dvorak
- From the PetPB Pet Emergency Clinic, Boynton Beach, FL (R.L.); Carolina Veterinary Specialists, Matthews, NC (R.L., L.D.); IDEXX Reference Laboratory, West Sacramento, CA (D.G.); and Pet Rays, Spring, TX (A.B.)
| | - David W Gardiner
- From the PetPB Pet Emergency Clinic, Boynton Beach, FL (R.L.); Carolina Veterinary Specialists, Matthews, NC (R.L., L.D.); IDEXX Reference Laboratory, West Sacramento, CA (D.G.); and Pet Rays, Spring, TX (A.B.)
| | - Anne Bahr
- From the PetPB Pet Emergency Clinic, Boynton Beach, FL (R.L.); Carolina Veterinary Specialists, Matthews, NC (R.L., L.D.); IDEXX Reference Laboratory, West Sacramento, CA (D.G.); and Pet Rays, Spring, TX (A.B.)
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12
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Darzi A, Taheri H, Kamali Ahangar S, Mirzapour Shafiei A, Asghari Y. Torsion of a Giant Pedunculated Hemangioma of the Liver Presenting With Acute Abdomen: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e38198. [PMID: 27781125 PMCID: PMC5068247 DOI: 10.5812/ircmj.38198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/14/2016] [Accepted: 06/19/2016] [Indexed: 12/27/2022]
Abstract
Introduction Hemangioma is the most common benign tumor of the liver. Most cases are asymptomatic and do not require treatment. A hemangioma can rarely be pedunculated; as a result, it may undergo torsion and infarction, which can make it symptomatic. Case Presentation We report the case of a 45-year-old woman with acute abdominal pain due to torsion of a giant pedunculated hepatic hemangioma around its vascular stalk. Conclusions Pedunculated hemangioma of the liver is an uncommon benign tumor, a rare differential diagnosis for a mass located in the upper abdomen. All incidentally detected pedunculated hemangiomas must be surgically managed, as these have a tendency to become torsioned, and there is also a risk of malignancy or rupture.
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Affiliation(s)
- Aliasghar Darzi
- Department of Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, IR Iran
| | - Hassan Taheri
- Department of Gastroenterology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, IR Iran
| | - Sekineh Kamali Ahangar
- Clinical Research Department, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, IR Iran
| | | | - Yasser Asghari
- Department of Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, IR Iran
- Corresponding Author: Yasser Asghari, Department of Surgery, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, IR Iran. Tel: +98-1132256285, Fax: +98-1132256285, E-mail:
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13
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Lee JY, Kim KH, Kang MS, Kim KH. Ectopic Hepatocellular Carcinoma Arising from the Peritoneum in a Patient with a History of Oropharyngeal Cancer: A Case Report. Case Rep Oncol 2015; 8:456-60. [PMID: 26600779 PMCID: PMC4649744 DOI: 10.1159/000441020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A subphrenic mass was noted on a surveillance computed tomography (CT) scan of a 65-year-old man who had achieved complete remission of oropharyngeal cancer after concurrent chemoradiotherapy. The mass was 3.2 cm in size and showed a multilobular enhancing pattern along the peritoneal lining. The patient was negative for hepatitis B surface antigen and anti-hepatitis C virus antibody. His carcinoembryonic antigen level was within the normal range. Contrast-enhanced CT revealed no mass in the liver. He underwent surgery, and a pale yellowish soft tumor measuring 3.8 × 3.2 × 1.2 cm was resected. Histologically, the tumor was confirmed to be a hepatocellular carcinoma. Currently, he is doing well, and has been followed up without any signs of recurrence.
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Affiliation(s)
- Ji Young Lee
- Division of Hematology-Oncology, Department of Internal Medicine, South Korea
| | - Kwang Hee Kim
- Department of General Surgery, Inje University College of Medicine, Busan, South Korea
| | - Mi Seon Kang
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ki Hyang Kim
- Division of Hematology-Oncology, Department of Internal Medicine, South Korea
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14
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Zhang X, Zhou Z. Hepatic hemangioma masquerading as a tumor originating from the stomach. Oncol Lett 2015; 9:1406-1408. [PMID: 25663921 PMCID: PMC4315127 DOI: 10.3892/ol.2015.2863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 11/06/2014] [Indexed: 01/21/2023] Open
Abstract
Hemangioma is the most common benign hepatic neoplasm. The majority of cases are asymptomatic and can be confirmed by imaging examinations, including enhanced computed tomography and magnetic resonance imaging. Exophytic growth is not common and pedunculated cases are extremely rare. The present study reports a case that was pre-operatively misdiagnosed as a stomach-originating tumor. Laparoscopic exploration confirmed that this tumor was a hepatic hemangioma with a long peduncle originating from the left edge of the liver. The final diagnosis of cavernous hemangioma was confirmed by postoperative pathology. This indicates that hepatic hemangioma with a long peduncle has the possibility to be inaccurately diagnosed. Laparoscopic examination is required for such cases.
