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D'Silva M, Na HY, Cho JY, Han HS, Yoon YS, Lee HW, Lee JS, Lee B, Kim M. Diagnosis and surgical treatment of a rare hepatic angiomyolipoma with internal hemorrhage. Ann Hepatobiliary Pancreat Surg 2021; 25:532-535. [PMID: 34845127 PMCID: PMC8639315 DOI: 10.14701/ahbps.2021.25.4.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/30/2021] [Indexed: 11/17/2022] Open
Abstract
Although angiomyolipoma (AML) is commonly found in the kidney, its appearance in the liver is rare. The first hepatic AML was reported by Ishak in 1976. Since then, there have been various reports of AML. An AML is a tumour affecting adipocytes, muscle tissues, and blood vessels. Hepatic AML has been associated with tuberous sclerosis. Its spontaneous occurrence has also been noticed. It can have a varied presentation with some being asymptomatic, others presenting with a dull aching pain, while some with disastrous consequences due to rupture and torrential bleeding intra-abdominally. Herein, we present a case of a 47-year-old female with a large hepatic AML having an internal hemorrhage that caused changes in hepatic arteries. In our case, magnetic resonance imaging was unable to establish a diagnosis. Intraoperatively, AML caused dilatation and engorgement of vessels around the porta. Immediately post resection, vessel dilatation and engorgement were reduced on table. Another notable feature was that these changes caused no intra-operative or post-operative hemodynamic changes. We report a case of a huge hepatic AML with internal hemorrhage associated with perihepatic vascular changes having a successful surgical treatment.
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Affiliation(s)
- Mizelle D'Silva
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun Suh Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Moonhwan Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Attard A, Piscopo N, Schembri J, Buhagiar T, Cortis K, Ellul P. A Rare Case of PEComa of the Liver. GE Port J Gastroenterol 2021; 28:217-221. [PMID: 34056048 DOI: 10.1159/000509192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/20/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Abigail Attard
- Division of Gastroenterology, Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, Malta
| | - Naomi Piscopo
- Division of Gastroenterology, Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, Malta
| | - John Schembri
- Division of Gastroenterology, Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, Malta
| | - Tiffany Buhagiar
- Histopathology Department, Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, Malta
| | - Kelvin Cortis
- Medical Imaging, Hepatobiliary Radiology and Interventional Oncology, Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, Malta
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, Malta
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Abstract
Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) are the most common primary liver malignancies. HCC and ICC have characteristic imaging findings, but a number of benign entities can appear similar and can cause diagnostic dilemma. Ideally, accurate and timely diagnosis of these conditions can help the patient to avoid a needle biopsy or even unnecessary treatment. In this article, we present various benign liver lesions that display imaging characteristics that are similar to HCC and ICC on magnetic resonance imaging (MRI) and discuss salient features that may assist in accurate diagnosis.
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Affiliation(s)
| | - Hsien Min Low
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Novena, Singapore
| | - Myeong-Jin Kim
- Department of Diagnostic Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Cher Heng Tan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Novena, Singapore
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Kasper P, Holzapfel B, Whaba R, Suchan M, Drebber U, Goeser T, Michels G, Jaspers N. [Abdominal pain and unclear focal liver lesion in 46-year-old female patient]. Internist (Berl) 2019; 61:96-101. [PMID: 31705159 DOI: 10.1007/s00108-019-00698-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A 46-year-old woman presented with recurrent right upper quadrant pain. Abdominal ultrasound revealed an inhomogeneous liver lesion (4 × 7 cm) with complex echotexture. Since further contrast-enhanced imaging tests were inconclusive and lesion integrity remained unclear, a left hemihepatectomy was performed. Histological examination revealed a hepatic epithelioid angiomyolipoma. Hepatic epithelioid angiomyolipoma is a rare, mostly benign, mesenchymal hepatic tumor, composed of smooth muscle cells, adipose tissue, and blood vessels of varying proportions, and its correct diagnosis remains a clinical challenge.
