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1
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Nakashima Y, Hiramatsu K, Fukaya M, Aoba T, Arimoto A, Yamashita H, Arai Y, Kato T. A case of hepatocellular carcinoma arising from the intraductal hepatic bile duct without parenchymal lesion. Clin J Gastroenterol 2025; 18:195-201. [PMID: 39433708 DOI: 10.1007/s12328-024-02054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Accepted: 10/14/2024] [Indexed: 10/23/2024]
Abstract
Hepatocellular carcinoma (HCC) rarely presents as an intraductal tumor with no parenchymal lesions. Here, we present a case of HCC arising from an intrahepatic bile duct. A 74-year-old man who had been treated with direct-acting antiviral therapy for hepatitis C virus infection was referred to our hospital because of elevated serum prothrombin levels induced by vitamin K absence II (PIVKA-II). Initial imaging revealed no findings suspicious of HCC; however, repeat CT six months later revealed dilation of the intrahepatic bile ducts in the lateral segment of the liver. Cholangiography revealed a significant stricture of B3, and biopsy suggested adenocarcinoma. A left hepatectomy was performed with a preoperative diagnosis of intrahepatic cholangiocarcinoma. Although a surface nodule on the lateral segment of the liver, suspicious for intrahepatic metastasis, was found intraoperatively, radical resection was performed. Histopathological examination revealed a tumor filling the intrahepatic bile duct from the stump to the peripheral bile duct, with no infiltration into the liver parenchyma. The surface nodule is a dilated peripheral bile duct filled with a tumor with no extrabiliary invasion. Immunohistochemistry suggested HCC. No tumor lesions were observed in the hepatic parenchyma, and the tumor was finally diagnosed as HCC stemming from the biliary epithelium.
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Affiliation(s)
- Yu Nakashima
- Department of General Surgery, Toyohashi Municipal Hospital, 50 Hachiken-Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan.
| | - Kazuhiro Hiramatsu
- Department of General Surgery, Toyohashi Municipal Hospital, 50 Hachiken-Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Masahide Fukaya
- Department of General Surgery, Toyohashi Municipal Hospital, 50 Hachiken-Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Taro Aoba
- Department of General Surgery, Toyohashi Municipal Hospital, 50 Hachiken-Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Atsuki Arimoto
- Department of General Surgery, Toyohashi Municipal Hospital, 50 Hachiken-Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Hiromasa Yamashita
- Department of General Surgery, Toyohashi Municipal Hospital, 50 Hachiken-Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
| | - Yoshifumi Arai
- Department of Pathology, Toyohashi Municipal Hospital, Toyohashi, Japan
| | - Takehito Kato
- Department of General Surgery, Toyohashi Municipal Hospital, 50 Hachiken-Nishi, Aotake-Cho, Toyohashi, Aichi, 441-8570, Japan
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2
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Xu Z, Stanton CN, Ahsan BU. Ectopic Liver Tissue Associated With the Gallbladder: Two Unique Patients and a Literature Review. Int J Surg Pathol 2024; 32:791-795. [PMID: 37488488 DOI: 10.1177/10668969231188910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Ectopic/accessory liver tissue is a rare developmental anomaly thought to be due to abnormal development of the liver during embryogenesis. Most patients with ectopic liver tissue are asymptomatic, and the condition is usually discovered incidentally during intraabdominal surgery or autopsy. In rare symptomatic cases, patients' presentations can range from mild liver function test abnormalities to severe abdominal pain or discomfort secondary to torsion and ischemia. Here, we report 2 patients with ectopic liver tissue identified incidentally during cholecystectomy: one with histologic manifestations of sickle cell congestion and the other with steatohepatitis. A possible relationship between ectopic liver tissue and gallbladder and biliary diseases, such as cholecystitis, has been proposed. To the best of our knowledge, ectopic liver tissue with sickle cell congestion has not been reported previously.
