1
|
Wu WK, Patel K, Padmanabhan C, Idrees K. Hepatocellular carcinoma presenting as an extrahepatic mass: A case report and review of literature. World J Gastrointest Oncol 2024; 16:2241-2252. [PMID: 38764834 PMCID: PMC11099426 DOI: 10.4251/wjgo.v16.i5.2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/03/2024] [Accepted: 03/20/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a primary liver tumor generally diagnosed based on radiographic findings. Metastatic disease is typically associated with increased tumor diameter, multifocality, and vascular invasion. We report a case of a patient who presented with extrahepatic HCC metastasis to a portocaval lymph node with occult hepatic primary on computed tomography (CT). We review the literature for cases of extrahepatic HCC presentation without known hepatic lesions and discuss strategies to differentiate between metastatic and ectopic HCC. CASE SUMMARY A 67-year-old male with remotely treated hepatis C was referred for evaluation of an enlarging portocaval, mixed cystic-solid mass. Serial CT evaluations demonstrated steatosis, but no cirrhosis or liver lesions. Endoscopic ultrasound demonstrated a normal-appearing pancreas, biliary tree, and liver. Fine needle aspiration yielded atypical cells. The differential diagnosis included duodenal or pancreatic cyst, lymphoproliferative cyst, stromal or mesenchymal lesions, nodal involvement from gastrointestinal or hematologic malignancy, or duodenal gastro-intestinal stromal tumor. After review by a multidisciplinary tumor board, the patient underwent open surgical resection of a 5.2 cm × 5.5 cm retroperitoneal mass with pathology consistent with moderately-differentiated HCC. Magnetic resonance imaging (MRI) subsequently demonstrated a 1.2 cm segment VIII hepatic lesion with late arterial enhancement, fatty sparing, and intrinsic T1 hyperintensity. Alpha fetoprotein was 23.3 ng/mL. The patient was diagnosed with HCC with portocaval nodal involvement. Review: We surveyed the literature for HCC presenting as extrahepatic masses without history of concurrent or prior intrahepatic HCC. We identified 18 cases of extrahepatic HCC ultimately found to represent metastatic lesions, and 30 cases of extrahepatic HCC found to be primary, ectopic HCC. CONCLUSION Hepatocellular carcinoma can seldomly present with extrahepatic metastasis in the setting of occult primary. In patients with risk factors for HCC and lesions suspicious for metastatic disease, MRI may be integral to identifying small hepatic lesions and differentiating from ectopic HCC. Tumor markers may also have utility in establishing the diagnosis.
Collapse
Affiliation(s)
- Wei Kelly Wu
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Krutika Patel
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Chandrasekhar Padmanabhan
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Kamran Idrees
- Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| |
Collapse
|
2
|
Nakajima T, Tsukamoto T. Ectopic Hepatocellular Carcinoma in the Gallbladder Wall With Choledocholithiasis: A Case Report. Cureus 2023; 15:e49534. [PMID: 38156130 PMCID: PMC10753168 DOI: 10.7759/cureus.49534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
An ectopic hepatocellular carcinoma (HCC) that originates from the ectopic liver is defined as a hepatic organ or tissue not conventionally linked to surrounding tissues. Ectopic HCC has a rare clinical incidence, and diagnosing it before surgery is challenging. Its characteristics and biological behavior have not been fully elucidated. This report presents a unique case of ectopic HCC in the gallbladder, discontinuous with the liver. A 74-year-old man was referred to our hospital after primarily complaining of fever and right hypochondrium pain. Plain computed tomography revealed a significantly thickened gallbladder wall containing fluid collection and incarceration of gallstone in the common bile duct. He was diagnosed with acute cholecystitis and obstructive cholangitis due to choledocholithiasis. After percutaneous transhepatic gallbladder drainage and endoscopic lithotomy for choledocholithiasis, a cholecystectomy was performed. Macroscopically, the resected gallbladder had a yellowish tumor (1 cm) within the significantly thickened gallbladder wall. Histopathological examination identified moderately differentiated HCC on the ectopic liver, discontinuous with the liver. Immunohistologically, the tumor was finally diagnosed as ectopic HCC with alpha-fetoprotein positive expression.
