Solitary fibrous tumor of the liver

BACKGROUND: Solitary fibrous tumor of the liver is a rare neoplasm. So far, 23 cases have been described in the English literature. We reported an additional case. METHODS: A 46-year-old woman presented with abdominal mass for 2 weeks. Both abdominal sonography and CT scan showed a solid mass occupying the right lobe of the liver. Right lobectomy was performed and the tumor was resected. RESULTS: Pathological examination showed spindle cell and fibroblast-like cells within the collagenous troma. On immunohistochemical staining, these spindle tumor cells showed diffusely CD34 positive reactivity. The post-operative course was uneventful. The patient recovered smoothly, and was alive half a year without evidence of disease recurrence. CONCLUSIONS: The proper diagnosis was depended on CD34 immunohistochemical study. The number of solitary fibrous tumor of the liver reported to date is too limited to confirm the definite prognosis of the tumor.     

A new approach to the surgical treatment of parasitic cysts of the liver： Hepatectomy using the liver hanging maneuver

AIM： To review 11 patients with parasitic cysts of the liver, who were treated by hepatic Iobectomy using the liver hanging maneuver （LHM）.
METHODS： Between January 2003 and June 2006, we retrospectively analyzed patients who underwent surgical treatment due to parasitic cysts of the liver, at the Ege University School of Medicine, Department of General Surgery. Of these, the patients who underwent hepatic lobectomy using the LHM were reviewed and evaluated for surgical treatment outcome.
RESULTS： Over a three-year period, there were 102 patients who underwent surgical treatment for parasitic cysts of the liver. Of these, 11 （10%） patients with parasitic cysts of the liver underwent hepatic Iobectomy using the LHM. Presenting symptoms were abdominal pain, dyspepsia, and cholangitis. Cyst locations were as follows： right lobe filled with cyst, 7 （63%）; segmental location, 2 （18%）; and multiple locations, 2 patients （18%）. All patients underwent hepatic Iobectomy with an anterior approach using the LHM. The intraoperative blood transfusion requirement was one unit for 3 patients and two units for one patient. Postoperative complications included pulmonary atelectasy （2, 18%） and pleural effusion （2, 18%）. No significant morbidity or mortality was observed.
CONCLUSION： We concluded that hepatic Iobectomy using the LHM should be considered, not only for hepatic tumors or donor hepatectomy, but also to treat parasitic cysts of the liver.     

What is the long-term outcome of the liver allograft?

With improved long-term survival following liver transplantation (LT), issues relating to the assessment of the liver allograft in long-term survivors are becoming increasingly relevant. Histological abnormalities are commonly present in late post-transplant biopsies, including protocol biopsies from patients who appear to be well with good graft function. Recurrent disease is the commonest recognised cause of abnormal graft histology, but may be modified by the effects of immunosuppression or interactions with other graft complications, resulting in complex or atypical changes. Other abnormalities seen in late post-transplant biopsies include rejection (which often has different appearances to those seen in the post-transplant period), de novo disease, "idiopathic" post-transplant hepatitis (IPTH) and nodular regenerative hyperplasia. In many cases graft dysfunction has more than one cause and liver biopsy may help to identify the predominant cause of graft damage. Problems exist with the terminology used to describe less well understood patterns of graft injury, but there is emerging evidence to suggest that late rejection, de novo autoimmune hepatitis and IPTH may all be part of an overlapping spectrum of immune-mediated injury occurring in the late post-transplant liver allograft. Careful clinico-pathological correlation is very important and the wording of the biopsy report should take into account therapeutic implications, particularly whether changes in immunosuppression may be indicated. This article will provide an overview of the main histological changes occurring in long-term survivors post-LT, focusing on areas where the assessment of late post-transplant biopsies is most relevant clinically.     

What determines ageing of the transplanted liver?

Background

Liver transplantation is used to treat patients with irreversible liver failure from a variety of causes. Long-term survival has been reported, particularly in the paediatric population, with graft survival longer than 20 years now possible. The goal for paediatric liver transplantation is to increase the longevity of grafts to match the normal life expectancy of the child. This paper reviews the literature on the current understanding of ageing of the liver and biomarkers that may predict long-term survival or aid in utilization of organs.

Methods

Scientific papers published from 1950 to 2013 were sought and extracted from the MEDLINE, PubMed and University of Melbourne databases.

Results

Hepatocytes appear resistant to the ageing process, but are affected by both replicative senescence and stress-related senescence. These processes may be exacerbated by the act of transplantation. The most studied biomarkers are telomeres and SMP-30.

Conclusion

There are many factors that play a role in the ageing of the liver. Further studies into biomarkers of ageing and their relationship to the chronological age of the liver are required to aid in predicting long-term graft survival and utilization of organs.     

Inflammatory pseudotumour of the liver: the residuum of a biliary cystadenoma?

Inflammatory pseudotumour is a rare form of a liver mass. We report the case of a 28-year-old man presenting with obstructive jaundice, in whom an inflammatory pseudotumour arose with the resolution of a mucus secreting cystic liver lesion. The initial features suggested an intrahepatic cystadenoma or cystadenocarcinoma, which on its involution left a solid mass. Histopathology showed an inflammatory pseudotumour with no evidence of malignancy. A similar case has been reported recently, with the development of an inflammatory pseudotumour following collapse of a liver cyst seen on imaging. These two cases may shed some light on the origins of these rare liver lesions.     

Hamartomatous lesion of the liver in an adult patient with biliary dilatations: a variant of inflammatory pseudotumor of the liver?