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Affiliation(s)
- Zhengfan Xu
- Department of Pathology and Laboratory Services, Henry Ford Hospital, Detroit, USA
| | - Cletus N Stanton
- Department of Surgery, Henry Ford Hospital and Henry Ford Macomb, Detroit, USA
| | - Beena U Ahsan
- Department of Pathology and Laboratory Services, Henry Ford Hospital, Detroit, USA
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3
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Imamura H, Taniguchi K, Yamashita M, Adachi T, Eguchi S. Ectopic Liver Tissue on the Gallbladder Wall Encountered During Laparoscopic Cholecystectomy. Cureus 2024; 16:e57088. [PMID: 38681300 PMCID: PMC11052924 DOI: 10.7759/cureus.57088] [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: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Ectopic liver tissue is a rare developmental anomaly that is not directly connected to the liver. We encountered ectopic liver tissue on the surface of the gallbladder wall during laparoscopic cholecystectomy. It has vasculature arising from the liver parenchyma and is classified according to its branching pattern. Ectopic liver tissue has been reported to occur in a variety of locations, and when encountered in surgery, it is clinically important to identify ectopic liver tissue with vascular supply to prevent unexpected bleeding. Ectopic liver tissue should be resected and examined histologically for the potential for malignancy when detected during surgical intervention.
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Affiliation(s)
- Hajime Imamura
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Ken Taniguchi
- Department of Surgery, Nagasaki Harbor Medical Center, Nagasaki, JPN
| | - Mampei Yamashita
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Tomohiko Adachi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, JPN
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4
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Ferjaoui W, Omry A, Changuel A, Mejri K, Mannai MH, Khalifa MB. A rare case report: Gallbladder-associated ectopic liver tissue: Challenges, insights, and surgical considerations. Int J Surg Case Rep 2024; 115:109261. [PMID: 38232414 PMCID: PMC10803931 DOI: 10.1016/j.ijscr.2024.109261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Ectopic liver tissue (ELT), a rare anomaly distinct from accessory liver, challenges conventional embryonic morphogenesis. Unlike the latter, ELT lacks a connection to the main liver, showcasing an unusual growth of normal liver tissue beyond its customary location. This peculiarity poses clinical and radiological challenges for surgeons throughout their careers, particularly during laparoscopic or open procedures. Elevated clinical significance arises from ELT's potential to progress into hepatocellular carcinoma, necessitating heightened awareness among surgeons. CASE REPORT This article presents a compelling case of ELT, discovered incidentally during a planned laparoscopic cholecystectomy. The patient, a 60-year-old female with a history of biliary colic, underwent a meticulous exploration revealing an undistended gallbladder with an unexpected brownish tissue fragment resembling hepatic parenchyma. CLINICAL DISCUSSION Ectopic liver tissue, dating back to early 20th-century records, challenges precise incidence determination. Theories regarding embryonic development around the fourth week in utero provide insights into ELT's origins and displacement from the hepatic diverticulum. Varied attachment locations and potential manifestations in other intra-abdominal and intra-thoracic sites add layers to the complexity of its diagnosis. Radiological studies, though challenging, offer glimpses of ELT, cautioning against percutaneous biopsies due to associated risks. CONCLUSION In conclusion, this case of ELT offers valuable insights into its diagnostic challenges and surgical considerations, underscoring the need for continued research and heightened awareness in the medical community. The rarity and varied presentations of ELT warrant ongoing exploration to refine diagnostic approaches and optimize patient outcomes.
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Affiliation(s)
- Wael Ferjaoui
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Ahmed Omry
- Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.
