Pseudotumor inflamatorio hepático, una entidad de difícil diagnóstico / Inflammatory pseudotumor of the liver: a condition hard to diagnose

RESUMEN El pseudotumor inflamatorio hepático es una lesión muy infrecuente, sin una etiología ni patogenia claras. Su diagnóstico preoperatorio no es habitual pero, en caso de realizarse, puede evitar la cirugía. Presentamos el caso de un paciente joven, con antecedente de lupus cutáneo que, tras debutar con una pancreatitis aguda, presenta episodios de colangitis y cuyos hallazgos radiológicos no permiten descartar la presencia de un colangiocarcinoma, por lo que se realiza hepatectomía izquierda, siendo el diagnóstico histológico final de pseudotumor inflamatorio hepático.

ABSTRACT Inflammatory pseudotumors of the liver are rare and lack clear etiology and pathogenesis. The preoperative diagnosis is seldom made but it avoids unnecessary surgery. We report the case of a young male patient with a history of cutaneous lupus and episodes cholangitis after an acute pancreatitis. As the imaging tests could not rule out cholangiocarcinoma, a left liver resection was performed, and the final histologic diagnosis was inflammatory pseudotumor of the liver.

Research progress on the risk factors affecting the function of transplanted liver in organ donation after death / 中华肝胆外科杂志

Liver dysfunction after liver transplantation is the most common complication of donation after cardiac death. Since there are many risk factors for liver dysfunction after liver transplantation, preventing it has become a hot topic in the field of liver transplantation. This article reviews the related studies on the quality, preservation of donor liver after the death of citizens and the factors during liver transplantation, so as to provide the best precaution strategy for liver dysfunction after liver transplantation.

Ultrasound guided fine needle aspiration cytology of space occupying lesions of liver

Background: The liver is a common site for primary and secondary tumors; most often from malignant tumors within the abdomen and from extra-abdominal primary malignant neoplasm, but also for sarcomas and lymphomas. The main indication of fine-needle aspiration cytology (FNAC) of the liver is diagnosis of single or multiple space occupying lesions. This study aims to evaluate the cyto-morphology of primary and secondary neoplasms of liver and non-neoplastic conditions in the smears of ultrasound guided fine needle aspiration of SOL of liver, to evaluate the cytomorphologic features and to evaluate the erroneous diagnosis when compared with cell block preparation of aspirate (tissue diagnosis).Methods: This study is hospital-based prospective study including 57 patients with space occupying lesion of the liver mass. FNAC were carried out under the guidance of sonography and/or computed tomography. The staining performed were conventional for smears of the aspirate. The cell blocks were prepared from the aspirates by the established procedures. The values of correlation were bought out.Results: Males predominated over females. The distribution of cases for cyto-diagnosis were as follows; cirrhosis with hepatic granulosa (3 cases),pyogenic abscess (3 cases), hepatic adenoma (2 cases), Focal nodular hyperplasia (2 cases), hepatoblastoma (1 case), hepatocellular carcinoma (17 cases), adenocarcinoma deposits (20 cases), deposits of small cell carcinoma (3 cases), deposits of ductal carcinoma (2 cases) and 1 case each of deposits of squamous cell carcinoma, non-Hodgkin’s lymphoma, neuroendocrine tumor and adeno-squamous carcinoma. Values of correlation were as follows: sensitivity 97.61%, specificity 100%, PPV 100%, NPV 97.82% and diagnostic accuracy of 98.85%.Conclusions: FNAC is concluded to be first rank diagnostic procedure in diagnosis of SOL of liver of varied etiology with high values of NPV and PPV. It is also concluded that it helps in staging of metastatic malignancies.

Ultrasound-guided fine-needle aspiration cytology of hepatic mass - A minimally invasive diagnostic approach

Background: Ultrasound-guided fine-needle aspiration (FNA) is a safe, simple, accurate, rapid, and an effective method for approaching a hepatic lesion. Objectives: The objectives of this study were as follows: (1) To assess the utility of ultrasound-guided FNA cytology (FNAC) in the diagnosis of hepatic mass, (2) to categorize hepatic masses into benign and malignant lesions to assess the nature of mass, and (3) to study the cytomorphological features of various liver lesions. Materials and Methods: The study was conducted in the department of pathology between January 2014 and April 2016. Ultrasound-guided FNAC was performed on 62 patients with hepatic mass lesions. The patients with hemangioma and hydatid disease of the liver diagnosed by ultrasonography were excluded to prevent undue complications. Results: There were 39 (62.9%) males and 23 (37.09%) females with a mean age of 52.5 years ranging from 10 to 85 years. Samples were adequate in 57 (93.5%) and inadequate in 5 (6.5%). Of 57 adequate samples, five show inflammation, two were benign, and 50 were malignant. Of the inflammatory lesions, pyogenic liver abscesses in 3 (5.26%) and amoebic liver abscesses in 2 (3.51%). Benign lesion included hepatic adenoma in 2 (3.51%). Of the malignant lesions, metastatic adenocarcinomas was in 22 (38.60%), hepatocellular carcinomas was in 10 (17.54%), metastatic deposits of poorly differentiated carcinoma was in 10 (17.54%), metastatic squamous cell carcinoma was in 5 (8.78%), hepatoblastoma was in 2 (3.51%), and cholangiocarcinoma was in 1 (1.75%) case. All the hepatocellular carcinomas in our study occurred in males (4 of 4). Conclusion: Ultrasound-guided FNAC of the liver has a significant role in diagnosis of palpable and non-palpable hepatic mass. It is a rapid, highly accurate, safe, and cost-effective diagnostic method which avoids invasive diagnostic procedures.

