|
1
|
Hage F, Mosa AA, Blumenkrantz M, Brown RN, Cavalle Garrido T, Bernier PL. Intrapericardial Ectopic Hepatic Tissue Masquerading as a Fetal Pericardial Tumor. World J Pediatr Congenit Heart Surg 2024; 15:230-232. [PMID: 37832158 PMCID: PMC10949140 DOI: 10.1177/21501351231201851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/07/2023] [Indexed: 10/15/2023]
Abstract
Prenatal diagnosis of pericardial mass, with associated large pericardial effusion, resected postnatally and diagnosed to be ectopic hepatic tissue on pathology.
Collapse
Affiliation(s)
- Fadi Hage
- Division of Pediatric Cardiac Surgery, McGill University, Montreal, Québec, Canada
| | - Alqasem Al Mosa
- Division of Pediatric Cardiac Surgery, McGill University, Montreal, Québec, Canada
| | | | | | | | - Pierre-Luc Bernier
- Division of Pediatric Cardiac Surgery, McGill University, Montreal, Québec, Canada
| |
Collapse
|
|
2
|
Montoya-Montoya O, Palomino Ayala S, Santana Montes M. Ectopic intrapelvic liver as an exceptional cause of female infertility: A case report. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2021; 86:311-313. [DOI: 10.1016/j.rgmxen.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 04/06/2020] [Indexed: 02/07/2023] Open
|
|
3
|
Jhamb S, Pillai H, Maguire C, Palamuthusingam P. Incidental finding of heterotopic supradiaphragmatic liver. J Surg Case Rep 2020; 2020:rjaa394. [PMID: 33101642 PMCID: PMC7568965 DOI: 10.1093/jscr/rjaa394] [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: 08/17/2020] [Accepted: 10/06/2020] [Indexed: 11/13/2022] Open
Abstract
Here we describe a case of heterotopic, supradiaphragmatic liver in a 65-year-old woman who was referred for investigation of a soft tissue gallbladder mass. Contrast-enhanced magnetic resonance imaging revealed adenomyomatosis of the gallbladder and supradiaphragmatic accessory liver tissue. This is a remarkably rare normal variant.
Collapse
Affiliation(s)
- Shaurya Jhamb
- Department of Surgery, Townsville University Hospital, Townsville 4814, Australia
| | - Harshil Pillai
- College of Medicine and Dentistry, James Cook University, Townsville 4814, Australia
| | - Christopher Maguire
- Department of Surgery, Townsville University Hospital, Townsville 4814, Australia
| | | |
Collapse
|
|
4
|
Paez SN, Schawkat K, Garces-Descovich A, Sawhney MS, Mortele KJ. Incidental finding of a supradiaphragmatic caudate lobe on cross-sectional imaging: An exceedingly rare entity. Clin Imaging 2019; 60:79-83. [PMID: 31864205 DOI: 10.1016/j.clinimag.2019.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 02/07/2023]
Abstract
Intrathoracic accessory lobes of the liver are exceedingly rare and usually found incidentally in asymptomatic patients. Its diagnosis poses a real challenge for radiologists due to its rarity, location and rounded solid mass appearance. Herein, we describe the case of a supradiaphragmatic caudate lobe of the liver in a 43-year-old African American woman presenting to the hospital for evaluation of an inferior vena cava (IVC) thrombus with CT. Final diagnosis was achieved by MRI using intravenous contrast material, showing a 4.7 cm by 2.7 cm oval shaped mass, with similar signal intensity to the main liver on all sequences. Appropriate diagnosis of this intrathoracic mass is important to negate the need for unnecessary procedures and set a proper follow up after clinical diagnosis.
