Ectopic Liver Tissue on the Gallbladder Wall Encountered During Laparoscopic Cholecystectomy.

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.

Two Ectopic Liver Lobes Discovered Incidentally at an Autopsy: A Case Report.

The ectopic liver lobe is a rare anomaly and is most frequently reported as a solitary mass. Herein, we report a case of multiple (two) ectopic liver lobes detected at an autopsy. A Japanese man in his 70s died of an infectious disease associated with acquired immunodeficiency syndrome (AIDS). Autopsy revealed the incidental finding of two 1-cm masses, located anterior to the inferior vena cava. Both masses were composed of liver tissue and had internal microscopic structures resembling the porta hepatis, consisting of an outflow bile duct and blood vessels. The outflow bile duct appeared to be continuous with the common bile duct, but the connection point of the outflow vessel was unclear. The liver tissue showed fibrous thickening of the central veins and portal venopathy, including fibrosis in the portal area as well as narrowing and loss of the portal veins. There was no evidence of congestion, fibrosis, biliary stasis, or neoplasm. The incidence of hepatocellular carcinoma is higher in the ectopic liver lobe than in the proper liver, presumably due to the abnormal circulation and bile excretion pathways. The patient also presented with portal venopathy; this suggests the presence of abnormal circulatory dynamics.

The contribution of ultrasound in the diagnostic pathway of a symptomatic hepatocellular adenoma arising from ectopic liver.

Ectopic liver (EL) is a rare congenital anomaly characterized by the presence of a mass composed of hepatic tissue localized in a different anatomical location with no connection to the native liver. Usually an incidental finding, EL can rarely cause symptoms such as abdominal pain due to torsion, intraperitoneal bleeding, compression, obstruction, or neoplastic transformation, both benign and malignant. EL is often suspected after instrumental investigations such as ultrasound, CT and MRI, however a definitive diagnosis is necessarily bioptic. Here we report a case of a 22-year-old Italian female patient with acute abdominal pain, who underwent abdominal ultrasound, CEUS with Sonovue®, CT scan and ultrasound-guided biopsy which raised the suspicion of hepatocellular adenoma (H-HCA). After a laparoscopic excision of the lesion a diagnosis of H-HCA was formulated.

A rare case report: Gallbladder-associated ectopic liver tissue: Challenges, insights, and surgical considerations.

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.

Ectopic Hepatocellular Carcinoma in the Gallbladder Wall With Choledocholithiasis: A Case Report.

An ectopic hepatocellular carcinoma (HCC) that originates from the ectopic liver is defined as a hepatic organ or tissue not conventionally linked to surrounding tissues. Ectopic HCC has a rare clinical incidence, and diagnosing it before surgery is challenging. Its characteristics and biological behavior have not been fully elucidated. This report presents a unique case of ectopic HCC in the gallbladder, discontinuous with the liver. A 74-year-old man was referred to our hospital after primarily complaining of fever and right hypochondrium pain. Plain computed tomography revealed a significantly thickened gallbladder wall containing fluid collection and incarceration of gallstone in the common bile duct. He was diagnosed with acute cholecystitis and obstructive cholangitis due to choledocholithiasis. After percutaneous transhepatic gallbladder drainage and endoscopic lithotomy for choledocholithiasis, a cholecystectomy was performed. Macroscopically, the resected gallbladder had a yellowish tumor (1 cm) within the significantly thickened gallbladder wall. Histopathological examination identified moderately differentiated HCC on the ectopic liver, discontinuous with the liver. Immunohistologically, the tumor was finally diagnosed as ectopic HCC with alpha-fetoprotein positive expression.

Laparoscopically Resected Ectopic Hepatocellular Carcinoma Mimicking Subepithelial Tumor of Stomach: A Case Report.

Ectopic hepatocellular carcinoma (HCC) can be defined as an HCC arising from hepatic parenchyma located in an extrahepatic organ or tissue. Fewer than 100 cases of ectopic liver have been reported. In 30 of these cases, HCC was detected in ectopic tissue. The author describes a case of ectopic HCC mimicking subepithelial tumor (SET) of the stomach successfully treated by laparoscopic resection. This case report also provides a pertinent review of the literature. A 61-year-old male was referred to our department for the management of an intra-abdominal mass found on abdominal computed tomography performed at a local medical center due to a 2-month history of vague abdominal pain. Abdominal magnetic resonance imaging and computed tomography showed a 7.2-cm sized heterogenous mass over the left subphrenic space adjacent to the stomach. Esophagogastroduodenoscopy showed a huge subepithelial mass at the fundus of the stomach. Based on the above findings, the diagnosis of SET of the stomach such as gastrointestinal stromal tumor or leiomyoma was suspected. Laparoscopic surgery was performed for definite diagnosis and treatment of the huge SET of the stomach. Histologic diagnosis was ectopic HCC of the trabecular type. Its histologic grade was consistent with Edmondson grade II. Although ectopic HCC is quite rare tumor of the stomach, it should be considered in the differential diagnosis of other abdominal mass-like lesions. Currently, with advances of laparoscopic surgery, laparoscopic resection for complete excision of ectopic HCC is possible with acceptable results.

