Giant mucinous biliary cystadenoma:a case report

Introduction B iliary cystadenoma and cystadenocarcinoma account for less than 5% of all intrahepatic cystic neoplasms originating from the bile duct.[1,2] The appearance of initial manifestations of the lesions may take years or in their fifth 4] decade.[3, The clinical features and optimal surgical management of the lesions have not been clearly defined. We report a case of giant intrahepatic biliary cystadenoma with mucus-secretion in an attempt to describe the clinical features, diagnosis,…     

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.     

Inflammatory pseudo-tumor of the liver: is pre-operative diagnosis possible?

Inflammatory pseudo-tumors of the liver are rare and difficult to diagnose, mimicking malignant tumors. OBJECTIVES: To specify the circumstances of detection and the clinical, biological, radiological and pathological features of inflammatory pseudo-tumors, in order to improve preoperative diagnosis. METHODS: Diagnosis of inflammatory pseudo-tumors of the liver was performed on surgical specimens in 8 patients from January 1987 to January 2001. We retrospectively analyzed the clinical, biological, radiological and pathological features of these 8 inflammatory pseudo-tumors. RESULTS: All the patients (5 females and 3 males) presented a chronic infectious syndrome and/or previous history of chronic inflammatory disease. The correlation between biological, radiological and pathological aspects showed two distinctive types of inflammatory pseudo-tumors: a type revealed by a biological inflammatory syndrome, with a non encapsulated, heterogeneous and hypervascular lesion at imaging, and a dense fibroblastic inflammatory pseudo-tumor with portal endophlebitis on histology (n=5), and a type without inflammatory syndrome, with an encapsulated, homogeneous, hypovascular lesion at imaging and abundant necrosis on histology (n=3). CONCLUSION: The analysis of previous history, of clinical, biological and radiological presentations, specially MRI, could predict the diagnosis of inflammatory lesion which must be confirmed by trans-parietal biopsy to avoid inappropriate radical hepatectomy.     

Mucinous cystadenoma of the appendix associated with adenocarcinoma of the sigmoid colon and hepatocellular carcinoma of the liver： Report of a case

Mucinous cystadenoma of the appendix is a rarecondition and represents one of the three entities withthe common name mucocele of the appendix.It ischaracterized by a cystic dilatation of the lumen withstasis of mucus inside it.Histopathologically mucoceleis divided into three groups:focal or diffuse mucosalhyperplasia,mucinous cystadenoma and mucinouscystadenocarcinoma.This condition is often associatedwith other neoplasia,especially adenocarcinoma ofthe colon and ovaries.We here describe a 57 year oldmale patient who presented with abdominal discomfort,constipation,fresh blood in stool and frequent urination.He had a big cystadenoma of the appendix associatedwith adenocarcinoma of the colon and hepatocellularcarcinoma of the liver.The patient underwent righthaemicolectomy,sigmoid colon resection and segmentalresection of the liver.Now 3 years later he has noevidence of disease relapse.According to this,westress the need of accurate preoperative diagnosis andintraoperative exploration of the whole abdomen in thesepatients.     

Inflammatory pseudotumor of the liver in association with a gastrointestinal stromal tumor: A case report

Inflammatory pseudotumor of the liver is a rare benignlesion that can mimic a malignant liver neoplasm.A caseof inflammatory pseudotumor of the liver found inassociation with a malignant gastrointestinal stromal tumor(GIST)of the small bowel was reported.The inflammatorypseudotumor was misdiagnosed as a metastasis fromthe GIST by frozen section.A correct diagnosis was madeonly after histopathological examination of the paraffinsection of the resected specimen.This case is particularlyinteresting because of the association of the two rarepathological entities and the diagnostic dilemma that arosefrom the similarity of their histological appearances.Toour knowledge,this association has not been reported inthe literature.     

Intraductal papillary mucinous neoplasm of the biliary tract: a real disease?

Background:

Despite increasing numbers of reports, biliary tract intraductal papillary mucinous neoplasm (BT-IPMN) is not yet recognized as a unique neoplasm. The aim of the present study was to define the presence of BT-IPMN in a large series of resected biliary neoplasms.

Methods:

From May 1994 to December 2006, BT-IPMN cases were identified by reviewing pathology specimens of all resected cholangiocarcinomas and other biliary neoplasms when cystic, papillary or mucinous features were cited in pathology reports.