Collapse
Affiliation(s)
- S Nicolas Paez
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA..
| | - Khoschy Schawkat
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.; Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University Zurich, Switzerland
| | - Alejandro Garces-Descovich
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Mandeep S Sawhney
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Koenraad J Mortele
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| |
Collapse
|
|
5
|
Mito K, Amano Y, Oshiro H, Matsubara D, Fukushima N, Ono S. Liver heterotopia associated with congenital diaphragmatic hernia: Two case reports and a review of the literature. Medicine (Baltimore) 2019; 98:e14211. [PMID: 30681597 PMCID: PMC6358339 DOI: 10.1097/md.0000000000014211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Liver heterotopia associated with congenital diaphragmatic hernia (CDH) is a rare condition; to the best of our knowledge, only 17 cases have been reported to date. The histogenesis and clinicopathological features are largely unknown. We herein report 2 cases of liver heterotopia associated with CDH along with 17 cases described in the literature to shed light on their clinicopathological characteristics. PATIENT CONCERNS Case 1 was a vaginally delivered male newborn who presented with respiratory distress immediately after birth. Case 2 was a female fetus who was found to have left-sided CDH during gestation. DIAGNOSIS In case 1, a chest X-ray revealed left-sided CDH. In case 2, magnetic resonance imaging performed at 33 weeks of gestation revealed left-sided CDH. INTERVENTIONS Case 1 underwent diaphragmatic patch repair surgery 3 days after birth. Histopathological examination following surgery in case 1 revealed the presence of ectopic liver tissue in the hernia sac. Case 2 was delivered by Cesarean section, and diaphragmatic patch surgery was performed 3 days after birth. During surgery, an isolated nodule was identified on the peritoneal side of the border of the defective foramen of the diaphragm. Histopathological examination following surgery in case 2 confirmed the presence of an epidermal cyst in the hernia sac. In addition, the isolated nodule was histopathologically found to be ectopic liver tissue. OUTCOMES In Case 1, CDH recurred at 6 months after surgery, and a second patch repair surgery was performed. The surgically removed hernia sac was found to contain microscopic ectopic liver tissue on histopathology. Case 1 recovered well after surgery, and there was no critical change during the 10-month postoperative period. Case 2 recovered well after surgery, and there was no critical change during the 20-month postoperative period. LESSONS There were no secondary pathological conditions associated with the presence of ectopic liver in CDH, such as torsion, infarction, rupture, intra-abdominal bleeding, or tumorization. Our observations suggest that liver heterotopia is a rare but asymptomatic condition in patients with CDH.
Collapse
Affiliation(s)
- Kumiko Mito
- Department of Diagnostic Pathology, Jichi Medical University Hospital
| | - Yusuke Amano
- Department of Diagnostic Pathology, Jichi Medical University Hospital
| | - Hisashi Oshiro
- Department of Diagnostic Pathology, Jichi Medical University Hospital
| | - Daisuke Matsubara
- Department of Diagnostic Pathology, Jichi Medical University Hospital
| | | | - Shigeru Ono
- Division of Pediatric Surgery, Department of Surgery, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| |
Collapse
|
|
6
|
Burke EP, Harkins P, Arih I, O'Donoghue G. A case of ectopic liver tissue adherent to the gallbladder. J Surg Case Rep 2018; 2018:rjy128. [PMID: 29942476 PMCID: PMC6009597 DOI: 10.1093/jscr/rjy128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/05/2018] [Accepted: 06/05/2018] [Indexed: 12/28/2022] Open
Abstract
We report a case of a 30-year-old lady who presented to the emergency department with a 1 day history of severe epigastric pain which radiated to the back. Focused history, physical exam findings, haematological and radiological investigations, including ultrasound scanning of the abdomen, supported the diagnosis of acute gallstone pancreatitis. She was managed conservatively and underwent elective laparoscopic cholecystectomy at a later date. Intraoperatively, there was noted to be a small nodule loosely adherent to the gallbladder serosa. Histology from this nodule revealed it to be a portion of anatomically normal liver parenchyma also referred to as ectopic liver tissue (ELT). ELT is a rare developmental abnormality in which normally functioning liver tissue develops at an extra-hepatic site. ELT is known to have an increased risk of neoplastic transformation and so we believe it to be of clinical importance.