Collapse
Affiliation(s)
| | - Tadashi Tsukamoto
- Department of Hepato-Biliary-Pancreatic Surgery, Juso City General Hospital, Osaka, JPN
| |
Collapse
|
3
|
Park YE. Laparoscopically Resected Ectopic Hepatocellular Carcinoma Mimicking Subepithelial Tumor of Stomach: A Case Report. Case Rep Oncol 2023; 16:645-651. [PMID: 37900853 PMCID: PMC10601708 DOI: 10.1159/000531842] [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: 04/26/2023] [Accepted: 06/23/2023] [Indexed: 10/31/2023] Open
Abstract
Ectopic hepatocellular carcinoma (HCC) can be defined as an HCC arising from hepatic parenchyma located in an extrahepatic organ or tissue. Fewer than 100 cases of ectopic liver have been reported. In 30 of these cases, HCC was detected in ectopic tissue. The author describes a case of ectopic HCC mimicking subepithelial tumor (SET) of the stomach successfully treated by laparoscopic resection. This case report also provides a pertinent review of the literature. A 61-year-old male was referred to our department for the management of an intra-abdominal mass found on abdominal computed tomography performed at a local medical center due to a 2-month history of vague abdominal pain. Abdominal magnetic resonance imaging and computed tomography showed a 7.2-cm sized heterogenous mass over the left subphrenic space adjacent to the stomach. Esophagogastroduodenoscopy showed a huge subepithelial mass at the fundus of the stomach. Based on the above findings, the diagnosis of SET of the stomach such as gastrointestinal stromal tumor or leiomyoma was suspected. Laparoscopic surgery was performed for definite diagnosis and treatment of the huge SET of the stomach. Histologic diagnosis was ectopic HCC of the trabecular type. Its histologic grade was consistent with Edmondson grade II. Although ectopic HCC is quite rare tumor of the stomach, it should be considered in the differential diagnosis of other abdominal mass-like lesions. Currently, with advances of laparoscopic surgery, laparoscopic resection for complete excision of ectopic HCC is possible with acceptable results.
Collapse
Affiliation(s)
- Yong-Eun Park
- Department of Surgery, College of medicine, Yeungnam University, Daegu, Republic of Korea
| |
Collapse
|
4
|
Bravo-Taxa M, Luque Vásquez-Vásquez C, Ruiz-Figueroa E, Taxa-Rojas L. [Ectopic hepatocellular carcinoma. A case report]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2022; 55:282-287. [PMID: 36154738 DOI: 10.1016/j.patol.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/08/2021] [Accepted: 02/21/2021] [Indexed: 06/16/2023]
Abstract
Ectopic liver (EL) is a rare developmental anomaly caused by the migration of hepatic cells to other locations during embryogenesis. Its incidence is thought to be between 0.24 and 0.47% and can occur in various sites, although the gall bladder is the most frequent. Approximately 100 cases of EL have been published, of which 28 developed hepatocellular carcinoma, whilst the orthotopic liver was unaffected. All cases are reported in Asian and Caucasian patients. We report the case of a 42-year-old patient with a solid lesion measuring 17×12×12cm apparently arising from the posterior wall of the stomach, displacing various organs and suggestive of a gastrointestinal stromal tumour (GIST). The liver, biliary tract and other structures were unremarkable. Histopathology revealed a diagnosis of hepatocellular carcinoma in ectopic liver tissue.
Collapse
Affiliation(s)
| | | | - Eloy Ruiz-Figueroa
- Departamento de Abdomen, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Luis Taxa-Rojas
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú; Laboratorio Oncológico Taxa, Lima, Perú
| |
Collapse
|
5
|
Kumar S, Kumar P, Jha K, Khatri A. Neonate with Congenital Duodenal Obstruction and Ectopic Hepatic Parenchyma. Fetal Pediatr Pathol 2022; 41:677-681. [PMID: 33945385 DOI: 10.1080/15513815.2021.1919809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BackgroundThe presence of hepatic parenchyma at ectopic locations is infrequently reported in neonatal age. Case details: A male neonate presented with clinical signs and symptoms of duodenal obstruction. At exploration, an annular pancreas was found as the causative factor and he underwent a Kimura's duodeno-duodenostomy. A pedicled cyst was attached to the stomach's greater curvature, was excised, and histologically was a mesothelial-lined cyst with ectopic liver, complete with bile ducts, in the cyst wall. Conclusion: Ectopic liver tissue may be clinically silent and found within the wall of a mesothelial cyst. Long-term complications of this ectopic tissue are not known.
Collapse
Affiliation(s)
- Shishir Kumar
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalya, New Delhi, India
| | - Parveen Kumar
- Department of Pediatric Surgery, Chacha Nehru Bal Chikitsalya, New Delhi, India
| | - Khushboo Jha
- Department of Pathology, Chacha Nehru Bal Chikitsalya, New Delhi, India
| | - Arti Khatri
- Department of Pathology, Chacha Nehru Bal Chikitsalya, New Delhi, India
| |
Collapse
|
6
|
de Araújo EM, Torres US, Pria HD, Torres LR, Pedroso MHNI, Racy DJ, D'Ippolito G. Anatomy and Imaging of Accessory Liver Lobes: What Radiologists Should Know. Semin Ultrasound CT MR 2022; 43:476-489. [DOI: 10.1053/j.sult.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
7
|
Liu Q, Li J, Pan Y, Zheng X, Gao B. Challenge in Diagnosis and Treatment of Ectopic Hepatocellular Carcinoma: A Case Report and Literature Review. Front Surg 2022; 9:827006. [PMID: 35433804 PMCID: PMC9008362 DOI: 10.3389/fsurg.2022.827006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Findings of ectopic hepatocellular carcinoma (EHCC) have been rarely documented. Complicated clinical features and unpredictable medical prognosis make diagnosis and treatment difficult. Case Presentation We reported a 59-year-old male patient who came to the hospital with epigastric discomfort and regurgitation of gastric acid. An enhanced CT scan revealed a 1.8 cm × 1.4 cm mass in the tail of pancreas without any positive finding in the liver. Postoperative MRI scan was performed but did not reveal any evidence of hepatic tumor. The tumor was resected in toto. Meanwhile, a 1 cm × 1 cm mass in the body of the stomach was found that was removed simultaneously. Histopathology showed that the pancreatic tumor was ectopic hepatocellular carcinoma (EHCC), and that the gastric nodule was gastrointestinal stromal tumor (GIST). The patient had an uneventful postoperative recovery. He has been living without recurrence for over 7 years since surgery. Owing to our knowledge, this is the second-longest disease-free survival time for EHCC in the literature. Conclusion Here, we present a rare case of EHCC in the pancreas, and review the current literature on EHCC. Operation was an effective treatment for patients with curable EHCC. EHCC with metastasis still needs more practice to improve the poor prognosis.
