ABSTRACT
Recently, laparoscopic surgery has become increasingly popular because of its lesser invasiveness, including smaller incisions, and fewer post-operative complications. It is also possible to observe the abdominal cavity by laparoscopy. We report a hepatocellular carcinoma arising in an accessory liver lobe detected during gynecological laparoscopic surgery. A 48-year-old woman who was undergoing laparoscopic hysterectomy for uterine fibroids was found to have a protruding, extrahepatic pedunculated tumor by intraoperative observation of the abdominal cavity during the fibroid procedure. We suspected FNH based on preoperative imaging findings, including abdominal ultrasound, computed tomographic scanning, and magnetic resonance imaging. We performed a laparoscopic partial hepatectomy. The cut surface of the tumor was similar to normal liver tissue. The pathological findings identified normal liver tissue and vessels, suggesting it was the accessory liver lobe. It also included a well-differentiated hepatocellular carcinoma. The final diagnosis was hepatocellular carcinoma arising in the accessory liver lobe. There have been no prior reports of extrahepatic liver tissue detected during gynecological surgery. This case reminded us of the importance of intra-abdominal observation during laparoscopic procedures. The opportunities to discover other cases of extrahepatic liver tissue by laparoscopy will increase.
Subject(s)
Liver Diseases/diagnosis , Liver Neoplasms/diagnosis , Female , Hepatectomy , Humans , Laparoscopy/methods , Liver Diseases/complications , Liver Diseases/surgery , Liver Neoplasms/complications , Liver Neoplasms/surgery , Middle Aged , Treatment Outcome , Uterine Diseases/complications , Uterine Diseases/surgeryABSTRACT
The total synthesis of the diterpene kellermanoldione 1 is reported. Stepwise [4 + 2] cycloaddition of the ketal diene 8 and the allenoate 3 afforded the exo adduct 10x as the major product. It was converted into 1 via six steps, among them a key nonconjugative hydrolysis of a gamma-methylene silyl enol ether.
Subject(s)
Diterpenes/chemical synthesis , Catalysis , Cyclization , Diterpenes/chemistry , Molecular Structure , Plants, Medicinal/chemistry , Polyenes/chemistry , StereoisomerismABSTRACT
[reaction: see text] The total synthesis of the diterpene hedychilactone B 1 is reported. The exo adduct 4x, the major product of the stepwise [4+2] cycloaddition of the diene 2 and the allenoate 3, has been converted into 1 via 7 steps, among them a key nonconjugative hydrolysis of a gamma-methylene silyl enol ether and an E-selective olefination.
Subject(s)
Anti-Inflammatory Agents/chemical synthesis , Diterpenes/chemistry , Lactones/chemical synthesis , Naphthalenes/chemical synthesis , Alkadienes/chemistry , Alkenes/chemistry , Diterpenes/chemical synthesis , Ethers/chemistry , Hydrolysis , Models, Chemical , Silanes/chemistry , Solvents/chemistry , StereoisomerismABSTRACT
The total synthesis of hedychenone 1 is described. The cycloaddition of the hindered diene 2 and the allenecarboxylate 3 has been shown conclusively to proceed via the [2+2] cycloadduct 5 to give a 2:1 mixture of the desired formal Diels-Alder adducts, the exo and endo isomers 4xn and is thus a stepwise [4+2] cycloaddition. The exo isomer 4x was converted in four steps (reduction, oxidation, olefination, and desilylation) into hedychenone 1. [reaction: see text]