Collapse
Affiliation(s)
- Eoghan P Burke
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - Patricia Harkins
- Department of Surgery, Tallaght University Hospital, Tallaght, Dublin, Ireland
| | - Ilona Arih
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - Gerry O'Donoghue
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| |
Collapse
|
|
7
|
Accessory liver within the thoracic cavity. Surg Radiol Anat 2018; 40:1085-1091. [PMID: 29860552 DOI: 10.1007/s00276-018-2046-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/31/2018] [Indexed: 02/07/2023]
Abstract
Ectopic intrathoracic liver tissue is extremely rare. Studies are mainly limited to case reports. In the vast majority of reported cases, a diagnosis of intrathoracic liver tissue was made either after a thoracic surgery or during a postmortem examination. However, once included in differential diagnosis, surgical intervention or biopsy procedures may be avoided with optimal diagnostic approach. In the present study, we conducted a literature review and proposed a new classification method for accessory liver within the thoracic cavity. This approach may provide a better understanding of underlying pathophysiology and aid in determination of optimal diagnostic modality and clinical management of such cases. According to our literature review, type II ectopic liver is the most common subtype followed by types I and III. All types can be definitively diagnosed with imaging modalities. On the other hand, it is important to prevent patients, particularly children, from unnecessary radiation exposure during performance of sophisticated diagnostic imaging modalities. Ultrasound is a safe, low-cost and accessible imaging modality that has not been previously reported in diagnosis of this entity. With addition of Color Doppler Imaging, ultrasound may allow for diagnosis with high precision in types I and II, as demonstrated in the present study. Based on long-term follow-up of a case reported here, this study also illustrates the natural course of this entity via non-operative management. This approach may prevent an unnecessary surgical intervention.
Collapse
|
|
8
|
Yao J, Guihard PJ, Wu X, Blazquez-Medela AM, Spencer MJ, Jumabay M, Tontonoz P, Fogelman AM, Boström KI, Yao Y. Vascular endothelium plays a key role in directing pulmonary epithelial cell differentiation. J Cell Biol 2017; 216:3369-3385. [PMID: 28838957 PMCID: PMC5626536 DOI: 10.1083/jcb.201612122] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/26/2017] [Accepted: 07/12/2017] [Indexed: 12/19/2022] Open
Abstract
J. Yao et al. demonstrate that loss of MGP, a BMP inhibitor, causes abnormal hepatic differentiation in lungs. They find that interactions between endothelium and epithelium separate pulmonary from hepatic differentiation during development. Lack of MGP triggers hepatic differentiation in the pulmonary epithelium, as regulated by the endothelium. The vascular endothelium is critical for induction of appropriate lineage differentiation in organogenesis. In this study, we report that dysfunctional pulmonary endothelium, resulting from the loss of matrix Gla protein (MGP), causes ectopic hepatic differentiation in the pulmonary epithelium. We demonstrate uncontrolled induction of the hepatic growth factor (HGF) caused by dysregulated cross talk between pulmonary endothelium and epithelium in Mgp-null lungs. Elevated HGF induced hepatocyte nuclear factor 4 α (Hnf4a), which competed with NK2 homeobox 1 (Nkx2.1) for binding to forkhead box A2 (Foxa2) to drive hepatic differentiation in Mgp-null airway progenitor cells. Limiting endothelial HGF reduced Hnf4a, abolished interference of Hnf4a with Foxa2, and reduced hepatic differentiation in Mgp-null lungs. Together, our results suggest that endothelial–epithelial interactions, maintained by MGP, are essential in pulmonary cell differentiation.
