[Diagnosis of an accessory liver lobe established by magnetic resonance imaging-guided core biopsy]

Morphological Study of Variations of the Human Cadaveric Liver and Its Clinical Implications

Introduction With increasing dependence on laparoscopic procedures, precise knowledge of external variations of the liver is essential for good surgical and interventional outcomes, preventing imaging misdiagnosis, and curtailing complications. The present study aims to evaluate the gross anatomical variations of the liver. Materials and Methods The 40 adult cadaveric livers of age 60-80 years were removed during the routine dissection for undergraduate medical students and examined for morphological variations in the form of size, shape, and fissures. Results Accessory fissures were observed on the caudate lobe (CL) in 23 (57.5%), on the quadrate lobe (QL) in seven (17.5%), on the right lobe (RL) in 29 (72.5%), and on the left lobe (LL) in 12 (30%) specimens. Netter's Type 2, Type 4, Type 5, Type 6, and Type 7 liver were observed in four (10%), seven (17.5%), one (2.5%), three (7.5%), and three (7.5%) specimens respectively. The most common shapes of the CL and QL were rectangular in 16 (40%) and quadrangular in 10 (25%) specimens respectively. Pons hepatis were seen in three (7.5%) specimens. The mean length (cm) of RL and LL were 17.75 ±3.09 and 16.9±3.69 respectively, whereas the mean transverse diameter (TD) (cm) of RL and LL were 7.98±1.20 and 7.85±1.58 respectively. The mean length and TD (cm) of CL were 5.62±1.67 and 2.48±1.00 respectively. The mean length and TD (cm) of the QL were 6.00±1.51 and 2.81±0.83 respectively. Conclusion Precise knowledge of these variations would be helpful for surgeons in planning and performing surgical procedures and for anatomists.

Accessory Lobe of Liver: A Rare Hepatic Variation With Diagnostic Dilemma

The liver is a very dynamic organ. Still, the gross anomalies of the liver are sparse. The accessory lobe of the liver is a rare anatomical variation with a prevalence of less than 1%. We present a case of an accessory lobe and two accessory grooves of the liver in a cadaver. The accessory lobe was an isolated anomaly, sessile in presentation, and attached to normal liver parenchyma. Although accessory lobes are rare, knowledge about them will reiterate to surgeons and radiologists to be mindful of them and to avoid misdiagnosis.

Accessory liver within the thoracic cavity

Ectopic intrathoracic liver tissue is extremely rare. Studies are mainly limited to case reports. In the vast majority of reported cases, a diagnosis of intrathoracic liver tissue was made either after a thoracic surgery or during a postmortem examination. However, once included in differential diagnosis, surgical intervention or biopsy procedures may be avoided with optimal diagnostic approach. In the present study, we conducted a literature review and proposed a new classification method for accessory liver within the thoracic cavity. This approach may provide a better understanding of underlying pathophysiology and aid in determination of optimal diagnostic modality and clinical management of such cases. According to our literature review, type II ectopic liver is the most common subtype followed by types I and III. All types can be definitively diagnosed with imaging modalities. On the other hand, it is important to prevent patients, particularly children, from unnecessary radiation exposure during performance of sophisticated diagnostic imaging modalities. Ultrasound is a safe, low-cost and accessible imaging modality that has not been previously reported in diagnosis of this entity. With addition of Color Doppler Imaging, ultrasound may allow for diagnosis with high precision in types I and II, as demonstrated in the present study. Based on long-term follow-up of a case reported here, this study also illustrates the natural course of this entity via non-operative management. This approach may prevent an unnecessary surgical intervention.

Ectopic liver: Different manifestations, one solution

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.

Accessory lobes of the liver: A report of 3 cases and review of the literature

This article is about 3 cases of accessory lobes of the liver. Case One involved a pedunculated accessory lobe of the liver (ALL), Case Two involved a true ectopic liver, and Case Three involved a sessile accessory lobe of the liver. All 3 cases were diagnosed by computed tomography (CT) or magnetic resonance imaging (MRI) and confirmed by surgical and histological examination. The pertinent literature on accessory lobes of the liver is also reviewed.