Incidence and characteristics of benign liver space-occupying mass in 17 721 patients with chronic hepatitis B: a color Doppler ultrasound-based case-control study / 南方医科大学学报

OBJECTIVE@#To analyze the incidence and risk factors of benign liver space-occupying mass in patients with chronic hepatitis B (CHB) and the ultrasound features that differentiate these masses from small hepatocellular carcinoma.@*METHODS@#We retrospectively analyzed the color Doppler and clinical data of 17 721 patients with CHB treated in the Hepatology Unit of Nanfang Hospital between January, 2016 and December, 2017. The data were compared with those of 21629 healthy control subjects undergoing routine physical examination in the Center of Heath Management of Nanfang Hospital during the same period.@*RESULTS@#Compared with the control subjects, the patients with CHB had significantly higher incidences of hepatic cysts (11.8% 8.7%, 0.05). Sonographically, the benign liver masses commonly showed homogeneous echo within the lesion with clear boundaries and regular shape. Hepatic hemangioma was distinctively hyperechoic in 83.32% (1579/1895) of the patients, while small hepatocellular carcinoma presented with weaker peripheral and internal blood flow signals with a lower flow velocity in the arteries and a higher flow velocity in the portal vein. Liver cirrhosis nodules mostly showed a mixture of strong and weak echoes (79.60%; 7637/9595) without blood flow signal within or around the nodule; an increased volume of the nodule accompanied by heterogeneous echoes within the nodule indicated an increased probability of malignant lesion. Hepatic cysts often displayed no echo within the lesion, but the echo could be enhanced posteriorly.@*CONCLUSIONS@#The patients with CHB are at a significantly higher risk of developing hepatic cysts, hepatic hemangiomas and hepatic cirrhosis nodules than the control population, and an older age and the male gender are associated with a higher incidence of hepatic cysts or cirrhosis. The differences in the sonographic and hemodynamic features can help to differentiate hepatic benign mass from malignant lesions, and kinetic changes in sonography can be used to monitor potential malignant transformation of the cirrhotic lesions.

Caracterización clinicoepidemiológica y ecográfica de pacientes con masa hepática sólida / Clinical epidemiological and ultrasonic characterization of patients with solid liver mass

Se realizó un estudio descriptivo y transversal de 87 pacientes diagnosticados con masa hepática sólida, los cuales fueron atendidos en el hospital gambiano de Farafenni, de enero a diciembre del 2008, con vistas a caracterizarles desde los puntos de vista clinicoepidemiológico y ecográfico. Se analizaron variables sociodemográficas y clínicas. Se tuvieron en cuenta criterios de inclusión y exclusión. Además, se empleó el porcentaje como medida de resumen. En la serie predominaron el sexo masculino, el grupo etario de 45-59 años, la hepatitis viral B como el antecedente patológico, el dolor abdominal como la manifestación clínica más frecuente y desde el punto de vista ecográfico los nódulos múltiples y la infiltración difusa.

A descriptive and cross sectional study was carried out in 87 patients diagnosed with solid liver mass, who were attended in the hospital of Farafenni, Gambia, from January to December 2008, in order to characterize them from clinical, epidemiological and ultrasonic points of view. Sociodemographic and clinical variates were analyzed. Inclusion and exclusion criteria were considered. Also, the percentage as summary measure was used. Male sex, age group of 45-59 years, viral hepatitis B as medical history, and abdominal pain as the most frequent clinical manifestation and multiple nodes and diffuse infiltration as ultrasonic findings prevailed in the series.

A Case of Chronic Myelogenous Leukemia with Extramedullary Hematopoiesis Presenting as Liver Mass / 대한혈액학회지

Extramedullary hematopoiesis denotes blood cell production in hematopoietic tissue other than bone marrow. Myeloproliferative disorders, including myelofibrosis, polycythemia vera, essential thrombocythemia and chronic myelogenous leukemia (CML) are the most common cause of extramedullary hematopoiesis. Extramedullary hematopoiesis most commonly occurs in the spleen, liver and lymph nodes but has been reported in almost all sites of the body. Usually extramedullary hematopoiesis has been reported to involve liver, without forming a liver mass in a patient with CML. We report a patient with CML who had extramedullary hematopoiesis presenting as a liver mass established by ultrasound-guided biopsy.