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Affiliation(s)
- Xingmao Zhang
- Department of Gastrointestinal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, P.R. China
| | - Zhixiang Zhou
- Department of Gastrointestinal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, P.R. China
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Zonca P, Martinek L, Ihnat P, Fleege J. Ectopic liver: Different manifestations, one solution. World J Gastroenterol 2013; 19:6485-6489. [PMID: 24151369 PMCID: PMC3801320 DOI: 10.3748/wjg.v19.i38.6485] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/05/2013] [Accepted: 07/13/2013] [Indexed: 02/06/2023] Open
Abstract
Developmental abnormalities are rare in the liver. This study presents two case reports of ectopic liver. The first case was a 31-year-old male with clinical indication for laparoscopic appendectomy. Laparoscopy identified a perforated appendix and an unknown tumorous lesion in the ligamentum hepato umbilicalis. The patient underwent a laparoscopic appendectomy, intraoperative lavage of the peritoneal cavity, and extirpation of the lesion in the ligamentum hepato umbilicalis. Histpathological examination of the excised tumor revealed that it comprised liver tissue with fibrinous changes. The tumor was completely separate from the liver with no connection. It was classified as an ectopic liver. No further therapy was required. The second case was a 59-year-old male with a tumor on the upper pole of the spleen, incidentally diagnosed in an ultrasound examination. The biopsy raised suspicion of hepatocellular carcinoma. A positron emission tomography-computed tomography examination revealed accumulation of F-18 fluorodeoxyglucose only in the tumor. The patient underwent a splenectomy with a resection and reconstruction of diaphragm. After the hepatocellular carcinoma was confirmed, adjuvant therapy (sorafenib) was initialized. The operations and postoperative recoveries were uncomplicated in both cases. Despite the low incidence of ectopic liver and rare complications, it is necessary to maintain awareness of this possibility. The potential malignancy risk for ectopic liver tissue is the basis for radical surgical removal. Therapy for hepatocellular carcinoma in an ectopic liver follows the same guidelines as those followed for treating the “mother” liver.
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Nenekidis I, Anagnostakou V, Paralikas I, Kokkori A, Dedeilias P, Zisis C. Ectopic hepatocellular carcinomas developed in the chest wall and skull. Asian Cardiovasc Thorac Ann 2011; 19:360-2. [PMID: 22100934 DOI: 10.1177/0218492311419460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 68-year-old man presented with a suppurating mass on his skull and a palpable mass on his right upper thoracic wall. Computed tomography revealed a round mass, 70 mm in diameter, invading the right pleural cavity, and a second tumor infiltrating the skull through the left parietal bone. Both masses were resected simultaneously. Histopathology showed that both tumors were hepatocellular carcinomas.
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Affiliation(s)
- Ioannis Nenekidis
- Department of Cardiothoracic and Vascular Surgery, Evaggelismos General Hospital, Athens, Greece.
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Moon HK, Kim HS, Heo GM, Shin WG, Kim KH, Jang MK, Lee JH, Kim HY, Kim DJ, Cho SJ. A case of pedunculated hepatic hemangioma mimicking submucosal tumor of the stomach. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 17:66-70. [PMID: 21494080 PMCID: PMC3304623 DOI: 10.3350/kjhep.2011.17.1.66] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hepatic hemangioma is the most common benign tumor of the liver. Most such hemangiomas are small, asymptomatic, and have an excellent prognosis. Giant hepatic hemangioma has been reported in the literature, but the exophytic and pedunculated forms of hepatic hemangioma are rare. A 56-year-old woman was referred to our hospital under the suspicion of having a gastric submucosal tumor. Abdominal computer tomography (CT) scans showed a pedunculated mass from the left lateral segment of the liver into the gastric fundus, exhibiting the atypical CT findings of hepatic hemangioma. We therefore decided to perform laparoscopic resection based on the symptoms, relatively large diameter, inability to exclude malignancy, and risk of rupture of the exophytic lesion. The pathology indicated it to be a cavernous hemangioma of the liver. Herein we report a case of pedunculated hepatic hemangioma mimicking a submucosal tumor of the stomach due to extrinsic compression of the gastric fundus.