| | - Amel Changuel
- Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Khouloud Mejri
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Med Hedi Mannai
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Med Bachir Khalifa
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
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5
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Arora GS, Kalra S. Ectopic Liver Tissue Encountered Incidentally During a Laparoscopic Cholecystectomy: A Case Report. Cureus 2023; 15:e42220. [PMID: 37484795 PMCID: PMC10359195 DOI: 10.7759/cureus.42220] [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: 07/20/2023] [Indexed: 07/25/2023] Open
Abstract
A 60-year-old male patient who presented with right upper quadrant (RUQ) pain was diagnosed with acute cholecystitis after an ultrasound of the abdomen revealed multiple gallstones, gallbladder wall thickening, pericholecystic fluid, and a positive sonographic Murphy sign. The patient was admitted, administered IV fluids, antibiotics, and pain relief, and scheduled for laparoscopic cholecystectomy. During surgery, an incidental finding of ectopic liver tissue attached to the gallbladder was noted. Histopathology confirmed the presence of chronic cholecystitis and multifaceted cholesterol stones. Normal liver tissue was noted in the ectopic mass. Ectopic liver tissue is defined as liver tissue located outside the main liver parenchyma and is usually asymptomatic. They are usually detected at the time of autopsies, incidentally during surgeries, or during imaging done for other etiologies. They can occur at various sites in the body. Ectopic liver tissue can cause potential complications such as hepatocellular carcinoma and torsion, and in the event that they are incidentally detected, it is advised to remove them. The case report highlights the importance of dealing with incidental findings during laparoscopic cholecystectomy and creating awareness about it.
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Affiliation(s)
| | - Shivam Kalra
- Department of Internal Medicine, Trident Medical Center, North Charleston, USA
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, IND
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6
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Gan L, Ren S, Lang M, Fang F, Chen L, Song T. Ectopic hepatocellular carcinoma of the right adrenal gland: a case description. Quant Imaging Med Surg 2023; 13:1248-1252. [PMID: 36819251 PMCID: PMC9929416 DOI: 10.21037/qims-22-629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 11/23/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Leijuan Gan
- Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China;,Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Shaohua Ren
- Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China;,Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Mengran Lang
- Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China;,Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Feng Fang
- Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China;,Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Lu Chen
- Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China;,Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Tianqiang Song
- Liver Cancer Center, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China;,Tianjin’s Clinical Research Center for Cancer, Tianjin, China
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7
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Zhang W, Weinberg L, Asadi K, Nikfarjam M. Gallbladder-associated ectopic liver tissue during cholecystectomy. ANZ J Surg 2022; 93:1079-1081. [PMID: 36221184 DOI: 10.1111/ans.18111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/04/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Wendall Zhang
- Department of Anaesthesia, Austin Health, Heidelberg, Australia
| | - Laurence Weinberg
- Department of Anaesthesia, Austin Health, Heidelberg, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, Australia
| | - Khashayar Asadi
- Department of Anatomical Pathology, Austin Health, Heidelberg, Australia
| | - Mehrdad Nikfarjam
- Hepatobiliary and Pancreatic and Liver Transplant Surgery Unit, Austin Health, The University of Melbourne, Melbourne, Australia
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8
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Smiley K, Partrick DA, Corkum KS, Derderian SC. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac036. [PMID: 35154641 PMCID: PMC8829024 DOI: 10.1093/jscr/rjac036] [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: 01/02/2022] [Revised: 01/02/2022] [Accepted: 01/16/2022] [Indexed: 11/14/2022] Open
Abstract
Extrahepatic liver (EL) rests are rare, with a reported annual incidence of 0.24–0.47. While reports often note EL incidentally found on pathologic specimens of aberrant tissue, there has been a case report of hepatocellular carcinoma arising from one of these rests, highlighting the importance of surgical resection. EL has been reported to cause symptoms such as abdominal pain, intraperitoneal bleeding and compression of adjacent organs. Most commonly, it has been identified in the gallbladder, likely due to proximity of the gallbladder to the native liver. The paucity of diagnostic tests makes the preoperative diagnosis challenging. We present a case of a 12-year-old female presenting with severe epigastric pain secondary to incapsulated EL tissue attached to the stomach via a narrow stalk. By describing this case, we hope to improve the diagnosis and management of abdominal masses with unclear etiology.