Collapse
Affiliation(s)
- Qicen Liu
- Department of General Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingyi Li
- Department of Emergency Intensive Care Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yi Pan
- Department of Pathology, Huangshan People's Hospital, Huangshan, China
| | - Xiang Zheng
- Department of Chronic Wound Diagnosis and Treatment Center, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
- *Correspondence: Xiang Zheng
| | - Bin Gao
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Bin Gao
| |
Collapse
|
8
|
Akbulut S, Demyati K, Ciftci F, Koc C, Tuncer A, Sahin E, Karadag N, Yilmaz S. Ectopic liver tissue (choristoma) on the gallbladder: A comprehensive literature review. World J Gastrointest Surg 2020; 12:534-548. [PMID: 33437404 PMCID: PMC7769742 DOI: 10.4240/wjgs.v12.i12.534] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 11/12/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver tissue situated outside the liver with a hepatic connection is usually called an accessory liver, and that without a connection to the mother liver, is called ectopic liver tissue.
AIM To identify studies in the literature on ectopic liver tissue located on the gallbladder surface or mesentery.
METHODS We present two patients and review published articles on ectopic liver tissue located on the gallbladder surface accessed via PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used included accessory liver lobe, aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic liver tissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopic liver tissue on the gallbladder. The search included articles published before June 2020 with no language restriction. Letters to the editor, case reports, review articles, original articles, and meeting presentations were included in the search. Articles or abstracts containing adequate information on age, sex, history of liver disease, preliminary diagnosis, radiologic tools, lesion size, surgical indication, surgical procedure, and histopathological features of ectopic liver tissue were included in the study.
RESULTS A total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 were female and 25 were male (no gender available for 4 patients), and the age range was 5 d to 91 years. Forty-nine patients underwent surgery for chronic cholecystitis or cholelithiasis, and 14 patients underwent surgery for acute cholecystitis. The remaining 28 patients underwent laparotomy for other reasons. Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. The remaining 19 patients underwent various other surgical procedures such as autopsy, liver transplantation, living donor hepatectomy, Whipple procedure, and liver segment V resection. Histopathologically, hepatocellular carcinoma was detected in the ectopic liver tissue of one patient.
CONCLUSION Ectopic liver tissue is a rare developmental anomaly which is usually detected incidentally. Although most studies suggest that ectopic liver located outside the gallbladder has a high risk of hepatocellular carcinoma, this is not reflected in statistical analysis.
Collapse
Affiliation(s)
- Sami Akbulut
- Department of Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
| | - Khaled Demyati
- Department of Surgery, An-Najah National University, Nablus 11941, Palestine
| | - Felat Ciftci
- Department of Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
| | - Cemalettin Koc
- Department of Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
| | - Adem Tuncer
- Department of Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
| | - Emrah Sahin
- Department of Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
| | - Nese Karadag
- Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Sezai Yilmaz
- Department of Liver Transplant Institute, Inonu University, Malatya 44280, Turkey
| |
Collapse
|
9
|
Rinka K, Uchida-Kobayashi S, Yoshida K, Odagiri N, Kotani K, Motoyama H, Fujii H, Hagihara A, Miyazaki T, Nishioka T, Shinkawa H, Tanaka S, Enomoto M, Tamori A, Kubo S, Kawada N. A case of ectopic hepatocellular carcinoma originating from the retroperitoneum. KANZO 2020; 61:597-606. [DOI: 10.2957/kanzo.61.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Affiliation(s)
- Koji Rinka
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| | | | - Kanako Yoshida
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| | - Naoshi Odagiri
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| | - Kohei Kotani
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| | - Hiroyuki Motoyama
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| | - Hideki Fujii
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| | - Atsushi Hagihara
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| | - Tooru Miyazaki
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University
| | - Takayoshi Nishioka
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University
| | - Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University
| | - Masaru Enomoto
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| | - Akihiro Tamori
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University
| | - Norifumi Kawada
- Department of Hepatology, Graduate School of Medicine, Osaka City University
| |
Collapse
|
10
|
Martínez-Acitores D, Hernández Ainsa M, Cortés García L, Bengochea Martínez ML, Palacios Fanlo MJ. Ectopic hepatocellular carcinoma arising from the peritoneum. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 111:809-811. [PMID: 31538485 DOI: 10.17235/reed.2019.6408/2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ectopic hepatocellular carcinoma is a rare entity. Most cases are asymptomatic and are occasionally found during autopsy or laparoscopy. They may sometimes cause relevant clinical problems such as abdominal pain or intra-abdominal bleeding. In this clinical case report, we review the literature in order to decipher the case of a 68-year-old female with an ectopic hepatocellular carcinoma that arose from the peritoneum. The patient was diagnosed after being studied due to a mild asymptomatic hypertransaminasemia.