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Affiliation(s)
- Han Kook Moon
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Triantafyllidis I, Papapavlou L, Nikoloudis N, Economou A, Andreadis E, Chrissidou M, Georgakis K, Chrissidis T. Ectopic Liver Tissue Attached to the Gallbladder Wall: a case report. CASES JOURNAL 2009; 2:6786. [PMID: 20126556 PMCID: PMC2814219 DOI: 10.1186/1757-1626-2-6786] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 03/24/2009] [Indexed: 12/13/2022]
Abstract
Introduction Ectopic liver tissue is a rare entity, reported to occur in several intra-, retro- and extra- peritoneal sites, including the gallbladder. It is usually detected incidentally, during laparoscopy, laparotomy, or autopsy. Several possible mechanisms may explain the development of liver ectopia. Although ectopic liver tissue is usually asymptomatic, it behaves like orthotopic liver, developing the same pathologic conditions. Case presentation We describe the case of a 54-year-old woman who was found to have a nodule attached to the gallbladder wall without any connection with the main liver, during an elective laparoscopic cholecystectomy for gallstone disease. The nodule was removed with the gallbladder and identified histologically as normal ectopic liver tissue. Conclusion It would seem sensible to resect the ectopic tissue if encountered during cholecystectomy for gallstones. Laparoscopic management of ectopic liver can be feasible.
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Affiliation(s)
- Ioannis Triantafyllidis
- Department of General Surgery, Edessa General Hospital, End of Egnatia str, 58200 Edessa, Greece
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Dhaliwal RS, Lacey JK. Ectopic hepatic parenchyma attached to the diaphragm: simulating a pulmonary mass in a cat. J Am Anim Hosp Assoc 2009; 45:39-42. [PMID: 19122063 DOI: 10.5326/0450039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A case of an ectopic lobe of the liver connected to a normal diaphragm is described. A 9-year-old, castrated male cat underwent thoracotomy for a pulmonary mass. The removed mass was attached to the diaphragm that histologically was ectopic liver. The ectopic liver had no connection with the main liver. Because the occurrence of ectopic supradiaphragmatic hepatic tissue is a possibility, this should be considered as a differential diagnosis for caudal pulmonary or caudal mediastinal masses in a cat. This report describes, to the authors' knowledge, the first case of ectopic hepatic tissue attached to the diaphragm of a cat. The authors also characterize the asymptomatic clinical presentation and radiographic findings of this cat and suggest further imaging with computed tomography in unusual case presentations.
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Affiliation(s)
- Ravinder S Dhaliwal
- Department of Oncology, All Care Animal Referral Center, 18440 Amistad Street, Fountain Valley, California 92708, USA
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Kubota K, Kita J, Rokkaku K, Iwasaki Y, Sawada T, Imura J, Fujimori T. Ectopic hepatocellular carcinoma arising from pancreas: A case report and review of the literature. World J Gastroenterol 2007; 13:4270-3. [PMID: 17696261 PMCID: PMC4250631 DOI: 10.3748/wjg.v13.i31.4270] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 56-year-old man was found to have a pancreatic tail tumor. His blood chemistry showed no infection with hepatitis B or C virus and no elevations of tumor markers or pancreatic hormones. Abdominal ultrasound showed an encapsulated, rather heterogeneous, hypoechoic tumor, 6.5 cm in maximum diameter, with a beak sign. Helical dynamic CT revealed an irregularly enhanced tumor with pooling of contrast medium in the delayed phase. Abdominal angiography showed a hypervascular tumor. With a tentative diagnosis of non-functional islet-cell tumor, the patient underwent resection of the pancreatic body and tail with splenectomy. The contour of the liver and its surface were normal. In microscopic examination, tumor cells arranged in a trabecular pattern with focal bile pigment resembling hepatocellular carcinoma (HCC). Immunohistochemically, these tumor cells were positivefor HEPPAR-1, CAM5.2, cytokeratin 18 and COX-2, but negative for MUC-1, and cytokeratins 7, 20 and 8. These results supported a diagnosis of HCC without any adenocarcinoma component. The patient is currently doing well without any signs of recurrence in either the remaining pancreas or liver three years after surgery. We report the rare case with ectopic HCC in the pancreas with a review of the literature.
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Affiliation(s)
- Keiichi Kubota
- Department of Gastroenterological Surgery, Dokkyo University Hospital, 880 Kitakobayashi, Mibu, Tochigi, Japan.
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