Results:

BT-IPMN was identified in 23 out of 253 (9%) specimens using the strict histopathological criteria of IPMN. The most common presenting symptom was abdominal discomfort which was present in 15 patients (65%). Only one of the original operative pathology reports used the term IPMN; 16 (70%) used the terms cystic, mucinous and/or papillary. BT-IPMN was isolated to non-hilar extra-hepatic ducts in 12 (52%), intra-hepatic ducts in 6 (26%) and hilar extra-hepatic ducts in 5 patients (22%). Carcinoma was found in association with BT-IPMN in 19 patients (83%); 5-year survival was 38% after resection.

Conclusion:

BT-IPMN occurs throughout the intra- and extra-hepatic biliary system and can be identified readily as a unique neoplasm. Broader acceptance of BT-IPMN as a unique neoplasm may lead to a better understanding of the pathogenesis of biliary malignancies.     

Inflammatory myofibroblastic tumour of the lung: a reactive lesion or a true neoplasm?

Inflammatory myofibroblastic tumour (IMT) of the lung represents an extremely rare type of inflammatory pseudo tumor that appears most commonly in children and young individuals. There has been an ongoing controversy whether an IMT is a reactive lesion or a true neoplasm making the further management extremely challenging. Purpose of the paper is through a literature review to highlight the existence of this rare tumour along with its key features and the management options available.     

Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant: What is the evidence?

The widespread uptake of different machine perfusion(MP) strategies for liver transplant has been driven by an effort to minimize graft injury. Damage to the cholangiocytes during the liver donation, preservation, or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary drainage. This problem continues to trouble clinicians, and may have catastrophic consequences for the graft and patient. Ischemic injury, as a result of compromised hepatic artery flow,...     

Inflammatory pseudotumor of the liver in association with a gastrointestinal stromal tumor：A case report

Inflammatory pseudotumor of the liver is a rare benign lesion that can mimic a malignant liver nioplasm. A case of inflammatory pseudotumor of the liver found in association with a malignant gastrointestinal stromal tumor (GIST) of the small bowel was reported. The inflammatory pseudotumor was misdiagnosed as a metastasis from the GIST by frozen section. A correct diagnosis was made only after histopathological examination of the paraffin section of the resescted specimen. This case is psrticularly interesting because of the association of the two rare pathological entities and the diagnostic dilemma that arose from the similarity of their histological appearances. To our knowledge,this association has not been reported in the literature.     

Doppler measurements: a surrogate marker of liver fibrosis?

OBJECTIVE: The potential diagnostic value of performing Doppler measurements of liver vasculature to assess early stages of liver fibrosis has not been established. Due to the potential clinical impact, this study focused on the correlation between Doppler measurements and histologically proven liver fibrosis. METHODS: Forty-three consecutive patients with chronic viral hepatitis (79% hepatitis C) were enrolled. At the time of liver biopsy, two independent investigators measured maximum and mean blood flow velocity, resistance indices, vessel diameter and blood flow volume in the portal vein, hepatic artery and hepatic veins. All measurements were taken in triplicate. The mean values were correlated to the degree of liver fibrosis using the Ludwig score. RESULTS: Sixty-seven per cent of the patients in our study group had no or only mild fibrosis (Ludwig score stage I or II). Thirty-three per cent showed progressive fibrosis or cirrhosis (Ludwig score stage III or IV). There was a large overlap in the Doppler measurements and findings between the various disease stages. No significant changes of Doppler parameters were detected, even between patients with no or mild fibrosis and patients with severe fibrosis (Ludwig score stage III or IV). CONCLUSIONS: Doppler measurements of the portal vein, hepatic artery and hepatic vein(s) are not a valid surrogate marker of liver fibrosis. Nor are Doppler measurements a useful method to estimate the degree of liver fibrosis.     

Bacillary angiomatosis of the liver, a suspected ultrasound diagnosis?

Infections with Bartonella henselae or Bartonella quintana present with vasoproliferative lesions in skin and parenchymatous organs in immunocompromised patients. A case report of a 38-year-old patient with HIV infection and hepatitis B surface antigen status is described. The dominant clinical symptoms in our patient were fever and icterus. Ultrasonography of the abdomen showed a picture similar to that of liver cirrhosis. Irregular (echorich) nodes with hyper-vascularization were suspected to be hepatocellular carcinoma. Ultrasound guided puncture of one of these lesions and histological examination revealed the diagnosis of bartonella infection. Under antibiotic treatment with clarithromycin and doxycycline the fever and the hyperbilirubinemia decreased. The sonographically detectable lesions reduced in size. Vasoproliferative lesions in immunodeficient patients caused by bartonella infection show a characteristic slightly hyperechogenic irregular pattern at ultrasound. Typically, circumscribed hypervascularization might be shown by color Doppler imaging. Liver cirrhosis and diffuse tumor infiltration should be excluded.