Collapse
|
11
|
Wang X, Zhang Q, Xu K. Hepatocellular carcinoma arising from left accessory liver lobe supplied by the branch of left hepatic artery: A case report. Medicine (Baltimore) 2019; 98:e16912. [PMID: 31577696 PMCID: PMC6783236 DOI: 10.1097/md.0000000000016912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Accessory liver lobe (ALL) is a rare congenital anomaly. ALL combined with hepatocellular carcinoma (HCC) is even rarer. Most ALLs with HCC are often located in the right liver, and are not supplied by the left hepatic artery. PATIENT CONCERNS A 77-year-old man was referred to our hospital because of the level of serum alpha-fetoprotein (AFP) continually increased for 1 month. He had no history of chronic hepatitis, alcohol abuse, or cirrhosis of the liver. DIAGNOSES Preoperative computed tomography (CT) scan revealed a 3.0 × 3.0 × 1.0 cm ovaloid-shaped solid mass in the left subphrenic area with isodensity. Magnetic resonance imaging (MRI) showed a mass with a heterogeneous signal on T1- and T2-weighted images. On contrast-enhanced CT and MRI, the mass showed a pattern of early enhancement and washout. Digital subtraction angiography (DSA) confirmed the mass was fed by the branch of left liver artery. INTERVENTIONS The mass was treated by transatheter arterial embolization (TAE) followed by surgical resection. Histopathologically showed HCC, consistent with a moderately differentiated. OUTCOMES Follow-up of 3 months after surgery, the level of AFP returned to normal gradually. CONCLUSIONS In this report, we describe a rare case of ALL with HCC, located in the left subphrenic area, especially which was supplied by the branch of left hepatic artery has rarely been described. The clinical presentation, radiological features are described in the literature.
Collapse
Affiliation(s)
- Xiaolong Wang
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Qingqiao Zhang
- Department of Interventional Radiology and Vascular Surgery, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| | - Kai Xu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, China
| |
Collapse
|
12
|
|
13
|
Abstract
RATIONALE Ectopic liver tissue can develop at various sites near the liver. Ectopic hepatocellular carcinomas (HCCs) arising from ectopic liver tissue have a rare clinical incidence. A very rare case has been observed to have metastasis after operation. PATIENT CONCERNS We report an extremely rare case with multiple masses which were identified in the head and body of the pancreas. DIAGNOSES Ectopic hepatocellular carcinomas. INTERVENTIONS The masses were removed by surgical resection. Histopathological analysis showed that both masses were ectopic HCC. OUTCOMES The patient was still alive and did not have metastasis and relapse. LESSONS The literature review for this rare case is also presented to highlight the risk of ectopic HCC and good prognosis of operation for ectopic HCC.
Collapse
Affiliation(s)
- Zhigui Li
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | | |
Collapse
|
14
|
Aarås AM, Reitan-Gjersøe TA, Waage A, Mala T, Edwin B, Løberg EM, Abildgaard A, Røsok BI. Laparoscopic resection of recurrent ectopic hepatocellular carcinoma: A case report with review of the literature and guidelines for follow-up. Int J Surg Case Rep 2015; 17:92-5. [PMID: 26590353 PMCID: PMC4701757 DOI: 10.1016/j.ijscr.2015.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/06/2015] [Accepted: 10/13/2015] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) in ectopic liver tissue is extremely rare. PRESENTATION OF CASE A 64-year-old woman presented initially with abdominal complaints. Computed tomography (CT) revealed a tumor in the diaphragm and laparoscopic resection of the tumor was performed. Histology showed HCC. During the next 4 years four more tumors, all of which showed HCC on histology and were located extrahepatically, was treated with laparoscopic resection. During this course the patient was followed with regular thoracoabdominal CT and measurement of serum alpha-fetoprotein (AFP). A negative magnetic resonance imaging (MRI) examination of the liver excluded a primary intrahepatic tumor. DISCUSSION The literature available on ectopic HCC and the guidelines for management of HCC do not address the postoperative surveillance of patients undergoing curative treatment. A follow-up regime has been proposed by Hatzaras et al. (2014) to include cross-sectional imaging of the liver and measurement of serum AFP levels [1]. CT would be the preferred study of choice in a total radiologic investigation of the abdomen. While MRI is prone to artifacts due to movements, CT scans allows so rapid recordings that this no longer is an issue. An early investigation of the liver for intrahepatic HCC should nevertheless be performed early to exclude primary intrahepatic HCC. CONCLUSION We recommend that patients with ectopic HCC should be followed every 6 months with measurement of AFP and abdominal CT imaging. MRI of the liver should be performed early to exclude primary intrahepatic HCC.