Collapse
Affiliation(s)
- Jiayi Yao
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Pierre J Guihard
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Xiuju Wu
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Ana M Blazquez-Medela
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Melissa J Spencer
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Medet Jumabay
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Peter Tontonoz
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,Department of Pathology and Laboratory Medicine, Howard Hughes Medical Institute, University of California, Los Angeles, Los Angeles, CA.,Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA
| | - Alan M Fogelman
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Kristina I Boström
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA .,Molecular Biology Institute, University of California, Los Angeles, Los Angeles, CA
| | - Yucheng Yao
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA .,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
|
9
|
Abstract
Heterotopic liver tissue is a relatively rare finding, which has historically been discovered incidentally during surgery or at autopsy. However, we present a 28-year-old woman who presented to the emergency department with shortness of breath and stabbing chest pain. An emergent CT angiogram of the chest was performed, which incidentally revealed a mediastinal paraesophageal mass. Subsequent endoscopic ultrasound showed a hypoechoic area that appeared to connect to the liver. A liver/spleen scan with SPECT/CT with Tc sulfur colloid demonstrated that the mass was paraesophageal heterotopic liver tissue with a connection to the orthotropic liver by a small stalk.
Collapse
|
|
10
|
Corsi A, Riminucci M. Liver heterotopia in the head of a patient with osteosarcoma of the maxilla. A paracrine tumor-induced hepatogenesis? Hum Pathol 2016; 60:147-150. [PMID: 27597524 DOI: 10.1016/j.humpath.2016.08.008] [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] [Received: 06/17/2016] [Revised: 08/03/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
Abstract
Heterotopia of liver tissue is uncommon. It has been reported at various sites, more frequently near the orthotopic liver, including gallbladder, hepatic ligaments, omentum, and retroperitoneum, rarely within the diaphragm and the thoracic cavity, and never within the head. We report here a 22-year-old patient surgically treated for a maxillary osteosarcoma in which microscopic liver tissue islands were incidentally detected in the respiratory mucosa of the surgical margin. The islands comprised well-differentiated HepPar-1-positive hepatocytes and were surrounded by cytokeratin-7- and cytokeratin-19-positive bile duct-like structures. This case, which is unique in the medical literature, may suggest an inductive paracrine effect of the osteosarcoma cells by secretion of factors promoting hepatocyte specification of primitive endodermal progenitors and subsequent liver morphogenesis.
Collapse
Affiliation(s)
- Alessandro Corsi
- Department of Molecular Medicine, Sapienza University, 00161 Rome, Italy.
| | - Mara Riminucci
- Department of Molecular Medicine, Sapienza University, 00161 Rome, Italy.
| |
Collapse
|
|
11
|
Cruz SM, Akinkuotu AC, Cass DL, Lee TC, Cassady CI, Mehollin-Ray AR, Ruano R, Welty SE, Olutoye OO. Space occupying lesions in the presence of congenital diaphragmatic hernia. J Pediatr Surg 2016; 51:710-3. [PMID: 26995524 DOI: 10.1016/j.jpedsurg.2016.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/07/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Previous reports describe lung malformations and other chest lesions in association with congenital diaphragmatic hernia (CDH), yet little is known how these lesions affect outcomes. We sought to evaluate the incidence and outcomes of patients diagnosed with chest lesions in association with CDH. METHODS The charts of all infants treated for CDH in a single tertiary center from January 2004 to January 2015 were reviewed. The outcomes of those with space occupying lesions (SOLs) in association with CDH were compared to those with isolated CDH. Statistical analysis was performed using Student's t-test and Mann-Whitney U test for continuous variables and Fisher's exact for categorical variables. RESULTS Of the 214 infants treated, 20 had an associated SOL (4 had>1 lesion). SOLs were confirmed by pathological examination and included: bronchopulmonary sequestration (n=10; 4.7%), ectopic liver (n=9; 4.2%), foregut duplication cyst (n=2; 1%), and other lesions (n=3; 1.4%). No statistical difference was noted in the long-term outcomes of patients with SOL in comparison to those with isolated CDH. CONCLUSION SOLs are not uncommon in neonates with CDH. Despite theoretical concerns, there is no evidence that SOLs are associated with worse outcomes, a finding which is helpful during prenatal counseling of families.