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Affiliation(s)
- P Kasper
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - B Holzapfel
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - R Whaba
- Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - M Suchan
- Klinik für Allgemein‑, Viszeral- und Tumorchirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - U Drebber
- Institut für Pathologie, Universitätsklinikum Köln, Köln, Deutschland
| | - T Goeser
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - G Michels
- Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - N Jaspers
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
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Mitra S, Rathi S, Debi U, Dhiman RK, Das A. Primary Hepatic Leiomyosarcoma: Histopathologist's Perspective of a Rare Case. J Clin Exp Hepatol 2018; 8:321-326. [PMID: 30302051 PMCID: PMC6175749 DOI: 10.1016/j.jceh.2018.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/25/2018] [Indexed: 12/12/2022] Open
Abstract
Primary hepatic leiomyosarcoma is a rare primary mesenchymal tumor of the liver requiring exclusion of any other primary site of origin and histological and immunohistochemical exclusion of other hepatic/extrahepatic tumors with spindle cell morphology. Only about 70 cases are reported in the English literature and many of these tumors have predisposing conditions in the form of immunosuppression or associated malignancies. The occurrence of this tumor in the immunocompetent individual is also known. Histomorphology of this tumor shows a spindle cell lesion which needs to be distinguished from other spindle cell lesions of this region. The main diagnostic challenge of this tumor lies in its rarity, lack of awareness and morphological mimickers in the given site. A complete range of immunohistochemical markers is required to distinguish the lesion from its close morphological mimickers. Here, we discuss a case of primary hepatic leiomyosarcoma in an adult female patient with detailed histomorphological differentials and respective immunoprofiles.
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Key Words
- AFP, Alpha Fetoprotein
- CEA, Carcinoembryonic Antigen
- CEMRI, Contrast Enhanced Magnetic Resonance Imaging
- EBER-ISH
- EBER-ISH, Epstein Barr Encoded RNA-In Situ Hybridization
- EBV, Epstein-Barr Virus
- FDG, Fluorodeoxyglucose
- FNAC, Fine Needle Aspiration Cytology
- GIST, Gastrointestinal Stromal Tumor
- PET-CT, Positron Emission Tomography – Computed Tomography
- SMA
- SMA, Smooth Muscle Antigen
- TPCT, Triple Phasic Computed Tomography
- UGIE, Upper Gastrointestinal Endoscopy
- USG, Ultrasonography
- gastrointestinal stromal tumor
- immunocompetent
- primary hepatic leiomyosarcoma
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Affiliation(s)
- Suvradeep Mitra
- Senior Resident, Department of Histopathology, PGIMER, Chandigarh, India
| | - Sahaj Rathi
- Senior Resident, Department of Hepatology, PGIMER, Chandigarh, India
| | - Uma Debi
- Assistant Professor, Department of Radiology, PGIMER, Chandigarh, India
| | - Radha K. Dhiman
- Professor and Head, Department of Hepatology, PGIMER, Chandigarh, India
| | - Ashim Das
- Professor, Department of Histopathology, PGIMER, Chandigarh, India,Address for correspondence: Ashim Das, Professor, PGIMER, Department of Histopathology, Research Block A, 5th Floor, Chandigarh 160012, India. Tel.: +91 9872223744.
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Mayes J, Heaton N. Angiomyolipoma in a Patient with Situs Inversus Totalis: Managing Two Rare Diseases. Case Reports Hepatol 2016; 2016:5060284. [PMID: 27525134 DOI: 10.1155/2016/5060284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/19/2016] [Indexed: 12/03/2022] Open
Abstract
Hepatic angiomyolipoma is an extremely rare benign hamartomatous lesion. Situs inversus totalis is a genetic condition occurring in 0.01% of the population. Following the kidney, the liver is the second most common site of angiomyolipoma. No consensus on the treatment of hepatic angiomyolipoma has been reached. However, the majority of these tumours are managed conservatively. Situs inversus totalis presents difficulties for procedures and is most commonly an incidental finding. These two conditions have not previously been reported and no genetic link has been established between them. This paper reports the association of both conditions in a 74-year-old female, reviews the literature, and presents CT imaging of the case.
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Zhou DS, Wang HB, Zhou ZG, Zhang YJ, Zhong Q, Xu L, Huang YH, Yeung SC, Chen MS, Zeng MS. TACC3 promotes stemness and is a potential therapeutic target in hepatocellular carcinoma. Oncotarget 2016. [PMID: 26219398 PMCID: PMC4695177 DOI: 10.18632/oncotarget.4643] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Transforming acidic coiled-coil protein 3 (TACC3) is essential for cell mitosis and transcriptional functions. In the present study, we first demonstrated that both TACC3 protein and mRNA levels were elevated in HCC tissue samples compared with non-cancerous tissue biopsies according to western blot analyses, immunohistochemistry (IHC) and quantitative real-time PCR (qRT-PCR) assays. Moreover, high TACC3 expression was positively correlated with poor overall survival (OS) and disease-free survival (DFS) (p < 0.001). Using HCC cell lines, we then demonstrated that either TACC3 knockdown or treatment with the potential TACC3 inhibitor KHS101 suppressed cell growth and sphere formation as well as the expression of stem cell transcription factors, including Bmi1, c-Myc and Nanog. Silencing TACC3 may suppress the Wnt/β-catenin and PI3K/AKT signaling pathways, which regulate cancer stem cell-like characteristics. Taken together, these data suggest that TACC3 is enriched in HCC and that TACC3 down-regulation inhibits the proliferation, clonogenicity, and cancer stem cell-like phenotype of HCC cells. KHS101, a TACC3 inhibitor, may serve as a novel therapeutic agent for HCC patients with tumors characterized by high TACC3 expression.