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Affiliation(s)
- Kyle Smiley
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Correspondence address. University of Colorado Anschutz School of Medicine, 13123 E. 16th Ave Aurora, CO 80045, USA. Tel: +1-804-517-6799; Fax: 720-777-7271; E-mail:
| | - David A Partrick
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Division of Pediatric Surgery, Children’s Hospital Colorado and University of Colorado, Aurora, CO, USA
| | - Kristine S Corkum
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Division of Pediatric Surgery, Children’s Hospital Colorado and University of Colorado, Aurora, CO, USA
| | - S Christopher Derderian
- University of Colorado Anschutz School of Medicine, Aurora, CO, USA
- Division of Pediatric Surgery, Children’s Hospital Colorado and University of Colorado, Aurora, CO, USA
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9
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Moshref LH, Alotaibi AM. Case Report: Ectopic Liver (Choristoma) Discovered During Laparoscopic Cholecystectomy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e932784. [PMID: 34424891 PMCID: PMC8404163 DOI: 10.12659/ajcr.932784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patient: Male, 47-year-old
Final Diagnosis: Ectopic liver
Symptoms: Right upper quadrant pain
Medication:—
Clinical Procedure: —
Specialty: Surgery
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Affiliation(s)
- Leena H Moshref
- Department of Surgery, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Abdulrahman M Alotaibi
- Department of Surgery, Doctor Soliman Fakeeh Hospital, Jeddah, Saudi Arabia.,Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
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10
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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: 14] [Impact Index Per Article: 2.8] [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.
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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
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11
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Kachi A, Bou Rached C, El-Helou E, Kanj M, Kansoun AH. Incidental Finding of Ectopic Liver during Laparoscopic Cholecystectomy. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921410. [PMID: 32009130 PMCID: PMC7020734 DOI: 10.12659/ajcr.921410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Case series Patients: Female, 44-year-old • Female, 62-year-old Final Diagnosis: Ectopic liver Symptoms: Asymptomatic Medication: — Clinical Procedure: Laparoscopic excision during cholecystectomy Specialty: Surgery
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Affiliation(s)
- Antoine Kachi
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.,Department of General Surgery, Geitaoui University Hospital, Beirut, Lebanon
| | - Charbel Bou Rached
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Etienne El-Helou
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Mouhammad Kanj
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Alaa H Kansoun
- Department of General Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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12
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Baral S, Babel S, Thapa N, Chhetri RK. Ectopic Liver Tissue in the Gall Bladder: A Rare Entity. Cureus 2019; 11:e6323. [PMID: 31938614 PMCID: PMC6946041 DOI: 10.7759/cureus.6323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/08/2019] [Indexed: 12/14/2022] Open
Abstract
Ectopic liver tissue (ELT) is a rare clinical entity that any surgeon faces in their career. Due to the association or propensity to develop hepatocellular carcinoma, this disease has gained clinical importance, and surgeons ought to be aware of the possible intervention and complications that can be associated with it. Incidence has been reported to be 0.24%-0.47%, with the gall bladder being the most common site. Anatomically, ELT in the gall bladder derives its blood supply either from the vascular pedicle arising with or without its own vein from the liver parenchyma or from branches of the cystic artery and, sometimes, through vascular structures embedded within the mesentery lying adjacent to the liver parenchyma. Surgically, it becomes important to delineate the blood supply because, often, the operating surgeon might encounter uncontrollable bleeding if the blood supply has been derived from the liver parenchyma itself. Complications that can be associated with ectopic liver are torsion, bleeding into the peritoneum, cirrhosis, and, sometimes, lead to malignant degeneration to hepatocellular carcinoma. It can be due to metabolic inactivity owing to less efficient vascular and biliary ductal systems, which sometimes might be confused for occult metastases from a primary hepatoma. Gall bladder-associated ELT is best managed by en bloc resection via laparoscopic cholecystectomy, which suffices if the biopsy comes out to be negative. However, as the risk of malignant degeneration still exists in about 3% of cases, some patients might need to undergo a second surgery for a negative resection margin and regional lymphadenectomy.