Collapse
Affiliation(s)
- Arne Marino Aarås
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Anne Waage
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Tom Mala
- Department of Gastrointestinal Surgery, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
| | - Bjørn Edwin
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway; The Interventional Centre, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Else Marit Løberg
- Department of Pathology, Oslo University Hospital, Kirkeveien 166, 0450 Oslo, Norway
| | - Andreas Abildgaard
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
| | - Bård Ingvald Røsok
- Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
| |
Collapse
|
15
|
Bal A, Yilmaz S, Yavas BD, Ozdemir C, Ozsoy M, Akici M, Kalkan M, Ersen O, Saripinar B, Arikan Y. A rare condition: Ectopic liver tissue with its unique blood supply encountered during laparoscopic cholecystectomy. Int J Surg Case Rep 2015; 9:47-50. [PMID: 25723748 PMCID: PMC4392331 DOI: 10.1016/j.ijscr.2015.02.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 12/13/2022] Open
Abstract
Developmental abnormalities of liver including ectopic liver are rare conditions. Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. Ectopic liver has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. The vascular anatomy of ectopic liver should be identified before the dissection of gallbladder in order to prevent hemorrhage from the liver parenchyma.
Introduction Developmental abnormalities of liver including ectopic liver tissue (ELT) are rare conditions. Few cases presenting ELT have been reported in literature till now. Even though the most common area seen is gallbladder, it is detected both abdominal and thoracic sites. There is a relationship between HCC and ectopic liver that necessitates the removal. Presentation of case A 51-year-old female was hospitalized because of abdominal pain. Gallstone and bile duct dilatation were determined during ultrasonographic (USG) evaluation. The patient was operated for cholecystectomy following a successful endoscopic retrograde cholangiopancreatography (ERCP). During operation, a mass located on gallbladder with its unique vascular support was identified and resected together with gallbladder. The mass had a separate vascular stalk arising from liver parenchyma substance and it was clipped with laparoscopic staples. The histopathological examination revealed that the mass adherent to gallbladder was ectopic liver confirming the intraoperative observation. The postoperative course of patient was uneventfull and she was discharged at the second day after the operation. Discussion Ectopic liver tissue is incidentally found both in abdominal and thoracic cavity. ELT can rarely be diagnosed before surgical procedures or autopsies. It can be overlooked easily by radiological techniques. Although it does not usually produce any symptom clinically, it can rarely result in serious complications such as bleeding, pyloric and portal vein obstruction. ELT also has the capacity of malignant transformation to hepatocellular carcinoma that makes it essential to be removed. Conclusion Although ELT is rarely seen, it should be removed when recognized in order to prevent the complications and malignant transformation.
Collapse
Affiliation(s)
- Ahmet Bal
- Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020 Afyon, Turkey
| | - Sezgin Yilmaz
- Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020 Afyon, Turkey.
| | - Betul Demirciler Yavas
- Afyon Kocatepe University, The Faculty of Medicine, Pathology Department, 03020 Afyon, Turkey
| | - Cigdem Ozdemir
- Afyon Kocatepe University, The Faculty of Medicine, Pathology Department, 03020 Afyon, Turkey
| | - Mustafa Ozsoy
- Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020 Afyon, Turkey
| | - Murat Akici
- Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020 Afyon, Turkey
| | - Mustafa Kalkan
- Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020 Afyon, Turkey
| | - Ogun Ersen
- Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020 Afyon, Turkey
| | - Baris Saripinar
- Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020 Afyon, Turkey
| | - Yuksel Arikan
- Afyon Kocatepe University, The Faculty of Medicine, General Surgery Department, 03020 Afyon, Turkey
| |
Collapse
|
16
|
Abstract
The presence of ectopic liver tissue has been reported in various abdominal and extra-abdominal sites, most often in the gall bladder. Other rare sites include the retroperitoneum and the adrenal gland, which are anatomically closer to the kidney. However, our literature search did not reveal any reports of ectopic liver tissue within the kidney. We present such a case, detected incidentally during a fetal autopsy histologic examination, and we review the possible developmental aspects causing it. Ectopic liver is usually asymptomatic, although it can carry pathology similar to the orthotopic liver. It can be associated with other congenital anomalies and, rarely, can be the cause for clinical emergencies. The most significant implication, however, is development of hepatocellular carcinoma because of an increased predisposition compared with the native liver. Hence, we suggest that ectopic liver in the kidney should be considered by histopathologists, even in unsuspecting cases.
Collapse
Affiliation(s)
- Ashirwad Merve
- Department of Cellular Pathology, The Royal London Hospital, Pathology and Pharmacy Building, 80 Newark Street, London E1 2ES, United Kingdom
| | | |
Collapse
|
17
|
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.