Collapse
Affiliation(s)
- Stephanie M Cruz
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States
| | - Adesola C Akinkuotu
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States
| | - Darrell L Cass
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Timothy C Lee
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States
| | - Christopher I Cassady
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Amy R Mehollin-Ray
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Rodrigo Ruano
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
| | - Stephen E Welty
- Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Pediatrics-Newborn Section, Baylor College of Medicine, Houston, TX, United States
| | - Oluyinka O Olutoye
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, United States; Texas Children's Fetal Center, Texas Children's Hospital, Houston, TX, United States; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States.
| |
Collapse
|
|
12
|
Moody WE, Hübscher SG, Rooney SJ, Doshi SN. Intracardiac ectopic liver mimicking atrial myxoma--An unusual cause for a right atrial mass. Int J Cardiol 2016; 209:210-2. [PMID: 26896625 DOI: 10.1016/j.ijcard.2016.02.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/02/2016] [Indexed: 01/31/2023]
Affiliation(s)
- William E Moody
- Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK.
| | - Stefan G Hübscher
- Institute of Immunology & Immunotherapy, University of Birmingham, Department of Cellular Pathology, Queen Elizabeth Hospital, Birmingham B15 2WB, UK
| | - Stephen J Rooney
- Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
| | - Sagar N Doshi
- Department of Cardiology, Nuffield House, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham B15 2TH, UK
| |
Collapse
|
|
13
|
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: 1.7] [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
|
|
14
|
Chen YY, Huang TW, Chang H, Hsu HH, Lee SC. Intrathoracic caudate lobe of the liver: A case report and literature review. World J Gastroenterol 2014; 20:5147-5152. [PMID: 24803833 PMCID: PMC4009555 DOI: 10.3748/wjg.v20.i17.5147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/09/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Heterotopic supradiaphragmatic livers are rare. A total of 23 cases of primary supradiaphragmatic livers have been reported in the literature. The clinical presentations of heterotopic supradiaphragmatic liver are variable. The simultaneous detection of intrathoracic accessory liver and pulmonary sequestration is extremely rare, and only one case has previously been reported. It is difficult to make a correct diagnosis preoperatively. We presented a 53-year-old woman with complaints of an intermittent, productive cough and dyspnea for two months that was refractory to medical treatment. She had no previous history of trauma or surgery. A chest radiograph only showed a widening of the mediastinum. Contrast-enhanced computed tomography of the chest revealed a well-circumscribed homogenous soft-tissue mass, approximately 4.35 cm × 2.5 cm × 6.14 cm in size, protruding through the right diaphragmatic crura to the right pleural cavity, attached to the inferior vena cava, esophagus and liver. There was no conclusive diagnosis before surgery. After the operation, we discovered that this patient was the first case of a supradiaphragmatic heterotopic liver, which passed through the inferior vena cava foramen and was coincidentally combined with an intralobar pulmonary sequestration that was found intraoperatively. We discussed its successful management with surgical resection via a thoracic approach and reviewed the published literature.
Collapse
|
|
15
|
Smiley K, O'Keefe S, Rasner JN, Iocono JA. Thoracoscopic resection of an intrathoracic accessory liver lobe: an incidental finding in the workup of a child with a respiratory infection. J Pediatr Surg 2013; 48:1618-20. [PMID: 23895983 DOI: 10.1016/j.jpedsurg.2013.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/22/2013] [Accepted: 05/25/2013] [Indexed: 11/17/2022]
Abstract
A case of an intrathoracic accessory liver lobe in a five-year-old female is presented, representing an incidental finding during workup for a respiratory infection. MRI was used to identify what appeared to be an accessory intrathoracic liver lobe. Thoracoscopy confirmed the diagnosis, and removal was achieved through a minimally invasive surgical procedure. Based on an electronic literature search, this is the first known report of minimally invasive techniques to remove accessory liver from the chest in a pediatric patient.