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Affiliation(s)
- Suman Baral
- Surgery, Lumbini Medical College and Teaching Hospital, Tansen, NPL
| | - Shrinit Babel
- Miscellaneous, Steinbrenner High School, Florida, USA
| | - Neeraj Thapa
- Surgery, Lumbini Medical College and Teaching Hospital, Tansen, NPL
| | - Raj K Chhetri
- Surgery, Lumbini Medical College and Teaching Hospital, Tansen, NPL
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13
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Abstract
INTRODUCTION Ectopic liver (EL) is a rare entity, which is reported to develop at various sites, such as the abdominal cavity, the retroperitoneal cavity, the pleural cavity, and the mediastinum. PATIENT CONCERNS A 27-year-old previously healthy Chinese man suffered from a discontinuous abdominal pain in the upper abdomen for 2 months. DIAGNOSIS The upper gastrointestinal endoscopy revealed there was a polypoid mucosal uplift on the distal region of the esophagus near the cardia. INTERVENTIONS Endoscopic polypectomy was performed. OUTCOMES Pathology examination showed the liver tissue. CONCLUSION EL should be excised as it may possibly lead to the development of a malignancy. Endoscopic resection was found to be safe and reliable in this case.
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Affiliation(s)
- Zi-Li Zhang
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Jin-Liang Wang
- Department of General Surgery, Xingtai Third Hospital, Xingtai, Hebei, People's Republic of China
| | - Chun-Li Guo
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Qi Li
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Lin Li
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Yi Pang
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
| | - Xiang-Chao Meng
- Department of General Surgery, The Third Central Clinical College of Tianjin Medical University, Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin Key Laboratory of Artificial Cell, Tianjin Institute of Hepatobiliary Disease, Tianjin
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14
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Granek RJ, Battye S, Wijeratne S. Ectopic liver attached to a chronically inflamed gallbladder: a rare and surgically challenging combination. ANZ J Surg 2018; 89:E388-E389. [PMID: 29756677 DOI: 10.1111/ans.14553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Romy J Granek
- Division of Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Werribee Mercy Hospital, Melbourne, Victoria, Australia
| | - Shane Battye
- Werribee Mercy Hospital, Melbourne, Victoria, Australia
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15
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Ozaki K, Yoshikawa J, Yamamoto T. Morphometric analyses of small accessory liver lobes using radiological imaging. Clin Imaging 2018; 51:43-49. [PMID: 29438826 DOI: 10.1016/j.clinimag.2018.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/22/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
AIM To investigate the prevalence and morphometric characteristics of small accessory liver lobes using computed tomography (CT) and magnetic resonance (MR) images. MATERIAL AND METHODS The study population comprised 3269 patients (1671 men and 1598 women; mean age, 67.1 ± 15.2 years) who had undergone abdominal CT examination. Small accessory liver lobes were identified after verification of their continuity with the liver parenchyma on CT images. Their imaging characteristics were analyzed and presented. RESULTS Thirty-five small accessory liver lobes in 33 patients (1.01%; 25 men and 8 women, 71.0 ± 11.7 years) were identified. Thirty-one patients (93.9%) had solitary lesions most frequently identified on liver segment 6 (80.0%) with the mean size 9.6 ± 4.8 mm. These showed iso (62.9%), hyper (28.6%), or hypoattenuation (8.6%) on unenhanced CT. Enhanced CT images were available for 29 lesions. Enhancement of 12 lesions (41.4%) was similar to that of the liver parenchyma, whereas 17 lesions (58.6%) showed poor enhancement. MR images were available for 10 lesions, which showed hyperintensity (50.0%) on T2-weighted images and poor enhancement (50.0%). The characteristics of other lesions were similar to those of the liver parenchyma. During observation (mean, 77.0 months; n = 29), 19 lesions remained the same size (65.5%), 5 new lesions increased size (17.2%), and 5 showed reduced size (17.2%). CONCLUSION Small accessory liver lobes, commonly located on segment 6, were frequently observed and did not necessarily show the same findings as the liver parenchyma. Time-dependent morphological changes were observed in approximately one-third of the lesions.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan.