Collapse
|
18
|
Affiliation(s)
- Krista Bannon
- Department of Surgery Providence Hospital Southfield, Michigan
| | - John Hraemic
- Department of Surgery Providence Hospital Southfield, Michigan
| | - Vijay Mittal
- Department of Surgery Providence Hospital Southfield, Michigan
| |
Collapse
|
19
|
Miyake T, Hoshino S, Yoshida Y, Aisu N, Tanimura S, Hisano S, Kuno N, Sohda T, Sakisaka S, Yamashita Y. Multiple ectopic hepatocellular carcinomas arising in the abdominal cavity. Case Rep Gastroenterol 2012; 6:629-34. [PMID: 23139654 PMCID: PMC3493015 DOI: 10.1159/000343433] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Ectopic hepatocellular carcinoma (HCC) is a very rare clinical entity that is defined as HCC arising from extrahepatic liver tissue. This report presents a case of ectopic multiple HCC arising in the abdominal cavity. A 42-year-old otherwise healthy male presented with liver dysfunction at a general health checkup. Both HCV antibody and hepatitis B surface antigen were negative. Laboratory examination showed elevations in serum alpha-fetoprotein and PIVKA-II. Ultrasonography and computed tomography revealed multiple nodular lesions in the abdominal cavity with ascites without a possible primary tumor. Exploratory laparoscopy was performed, which revealed bloody ascites and multiple brown nodular tumors measuring approximately 10 mm in size that were disseminated on the perineum and mesentery. A postoperative PET-CT scan was performed but it did not reveal any evidence of a tumor in the liver. The tumors resected from the peritoneum were diagnosed as HCC. The present case of HCC was thought to have possibly developed from ectopic liver on the peritoneum or mesentery.
Collapse
Affiliation(s)
- Toru Miyake
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Song Z, Chen G, Xu X, Chen J, Zhou Q. Pleural ectopic hepatic tissues mimicking intrapleural dissemination of tumour. ANZ J Surg 2012; 81:756-7. [PMID: 22295331 DOI: 10.1111/j.1445-2197.2011.05859.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
21
|
Matsuyama M, Sugiura S, Kakita A, Sato Y, Kuroda M. Hepatocellular carcinoma arising from ectopic liver tissue in the spleen producing insulin-like growth factor II. Pathol Res Pract 2010; 207:124-6. [PMID: 20943327 DOI: 10.1016/j.prp.2010.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/02/2010] [Accepted: 09/02/2010] [Indexed: 12/14/2022]
Abstract
We report a case of splenic tumor associated with severe hypoglycemia. The patient was a 69-year-old man with a large splenic tumor. He had suffered from relapsing hypoglycemic attacks and the lowest serum glucose level (4 mg/dl). He died 34 months after the onset of symptoms of left abdominal pain. Autopsy revealed large tumors in the spleen, 3 medium sized tumors in the lungs, and several small tumors in the liver. Microscopic studies of the splenic tumors revealed a hepatocellular carcinoma which showed a strongly positive reaction against anti-PIVKA-II and anti-"hepatocyte" antibodies. Several bile ductules thought to be heterotopic remnants of the liver tissues were found in the capsule of the spleen, adjoining the splenic tumor. It was suggested that the tumor originated from one of these ductules. Electron microscopic analysis showed numerous endocrine-like granules of every tumor cell, and 87-165 times stronger mRNA expression of insulin-like growth factor-II was measured in the tumor tissues when compared with normal liver tissue. Owing to these results, we believe that this is the first report of hepatocellular carcinoma that had developed from a liver tissue in the spleen.
Collapse
Affiliation(s)
- Mutsushi Matsuyama
- Clinical Laboratory, Hekinan Municipal Hospital, Hekinan, Aichi 447-8502, Japan.
| | | | | | | | | |
Collapse
|
22
|
Koh C, Kleiner DE, Sherry RM, Fowler DH, Heller T. When the left got left behind. Am J Gastroenterol 2009; 104:2644-5. [PMID: 19806108 PMCID: PMC3498507 DOI: 10.1038/ajg.2009.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - David E. Kleiner
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Richard M. Sherry
- Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Daniel H. Fowler
- Experimental Transplantation and Immunology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
23
|
Díez MJ, Canela T, Villas A, Gil M. [Contribution of (99m)Tc-mebrofenin scintigraphy to the diagnosis of ectopic liver. A case report]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2009; 28:125-7. [PMID: 19558953 DOI: 10.1016/s0212-6982(09)71355-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We present the case of a woman with a parasplenic mass who underwent abdominal ultrasounds, computed tomography and magnetic resonance imaging. The liver scintigraphy with (99m)Tc-Mebrofenin confirmed the diagnosis of ectopic liver.