Ectopic Liver Tissue Encountered Incidentally During a Laparoscopic Cholecystectomy: A Case Report.

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.

Ectopic Liver Tissue Associated With the Gallbladder: Two Unique Patients and a Literature Review.

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.

Incidental finding of intrathoracic caudate lobe of the liver associated with an arterovenous malformation.

In this case report we describe an occasional finding of intrathoracic caudate lobe protruding through the diaphragm foramen in a 73-year-old woman who came to our attention for a screening for coronary artery disease, due to the presence of cardiovascular risk. The patient had no symptoms. The computed tomography showed, a circumscribed homogeneous soft tissue mass that protruding through the aortic diaphragmatic foramen that was as isodense as the liver. Moreover was revealed an abnormal artery emerging from the celiac tripod which, through the diaphragmatic foramen, ends in an inferior pulmonary vein creating an arteriovenous malformation.

Heterotopic Hepatic Tissue in the Placenta: A Case Report.

Heterotopic hepatic tissue in placenta or umbilical cord is rare. The exact mechanism by which this heterotopia occurs has not been fully understood but is thought to be related to yolk sac primordia. To date, a handful of such cases have been reported. We present a case of heterotopic liver tissue within a chorionic stem villus of a 37 week-growth restricted neonate and describe the tissue morphology and its immunohistochemistry workup.

Carcinoma hepatocelular ectópico: reporte de caso y revisión de la literatura / Ectopic hepatocellular carcinoma. A case report

El hígado ectópico (HE) es una entidad infrecuente, debida a la migración aberrante de las células hepáticas durante la embriogénesis. La incidencia se estima entre el 0,24 y el 0,47%. Puede presentarse en numerosas localizaciones, siendo la vesícula la localización más común. Existen alrededor de 100 casos publicados de HE, de los cuales 28 han desarrollado carcinoma hepatocelular (CHC); mientras que el hígado ortotópico no presenta ninguna alteración; todos provienen de la literatura asiática y caucásica. Reportamos el caso de un paciente de 42 años con lesión sólida de 17×12×12cm, aparentemente dependiente de la pared posterior del cuerpo gástrico, y con desplazamiento de numerosas vísceras, sugiriendo como posibilidad diagnóstica GIST. Mientras que, otras estructuras como el hígado y las vías biliares fueron topográficamente normales. El estudio anatomopatológico concluyó que la tumoración descrita correspondía a un CHC originado en un HE.(AU)

Ectopic liver (EL) is a rare developmental anomaly caused by the migration of hepatic cells to other locations during embryogenesis. Its incidence is thought to be between 0.24 and 0.47% and can occur in various sites, although the gall bladder is the most frequent. Approximately 100 cases of EL have been published, of which 28 developed hepatocellular carcinoma, whilst the orthotopic liver was unaffected. All cases are reported in Asian and Caucasian patients.We report the case of a 42-year-old patient with a solid lesion measuring 17×12×12cm apparently arising from the posterior wall of the stomach, displacing various organs and suggestive of a gastrointestinal stromal tumour (GIST). The liver, biliary tract and other structures were unremarkable. Histopathology revealed a diagnosis of hepatocellular carcinoma in ectopic liver tissue.(AU)

[Ectopic hepatocellular carcinoma. A case report]. / Carcinoma hepatocelular ectópico: reporte de caso y revisión de la literatura.

Ectopic liver (EL) is a rare developmental anomaly caused by the migration of hepatic cells to other locations during embryogenesis. Its incidence is thought to be between 0.24 and 0.47% and can occur in various sites, although the gall bladder is the most frequent. Approximately 100 cases of EL have been published, of which 28 developed hepatocellular carcinoma, whilst the orthotopic liver was unaffected. All cases are reported in Asian and Caucasian patients. We report the case of a 42-year-old patient with a solid lesion measuring 17×12×12cm apparently arising from the posterior wall of the stomach, displacing various organs and suggestive of a gastrointestinal stromal tumour (GIST). The liver, biliary tract and other structures were unremarkable. Histopathology revealed a diagnosis of hepatocellular carcinoma in ectopic liver tissue.

Hepatocarcinoma sobre hígado ectópico intratorácico / Hepatocellular carcinoma in intrathoracic ectopic liver tissue

RESUMEN La presencia de tejido hepático ectópico es una situación inusual que se corresponde con alteraciones en la embriogénesis hepática. Suelen encontrarse de manera incidental y cobran particular importancia por su mayor potencial carcinogénico. El tratamiento de este tipo de patología es habitualmente quirúrgico. Se presenta el caso de una paciente femenina de 27 años que manifestó dolor torácico dorsal; por presentar además una formación evidenciable en la tomografía computarizada se decidió conducta quirúrgica. Asimismo se realiza una revisión bibliográfica del tema.