| | - Jun Yoshikawa
- Department of Radiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
| | - Toru Yamamoto
- Department of Radiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
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Termos S, AlDuwaisan A, Alali M, Faour H, AlHomoud H, Alsaleh A. Gallbladder-associated symptomatic hepatic choristoma: Should you resect? Int J Surg Case Rep 2017; 41:243-246. [PMID: 29100175 PMCID: PMC5686228 DOI: 10.1016/j.ijscr.2017.10.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Hepatic choristomas or ectopic livers are uncommon, and occur due to a failure of embryological liver development. They pose a risk of carcinogenesis, with transformation to hepatocellular carcinoma (HCC) being described in the literature (Arakawa et al., 1999). It is often a silent clinical finding that can occur anywhere in the body and is usually diagnosed incidentally during abdominal surgical procedures or autopsies (Eiserth et al., 1940). We present the case of a patient with a symptomatic ectopic liver that was detected preoperatively, and removed laparoscopically with the gallbladder. PRESENTATION OF CASE A 73-year-old lady was referred to our unit for a gallbladder tumor on ultrasound which was done for biliary colic. Tumor markers were normal. Computed tomography (CT) scan showed an enhanced soft tissue lesion measuring about 3×1.5cm interposed between the gallbladder and liver. Laparoscopic exploration revealed a bean-shaped hepatic choristoma attached to the liver on the medial wall of the gallbladder. The lesion was removed by en-bloc resection during laparoscopic cholecystectomy and extracted carefully in an endobag. Histopathological examination confirmed the absence of carcinogenesis. DISCUSSION AND CONCLUSION Hepatic choristomas (HC) are a rare entity, usually identified during abdominal surgeries. It had been reported in several studies with different presentations. Awareness of this unexpected finding and familiarity of its potential complications and carcinogenesis will improve care delivery when encountered. Surgical treatment should be considered when the choristoma is not attached to the liver, in light of its potential transformation into HCC.
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Affiliation(s)
- Salah Termos
- Hepatobiliary and Transplant unit, Department of Surgery, Al-Amiri Hospital, Kuwait.
| | - Abdullah AlDuwaisan
- Hepatobiliary and Transplant unit, Department of Surgery, Al-Amiri Hospital, Kuwait
| | - Mohammad Alali
- Hepatobiliary and Transplant unit, Department of Surgery, Al-Amiri Hospital, Kuwait
| | - Hussein Faour
- Hepatobiliary and Transplant unit, Department of Surgery, Al-Amiri Hospital, Kuwait
| | - Hana AlHomoud
- Hepatobiliary and Transplant unit, Department of Surgery, Al-Amiri Hospital, Kuwait
| | - Ahmad Alsaleh
- Hepatobiliary and Transplant unit, Department of Surgery, Al-Amiri Hospital, Kuwait
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George NE, Raghavapuram S, Banerjee D, Al-Shoha M, Fedda F, Tharian B. Ectopic Hepatocellular Carcinoma within a Choledochal Cyst Diagnosed Using Single-Operator Digital Cholangioscopy. Am J Gastroenterol 2017; 112:1347-1348. [PMID: 28766569 DOI: 10.1038/ajg.2017.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nayana E George
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Saikiran Raghavapuram
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Debdeep Banerjee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,School of Medicine, Texas Tech University Health Sciences Center, Amarillo, Texas, USA
| | - Mohammad Al-Shoha
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Faysal Fedda
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Benjamin Tharian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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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.
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Affiliation(s)
- Zhigui Li
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
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Case Report of Ectopic Liver on Gallbladder Serosa with a Brief Review of the Literature. Case Rep Surg 2016; 2016:7273801. [PMID: 27803835 PMCID: PMC5075603 DOI: 10.1155/2016/7273801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/22/2016] [Indexed: 12/19/2022] Open
Abstract
This case describes an intraoperative incidental finding and surgical removal of ectopic liver tissue attached to the gallbladder during a standard laparoscopic cholecystectomy for acute cholecystitis. These anomalies are rare, with interesting associations and possible clinically relevant complications. The details of the case, along with a brief literature review of embryology, common ectopic sites, and associations/complications, are presented in this paper. Since laparoscopic cholecystectomy is a very common procedure, it is important to increase vigilance of ectopic liver tissues during surgeries to minimize complications and provide optimal management.
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