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Affiliation(s)
- Dong-Sheng Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.,Shandong Provincial Qianfoshan Hospital, Jinan, P. R. China
| | - Hong-Bo Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.,Guangdong Provincial Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, P. R. China
| | - Zhong-Guo Zhou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Yao-Jun Zhang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Qian Zhong
- Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Li Xu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Yue-Hua Huang
- Guangdong Provincial Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, P. R. China
| | - Sai-Ching Yeung
- Department of General Internal Medicine, Ambulatory Treatment and Emergency Care, University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Min-Shan Chen
- Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
| | - Mu-Sheng Zeng
- Sun Yat-sen University Cancer Center, State Key Laboratory of Southern China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
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Aoki H, Arata T, Morihiro T, Kanaya N, Takeda S, Sui K, Shigeyasu K, Katsuda K, Tanakaya K, Takeuchi H. Spontaneous rupture of a hepatic angiomyolipoma: Report of a case. Clin J Gastroenterol 2014; 7:429-33. [PMID: 26184024 DOI: 10.1007/s12328-014-0517-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/16/2014] [Indexed: 12/15/2022]
Abstract
A 70-year-old female experienced sudden onset of back pain on the right side and was admitted to our hospital in December 2010. Abdominal computed tomography revealed an S7 hepatic mass measuring 7 cm in diameter accompanied by a subcapsular hematoma. Emergency angiography confirmed the diagnosis of a ruptured hepatic mass, and hemostasis was carried out by embolization of A8 and A7 of the liver. A right hepatic lobectomy was carried out 39 days following transarterial embolization. Although almost all aspects of the tumor were necrotic, residual tumor cells stained positive for HMB-45, and negative for α-SMA, S-100, CD 34, c-kit, CAM 5.2, and hepatocytes. The MIB-1 index was 2 %. Pathological diagnosis was hepatic angiomyolipoma (HAML). The patient has shown no signs of recurrence at 42 months following surgery. Here, we report on this case of spontaneous HAML rupture and discuss therapeutic strategies for HAML and ruptured hepatic tumors.
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Affiliation(s)
- Hideki Aoki
- Department of Surgery, National Hospital Iwakuni Clinical Center, 1-1-1 Atago-cho, Iwakuni, Yamaguchi, 740-8510, Japan,
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Huang G, Sun T, Zhang L, Wu Q, Zhang K, Tian Q, Huo R. Combined application of alginate dressing and human granulocyte-macrophage colony stimulating factor promotes healing in refractory chronic skin ulcers. Exp Ther Med 2014; 7:1772-1776. [PMID: 24926383 PMCID: PMC4043589 DOI: 10.3892/etm.2014.1652] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/21/2014] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to evaluate the clinical therapeutic effect of the combined application of alginate and recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on the healing of refractory chronic skin ulcers. A single center, three arm, randomized study was performed at Jinan Central Hospital (Jinan, Shandong, China). A total of 60 patients with refractory chronic skin ulcers, which persisted for >1 month, were enrolled and randomly assigned into one of the following three groups: alginate dressing/rhGM-CSF group (group A), rhGM-CSF only group (group B) and conventional (vaseline dressing) group (group C). The wound area rate was measured, granulation and color were observed and pain was evaluated. The data were summarized and statistical analysis was performed. The results demonstrated that group A exhibited a significantly faster wound healing rate and lower pain score compared with the other groups (P<0.01). In conclusion, the combined application of alginate dressing and rhGM-CSF for the treatment of refractory chronic skin ulcers demonstrated significant advantages. It promoted the growth of granulation tissue, accelerated re-epithelialization and also effectively reduced wound pain, and thus improved the quality of life for the patient. This suggests that the combined application of alginate and rhGM-CSF may be an effective therapeutic strategy for the clinical treatment of refractory chronic skin ulcers.
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Affiliation(s)
- Guobao Huang
- Department of Burn and Plastic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China ; Department of Burn and Plastic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Tangqing Sun
- Department of Burn and Plastic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Lei Zhang
- Department of Burn and Plastic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Qiuhe Wu
- Department of Burn and Plastic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Keyan Zhang
- Department of Burn and Plastic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Qingfen Tian
- Department of Burn and Plastic Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan, Shandong 250013, P.R. China
| | - Ran Huo
- Department of Burn and Plastic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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