Collapse
Affiliation(s)
- Katherine Smiley
- University of Kentucky College of Medicine, University of Kentucky, Lexington, KY, USA
| | | | | | | |
Collapse
|
|
16
|
Morris MW, Helling TS, Creswell LL, Jordan B, Mitchell ME. Ectopic liver masquerading as a floating intracaval mass. J Vasc Surg 2012; 55:1759-61. [PMID: 22360917 DOI: 10.1016/j.jvs.2011.12.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 12/09/2011] [Accepted: 12/24/2011] [Indexed: 12/17/2022]
Abstract
Ectopic liver is defined as liver parenchyma situated outside the liver proper with no connection to native hepatic tissue. This rare developmental anomaly is most commonly described as an attachment to the gallbladder with an incidence <0.3%, but it has been reported in other locations within the abdomen and thorax.(2-4) Most cases are found incidentally in asymptomatic patients, but ectopic liver has been known to cause visceral or vascular obstruction.(4,5) Herein we present a unique case of ectopic liver attached by a thin stalk seemingly floating in the suprahepatic inferior vena cava.
Collapse
Affiliation(s)
- Michael Wyatt Morris
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS 39216, USA.
| | | | | | | | | |
Collapse
|
|
17
|
Xu L, Jeudy J, Burke AP. Ectopic hepatic tissue presenting as right atrial mass. Hum Pathol 2012; 43:958-60. [PMID: 22277917 DOI: 10.1016/j.humpath.2011.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 10/11/2011] [Accepted: 10/14/2011] [Indexed: 11/17/2022]
Abstract
A 52-year-old woman had a well-circumscribed, mobile mass (1.8 × 1.7 cm) in the right atrium detected by echocardiography and confirmed by magnetic resonance imaging. Subsequent histologic evaluation of the mass revealed benign, ectopic hepatic tissue. Ectopic liver is a rare occurrence, and most frequent anatomical distribution of ectopic hepatic tissue is the region around the gallbladder. In exceptional cases, ectopic liver can be found within the thorax. The reported case demonstrates that ectopic liver should be included in the differential diagnosis of right atrial masses removed surgically.
Collapse
Affiliation(s)
- Lauren Xu
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD 21201, USA
| | | | | |
Collapse
|
|
18
|
An J, Han J, Lee KS, Choi YS. Supradiaphragmatic Heterotopic Liver Presenting as a Pleural Mass: A Case Report. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.3.191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jungsuk An
- Department of Pathology, Gachon University Gil Hospital, Incheon, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
|
19
|
Algin C, Yaylak F, Olgun EG, Caglikulekci M. Laparoscopic removal of an incidental ectopic liver: short report of a case. Case Rep Gastroenterol 2008; 2:134-7. [PMID: 21490853 PMCID: PMC3075181 DOI: 10.1159/000121283] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Ectopic liver is a rare clinical entity, which may be rarely of clinical importance. It is generally reported to be small in size and without a connection to the mother liver. A case of an incidental ectopic liver nodule that was connected with a vascular peduncle to the Couinad segment IVa of the liver has been reported. Microscopic examination revealed chronic inflammatory changes, which should be considered to be the result of intermittent circulatory disturbances.
Collapse
Affiliation(s)
- Cem Algin
- Department of General Surgery, Dumlupinar University Hospital, Kutahya, Turkey
| | | | | | | |
Collapse
|
|
20
|
Gehér P, Füredi A, Kecskés LI. [Videothoracoscopic removal of ectopic liver]. Magy Seb 2007; 60:310-311. [PMID: 18065371 DOI: 10.1556/maseb.60.2007.6.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Authors present a case of an ectopic liver in the chest of a 14 year-old female patient. The lesion was discovered by screening chest X-ray and was consequently removed by videothoracoscopic surgery. A brief literature review was carried out, too.
Collapse
Affiliation(s)
- Pál Gehér
- Vas Megyei Markusovszky Lajos Altalános, Rehabilitációs és Gyógyfürdo Kórház, Egyetemi Oktatókórház, Nonprofit Zrt. Mellkassebészeti Osztály, 9700 Szombathely.
| | | | | |
Collapse
|
|
21
|
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
|
|
22
|
Patel Y, McNally J, Ramani P. Left congenital diaphragmatic hernia, absent pericardium, and liver heterotopia: a case report and review. J Pediatr Surg 2007; 42:E29-31. [PMID: 17502173 DOI: 10.1016/j.jpedsurg.2007.03.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A case of a left congenital diaphragmatic hernia (CDH), absent pericardium, and a hernial sac containing ectopic liver tissue is presented. This triplicate of defects is exceedingly rare with only 2 previous reports in the literature dating back to 1936. This case supports the evidence that CDH is the result of failure of the closure of the pleuroperitoneal canals by the growth of the posthepatic mesenchymal plate. Moreover, the role of the phrenic nerve as a mediator for both CDH and absent pericardium is discussed.