ABSTRACT Ectopic liver tissue is a rare finding due to aberrant migration of hepatic cells during embryonic development that is mostly found incidentally and has particular relevance because of its significant carcinogenic potential. Surgical management is usually indicated. We report the case of a 27-year-old female patient with thoracic back pain and a mass in the computed tomography scan who underwent surgery. A bibliographic review is also presented.

Challenge in Diagnosis and Treatment of Ectopic Hepatocellular Carcinoma: A Case Report and Literature Review.

Background: Findings of ectopic hepatocellular carcinoma (EHCC) have been rarely documented. Complicated clinical features and unpredictable medical prognosis make diagnosis and treatment difficult. Case Presentation: We reported a 59-year-old male patient who came to the hospital with epigastric discomfort and regurgitation of gastric acid. An enhanced CT scan revealed a 1.8 cm × 1.4 cm mass in the tail of pancreas without any positive finding in the liver. Postoperative MRI scan was performed but did not reveal any evidence of hepatic tumor. The tumor was resected in toto. Meanwhile, a 1 cm × 1 cm mass in the body of the stomach was found that was removed simultaneously. Histopathology showed that the pancreatic tumor was ectopic hepatocellular carcinoma (EHCC), and that the gastric nodule was gastrointestinal stromal tumor (GIST). The patient had an uneventful postoperative recovery. He has been living without recurrence for over 7 years since surgery. Owing to our knowledge, this is the second-longest disease-free survival time for EHCC in the literature. Conclusion: Here, we present a rare case of EHCC in the pancreas, and review the current literature on EHCC. Operation was an effective treatment for patients with curable EHCC. EHCC with metastasis still needs more practice to improve the poor prognosis.

Heterotopic Liver Nodule Compressing a Two-Vessel Umbilical Cord: An Unusual Cause of Intrauterine Fetal Demise.

Heterotopic liver tissue in the umbilical cord is rare, and the outcome is quite unpredictable based on the few reported cases. We present a case of heterotopic liver nodule in the umbilical cord of a midtrimester fetus who died in utero. Although such association has only been reported once, heterotopic nodular tissue in the umbilical cord must be regarded as a potential cause of fetal demise by a mechanism analogous to the more common umbilical cord abnormalities resulting in umbilical vessel compromise.

Ectopic liver tissue in the left hypocondrium: a case report and a literature review / Tejido hepático ectópico en el hipocondrio izquierdo: reporte de un caso y revisión de la literatura

Ectopic liver tissue is a rare developmental abnormality. It is often asymptomatic and is commonly found incidentally, during surgery or autopsy. It has been reported in various abdominal and extra-abdominal sites, most often in the gall bladder. We are reporting an incidentally found mass in the left subdiafragmatic region, diagnosed as ectopic liver in abdominal CT and intraoperatively. We aim to assess the importance of imaging examinations in the differential diagnosis of intraabdominal masses ranging from benign to malignant entities and to point out that despite the low incidence of ectopic liver, it is necessary to be aware of this diagnostic possibility.

El tejido hepático ectópico es una rara anormalidad del desarrollo. A menudo es asintomático y generalmente se encuentra de manera incidental, durante la cirugía o la autopsia. Se ha informado en varios sitios abdominales y extraabdominales, con mayor frecuencia en la vesícula biliar. Reportamos el caso de una masa encontrada en la región subdiafragmática izquierda, diagnosticada como hígado ectópico en la TC abdominal e intraoperatoriamente. Nuestro objetivo fue evaluar la importancia de los exámenes por imágenes en el diagnóstico diferencial de masas intraabdominales que incluyen masas benignas como también malignas, y señalar que a pesar de la baja incidencia de hígado ectópico, es necesario tener en cuenta esta posibilidad en el diagnóstico.

Ectopic liver tissue (choristoma) on the gallbladder: A comprehensive literature review.

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.

A minimally-invasive cryogel based approach for the development of human ectopic liver in a mouse model.

Human liver tissue is preferable over nonhuman liver tissue for preclinical drug screening, as the former can better predict side effects specific to humans. However, due to limited supply and ethical issues with human liver tissue, it is desirable to develop an animal model having functional human liver tissue. In this study, we have established an ectopic functional human liver tissue in a mouse model, using a minimally-invasive method. Firstly, a human liver tissue mass using HepG2 cells and poly(N-isopropylacrylamide) (PNIPAAm) incorporated poly(ethylene glycol)-alginate-gelatin (PAG) cryogel matrix was developed in vitro. It was later implanted in mouse peritoneal cavity using a 16 G needle. Viscoelastic nature along with low Young's modulus provided injectable properties to the cryogel. We confirmed minimal cell loss/death while injecting. Further, by in vivo study efficacy of both injectable and surgical implantation approaches were compared. No significant difference in terms of cell infiltration, human serum albumin (HSA) secretion and enzyme activity confirmed efficacy. This model developed using a minimally-invasive approach can overcome the limitations of surgical implantation due to its cost effective and user friendly nature.