An unusual tumor-like lesion (1.2 cm in diameter) in the left lobe of the liver in a 67-year-old woman with dilatations of the common and hepatic bile ducts is reported. Histologically, this lesion was composed of hyalinized connective tissue, several dilated bile ducts with periductal fibrosis and biliary epithelial proliferation, lymphocytic and plasmacytic infiltrates, stenotic venous and arterial vasculature, and nerve bundles. Although these elements were found in a disordered pattern and appeared to have a hamartomatous etiology, each of these pathologic components seemed inflammatory in character. Besides, clinical data disclosed that this lesion was acquired in origin. Although such a hepatic tumor-like lesions has not previously been reported to the best of our knowledge, this tumorous lesion shared features of hepatobiliary lesions reported in intrahepatic calculi, a form of chronic cholangitis. It seems likely that this tumor-like lesion might have arisen from localized chronic cholangitis, possibly related to the dilatations of the common and hepatic ducts, and we suggest that this lesion be named "fibroductal variant" of inflammatory pseudotumor of the liver.     

Relationship between the severity of hepatitis C virus-related liver disease and the presence of Helicobacter species in the liver： A prospective study

INTRODUCTION Chronic hepatitis C virus (HCV) infection is a major public health problem with over 170 million people infected worldwide. It is the leading cause of chronic liver disease and the main indication for liver transplantation in the Western worl…     

Inflammatory pseudotumor of the liver: 13 cases of MRI findings

INTRODUCTIONInflammatory pseudotumor of the liver,a rarebenign lesion,is often confused with the malignanttumors.Until 1998,less than 80 cases had beenreported in the world.The accuracy of the pre-surgical diagnosis was low,and very fewmaterials on the diagnosis using dynamic MRI werereported.We collected thirteen cases ofinflammatory pseudotumor of the liver werecollected and proved by pathology with MRIstudies.Our purpose is to describe and analyze theMR!findings of this lesion and find out the valuablesigns suggesting the diagnosis so as to avoidunnecessary operations.     

The role of liver biopsy in the workup of liver dysfunction late after SCT: is the role of iron overload underestimated?

Abnormalities in liver function tests are common in hematopoietic SCT (HSCT) recipients. We retrospectively investigated the role of liver biopsy in determining the cause of elevated liver enzymes and its impact on the management of patients in the post-HSCT setting. A total of 24 consecutive liver biopsies were obtained from 20 patients from September 2003 to December 2007. A definite histopathologic diagnosis was obtained in 91.7% of the biopsies. Iron overload (IO) was found in 75% and GVHD in 54.2% of the patients. The initial clinical diagnosis of GVHD was confirmed in 56.5% and refuted in 43.5% of the allogeneic HSCT recipients. The median number of post transplant transfusions, percent transferrin saturation and ferritin levels were found to be higher in patients who had histologically proven hepatic IO (p1=0.007, p2=0.003 and p3=0.009, respectively). Regression analysis showed a significant correlation between serum ferritin levels and histological grade of iron in the hepatocytes. Our data suggest that hepatic IO is a frequent finding in the post-HSCT setting, which contributes to hepatic dysfunction and it should be considered in the differential diagnosis, particularly in patients with high serum ferritin levels.     

What features of the pathological morphology of the liver increase the accuracy of diagnostic imaging for cirrhosis?

Journal of Gastroenterology -     

A symptomatic cyst of the ligamentum teres of the liver： A case report

Cysts of the liver ligaments are extremely rare and cysts of the ligamentum teres of the liver have been sporadically reported in the literature during the last century. The present report describes a case of a symptomatic patient with a cyst of the ligamentum teres of the liver. The patient presented with right upper quadrant pain and indigestion during the last 2 years. Ultrasound and computed tomography scans revealed a water-density mass attached to the anterior abdominal wall, but definite diagnosis could not be reached. The cyst was completely excised during laparotomy. Cysts of the ligamentum teres of the liver, although infrequent, may produce clinical symptoms and require excision. Ultrasound and computed tomography scan preoperatively cannot rule out malignancy, thus exploratory laparotomy and total resection of these lesions are necessary.     

Focal nodular hyperplasia of the liver in 86 patients

Introduction Focal nodular hyperplasia (FNH) of the liver is a rare liver cell-derived benign tumor. It is well described in its classical form, characterized bya stellate central scar and hyperplastic nodules since it was first introduced by Edmondson in 1958.[1] Most FNH are asymptomatic and are discovered incidentally during physical examination, abdominal surgery, or autopsy, but some large FNH may be associated with significant symptoms.[2] To this day, the nature and pathogenesis of …     

Cystic tumors of the liver： A practical approach

Biliary cyst tumors （cystadenoma and cystadenocarcinoma） are an indication for liver resection. They account for only 5% of all solitary cystic lesions of the liver, but differential diagnosis with multiloculated or complicated biliary cysts, atypical hemangiomas, hamartomas and lymphangiomas may be difficult. The most frequent challenge is to differentiate biliary cyst tumors from hemorrhagic cysts. Computerized tomography （CT） and magnetic resonance imaging （MRI） are often not diagnostic and in these cases fine needle aspiration （FNA） is used to confirm the presence of atypical biliary cells. FNA, however, lacks adequate sensitivity and specificity and should always be used in conjunction with imaging. Pre-operative differentiation of cystadenoma from cystadenocarcinoma is impossible and surgery must be performed if a biliary cyst tumor is suspected. When multiple cystic lesions are observed throughout the liver parenchyma, it is important to exclude liver metastasis, of which colonic cancer is the most common primary site. Multiple biliary hamartomas （von Meyenburg complex） can appear as a mixture of solid and cystic lesions and can be confused with cystic metastasis. Strong and uniform T2 hyperintensity on MRI is usually diagnostic, but occasionally a percutaneous biopsy may be required.