Collapse
Affiliation(s)
- Y Patel
- Department of Paediatric Surgery, Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | | | | |
Collapse
|
|
23
|
Bouchikh M, Zouidia F, Ouadnouni Y, Smahi M, Msougar Y, Lakranbi M, Achir A, Harrak L, Caidi M, Mansouri F, Benosman A. [Intrapulmonary thymic choristoma]. REVUE DE PNEUMOLOGIE CLINIQUE 2007; 63:59-61. [PMID: 17457287 DOI: 10.1016/s0761-8417(07)90092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
|
|
24
|
Robertson DJ, Harmon CM, Goldberg S. Right congenital diaphragmatic hernia associated with fusion of the liver and the lung. J Pediatr Surg 2006; 41:e9-10. [PMID: 16769329 DOI: 10.1016/j.jpedsurg.2006.02.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We present the case of a male infant at a gestational age of 41 weeks who presented with a right congenital diaphragmatic hernia. During surgical exploration, right hepatopulmonary fusion was encountered. We review the existing literature on this problem, describe a novel surgical approach, and review the embryology of this complex lesion.
Collapse
Affiliation(s)
- Daniel J Robertson
- Division of Pediatric Surgery, Children's Hospital of Alabama, University of Alabama-Birmingham, Birmingham, AL 35233, USA
| | | | | |
Collapse
|
|
25
|
Chen F, Heller DS, Bethel C, Faye-Petersen O. Intrathoracic ectopic lobe of liver presenting as pulmonary sequestration. Fetal Pediatr Pathol 2005; 24:155-9. [PMID: 16338877 DOI: 10.1080/15227950500305520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Intrathoracic ectopic lobe of the liver in the presence of a normal intact diaphragm is extremely rare. We report a case of a 13-month-old male initially diagnosed with pneumonia and pulmonary sequestration who was found to have an intrathoracic liver lobe and intact diaphragm. The presence of this condition suggests an event preceding closure of the diaphragm and illustrates the unique potential of pediatric pathology to shed light on human embryology.
Collapse
Affiliation(s)
- Fan Chen
- Department of Pathology, UMDNJ-New Jersey Medical School, Newark, New Jersey 07101, USA
| | | | | | | |
Collapse
|
|
26
|
Abstract
A large ectopic liver nodule connected to the greater omentum had undergone infarction and separation because of torsion of its connecting stalk and was the cause of acute abdominal pain and elevated liver enzymes in a young female child. At laparotomy for a suspected perforated appendicitis, a hemorrhagic peritoneal fluid was found, together with an intraperitoneal solid mass lying freely in the right iliac fossa. The definitive diagnosis was obtained by histopathology. This is the first known such reported case.
Collapse
Affiliation(s)
- Hussain B Elsayes
- Department of Surgery, Alfujairah Hospital, PO Box 4841, Alfujairah, UAE.
| | | | | | | |
Collapse
|
|
27
|
Abstract
The authors describe a case of supradiaphragmatic accessory liver seen on prenatal ultrasound examinations, mimicking fetal hydrothorax and causing life-threatening respiratory failure after birth. The accessory liver with a transdiaphragmatic pedicle to the caudate lobe of the normal liver was found at throracotomy after failure to expand the lung by chest drainage. The "hydrothorax" turned out to be multilocular mesothelial cyst collection surrounding the ectopic liver. This is the first report of the development of a thoracic accessory liver followed by obstetric ultrasound examinations.
Collapse
Affiliation(s)
- Reijo Luoma
- King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
| | | |
Collapse
|