Collapse
Affiliation(s)
- M J Díez
- Servicio de Medicina Nuclear ID, Institut de Diagnòstic per la Imatge, Hospital Universitari Arnau de Vilanova, Lleida, España.
| | | | | | | |
Collapse
|
24
|
Laparoscopic resection of a hepatocellular carcinoma arising from an ectopic liver. Surg Laparosc Endosc Percutan Tech 2008; 18:508-10. [PMID: 18936678 DOI: 10.1097/sle.0b013e31817e920f] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Ectopic livers are rarely seen intra-abdominal lesions. Ectopic hepatocellular carcinoma (HCC) can be defined as an HCC arising from hepatic parenchyma located in an extrahepatic organ or tissue. The authors report a case of a primary, well-differentiated HCC arising from ectopic liver tissue in the left subphrenic space at the upper portion of the gastrorenal ligament that was successfully treated by laparoscopic resection. A 59-year-old man was referred to our department for the management of an intra-abdominal mass, which was incidentally found in a follow-up abdominal computed tomography scan for splenic laceration. The preoperative diagnosis suggested that it was a nonspecific stomach mass of maximal diameter 4.5 cm, such as, a gastrointestinal stromal tumor, located between the diaphragm and spleen. A computed tomography scan identified no mass in the liver. Laparoscopic resection was performed, and the final pathologic result confirmed that it was a HCC. The patient's postoperative course was unremarkable. This is the first reported case of a laparoscopically treated ectopic HCC. Moreover, laparoscopic resection was found to be safe and reliable in this case.
Collapse
|
25
|
Abstract
Ectopic liver is hepatic tissue that histologically resembles the mother tissue but is located at a site away from its usual location. Initially thought to be a rare anatomical anomaly of no clinical significance, it is now increasingly recognised to be capable of causing clinically relevant pathology. More specifically, it has been associated with a higher incidence of hepatocellular carcinoma, cholelithiasis and cholecystitis. Here, we report a case of ectopic liver encountered incidentally during laparoscopic cholecystectomy.
Collapse
Affiliation(s)
- Cherry E Koh
- Department of Surgery, Goulburn Valley Base Hospital, Victoria, Australia.
| | | |
Collapse
|
26
|
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.
Collapse
Affiliation(s)
- Keiichi Kubota
- Department of Gastroenterological Surgery, Dokkyo University Hospital, 880 Kitakobayashi, Mibu, Tochigi, Japan.
| | | | | | | | | | | | | |
Collapse
|
27
|
Cardona D, Grobmyer S, Crawford JM, Liu C. Hepatocellular carcinoma arising from ectopic liver tissue in the pancreas. Virchows Arch 2007; 450:225-9. [PMID: 17216188 DOI: 10.1007/s00428-006-0353-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2006] [Revised: 11/03/2006] [Accepted: 11/12/2006] [Indexed: 12/17/2022]
Abstract
Liver tissue ectopia is a well-documented phenomenon. Rarely, hepatocellular carcinoma arises from the ectopic liver tissue. In this paper, we report a case of a primary, well-differentiated hepatocellular carcinoma arising from ectopic liver tissue in the pancreas. The patient is a 58-year-old Hispanic man with no history of underlying liver diseases or chronic pancreatic diseases. Patient presented with a several days history of abdominal pain with radiation to his right upper quadrant. Imaging study revealed a 3.7 x 3.3-cm mass in the distal pancreas. No other lesions were identified. Preoperative fine needle aspiration revealed blood and atypical hepatocytes. The patient underwent distal pancreatectomy and splenectomy for suspected neuroendocrine tumor. Gross examination revealed a well-circumscribed 3.3-cm, beige-tan, pseudolobulated tumor with focal areas of hyperpigmentation. A microscopic examination revealed hepatoid cells arranged in a trabecular pattern with focal bile pigment. Immunohistochemistry study showed that the tumor cells were reactive with hepatocyte antigen (Hep par 1), alpha-1 antitrypsin, but negative for synaptophysin and chromogranin. Immunostain for polyclonal carcinoembryonic antigen showed a typical bile canalicular pattern. These results support that this tumor in the pancreas is hepatocellular carcinoma, most likely arising from ectopic liver tissue within the pancreas.
Collapse
Affiliation(s)
- Diana Cardona
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA
| | | | | | | |
Collapse
|
28
|
Huang TW, Chan DC, Lee HS, Yao NS, Lee SC, Cheng YL. Ectopic hepatocellular carcinoma of the diaphragm. Dig Dis Sci 2007; 52:1118-20. [PMID: 17347886 DOI: 10.1007/s10620-006-9329-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2005] [Accepted: 03/22/2006] [Indexed: 12/14/2022]
Abstract
Ectopic hepatocellular carcinoma (HCC) is very rarely reported. It may occur at various sites. To the best of our knowledge, only one case of ectopic HCC of the diaphragm has been reported. We present another such case with invasion to the lung. Subtotal resection of the left hemidiaphragm, wedge resection of the lung (left lower lobe), and splenectomy were undertaken. Postoperative course was unremarkable; the patient received two courses of adjuvant chemotherapy with cisplatin, VP-16, and bleomycin 1 month later. Follow-up computed tomography and ultrasound were performed 8 months later; there was no local recurrence or distal metastasis.
Collapse
Affiliation(s)
- Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Kung Road 2nd Section, Taipei, 114 Taiwan, ROC
| | | | | | | | | | | |
Collapse
|
29
|
Liu KL, Ho MC, Chen PJ. Ectopic liver with hepatocellular carcinoma in the peritoneum. AJR Am J Roentgenol 2007; 188:W206-7. [PMID: 17242230 DOI: 10.2214/ajr.06.0694] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Kao-Lang Liu
- National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | | | | |
Collapse
|
30
|
Abstract
CASE HISTORY A 14-year-old neutered male Bearded Collie was presented with a history of recurrent, intermittent urinary incontinence of 7 years duration. CLINICAL FINDINGS A large, firm, non-painful mass was found in the mid-abdominal region on palpation. Ultrasonography of the mass revealed a compartmentalised structure with mixed echogenicity, and which did not appear to be associated with any of the abdominal organs. Ultrasound-guided fine needle aspirates contained several clusters of epithelial cells with cytological features of hepatocytes. At exploratory laparotomy, the mass was found in the gastrosplenic ligament within the greater omentum. PATHOLOGICAL FINDINGS AND DIAGNOSIS: Histopathologically, the mass consisted of sheets of hepatocytes, but without the characteristic hepatic architecture. The cells showed moderate variation in nuclear size and were sometimes binucleate. A diagnosis of hepatocellular carcinoma (HCC) in the mesentery was made. CLINICAL RELEVANCE The presence of ectopic hepatic tissue has been reported rarely in man and cats, but not in the dog. Neoplastic transformation of ectopic hepatic tissue is seen in man. This is the first report of the presentation, clinical findings and treatment of a dog with ectopic HCC.
Collapse
Affiliation(s)
- I R Burton
- 1021 Maungakawa Road, RD4, Cambridge, New Zealand
| | | | | | | | | |
Collapse
|
31
|
Leone N, Saettone S, De Paolis P, Carucci P, Brunello F, De Angelis C, Menozzi G, Rizzetto M. Ectopic livers and related pathology: report of three cases of benign lesions. Dig Dis Sci 2005; 50:1818-22. [PMID: 16187180 DOI: 10.1007/s10620-005-2944-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 11/09/2004] [Indexed: 02/07/2023]
Affiliation(s)
- Nicola Leone
- Department of Gastroenterology, Molinette Hospital, Turin, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Çoban Ş, Yüksel O, Köklü S, Ceyhan K, Baykara M, Dökmeci A. Atypical presentation of hepatocellular carcinoma: a mass on the left thoracic wall. BMC Cancer 2004; 4:89. [PMID: 15574203 PMCID: PMC535896 DOI: 10.1186/1471-2407-4-89] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Accepted: 12/01/2004] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma is a common malignancy for which chronic hepatitis B infection has been defined as the most common etiologic factor. The most frequent metastatic sites are the lung, bone, lymphatics, and brain, respectively. Metastases to the chest wall have been reported only rarely. CASE PRESENTATION We report a patient with hepatocellular carcinoma who presented with an isolated metastatic mass on the left anterolateral chest wall in the axillary region. CONCLUSIONS Metastasis of HCC should be included in the differential diagnosis of rapidly growing lesions in unusual localizations, particularly in patients with chronic liver disease even if a primary tumor can not be radiologically identified.
Collapse
Affiliation(s)
- Şahin Çoban
- Department of Gastroenterology, Ankara University Medical School, 06100, Ankara, Turkey
| | - Osman Yüksel
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, 06100, Ankara, Turkey
| | - Seyfettin Köklü
- Department of Gastroenterology, Türkiye Yüksek İhtisas Hospital, 06100, Ankara, Turkey
| | - Koray Ceyhan
- Division of Clinical Cytology, Department of Pathology, Ankara University Medical School, 06100, Ankara, Turkey
| | - Meltem Baykara
- Department of Gastroenterology, Ankara University Medical School, 06100, Ankara, Turkey
| | - Abdulkadir Dökmeci
- Department of Gastroenterology, Ankara University Medical School, 06100, Ankara, Turkey
| |
Collapse
|
33
|
Abstract
Hepatocellular carcinomata are relatively rare in the western hemisphere, but they are much more common in South-East Asia and sub-Saharan Africa due to high endogenous levels of hepatitis B and C. Ectopic liver tissue usually is found incidentally (frequently at cholecystectomy), but it may also be found due to neoplastic changes or compressive effects. Ectopic liver tissue has an increased neoplastic potential over orthotopic liver, which we postulate is due to compromised vascular supply and biliary drainage. These lesions may be susceptible to surgical resection, although long-term follow-up data are poor. Ectopic or accessory liver tissue is a rare condition. Most commonly, it is found incidentally, but it may also be found as a result of neoplasia or compressive effects. These lesions appear to have an increased potential for the development of hepatocellular carcinoma in the absence of malignancy in the mother liver. Due to their anatomical features, these carcinomata appear to be susceptible to curative resection, although long-term follow-up data are poor. These carcinomata have been reported more frequently from South-East Asia than from Western countries; however, the common risk factors for hepatocellular carcinoma, such as infection with hepatitis B or C and cirrhosis, appear to be less implicated than in carcinomata of the orthotopic liver. In ectopic or accessory liver tissue, development of hepatocellular carcinoma may be the result of compromised vascular supply or biliary drainage.
Collapse
Affiliation(s)
- Christine P J Caygill
- UK National Barrett's Oesophagus Registry (UKBOR), University Department of Surgery, Royal Free Hospital, London, UK.
| | | |
Collapse
|