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We aimed to assess changes in the composition of the waiting list for liver transplantation (LT) after expanding from Milan to "up-to-seven" criteria in patients with hepatocellular carcinoma (HCC). A consecutive cohort of 255 LT candidates was stratified in a pre-expansion era (2016-2018; n = 149) and a post-expansion era (2019-2021; n = 106). The most frequent indication for LT was HCC in both groups (47.7% vs. 43.4%; p = 0.5). The proportion of patients exceeding the Milan criteria in the explanted liver was nearly doubled after expansion (12.5% vs. 21.1%; p = 0.25). Expanding criteria had no effect in drop-out (12.3% vs. 20.4%; p = 0.23) or microvascular invasion rates (37.8% vs. 38.7%; p = 0.93). The length on the waiting list did not increase after the expansion (172 days [IQR 74-282] vs. 118 days [IQR 67-251]; p = 0.135) and was even shortened in the post-expansion HCC subcohort (181 days [IQR 125-232] vs. 116 days [IQR 74-224]; p = 0.04). Tumor recurrence rates were reduced in the post-expansion cohort (15.4% vs. 0%; p = 0.012). In conclusion, expanding from Milan to up-to-seven criteria for LT in patients with HCC had no meaningful impact on the waiting list length and composition, thus offering the opportunity for the adoption of more liberal policies in the future.
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AIM: To determine the prevalence of endoscopic lesions unrelated with portal hypertension in patients with cirrhosis. PATIENTS AND METHODS: Cross-sectional study including a consecutive cohort of patients with liver cirrhosis enrolled in a screening program of oesophageal varices who underwent an upper gastrointestinal endoscopy from November, 2013, to November, 2018. Clinical predictors of endoscopic lesions unrelated to portal hypertension were analyzed by univariate and multivariate logistic regression. RESULTS: A total of 379 patients were included. The most frequent aetiology of liver disease was alcohol consumption (60.4%). The prevalence of endoscopic lesions unrelated with portal hypertension was 39.6% (n=150). Among 96 patients with peptic lesions, urease was obtained in 56.2% of patients (positive in 44.4% of them). The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. The prevalence of endoscopic lesions unrelated to portal hypertension was not associated with age, gender, liver function or ultrasound findings of portal hypertension. Smokers had a trend to increased prevalence of endoscopic lesions unrelated to portal hypertension (43.2% vs. 34.6%; p=0.09), particularly peptic ulcer (6.4% vs. 0.6%; p=0.05) and peptic duodenitis (17.3% vs. 6.3%; p=0.002). Active smoking was the only independent predictor of peptic ulcer or duodenitis (OR=2.56; p=0.017). CONCLUSION: Active smoking is a risk factor for endoscopic lesions unrelated to portal hypertension. This finding should be further investigated to reassess endoscopic screening programs in cirrhotic smokers.
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Duodenitis , Várices Esofágicas y Gástricas , Hipertensión Portal , Úlcera Péptica , Várices , Estudios Transversales , Duodenitis/complicaciones , Duodenitis/patología , Endoscopía Gastrointestinal/efectos adversos , Várices Esofágicas y Gástricas/diagnóstico por imagen , Várices Esofágicas y Gástricas/epidemiología , Várices Esofágicas y Gástricas/etiología , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/etiología , Humanos , Hipertensión Portal/complicaciones , Hipertensión Portal/diagnóstico por imagen , Hipertensión Portal/epidemiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/epidemiología , Cirrosis Hepática/patología , Úlcera Péptica/complicaciones , Vena Porta/patología , Várices/complicaciones , Várices/patologíaRESUMEN
Intraductal papillary neoplasm of the bile duct (IPNB) is an uncommon disease which was first included in the World Health Organization classification of neoplasms in 2010. A 64-year-old female was admitted to the hospital because of a hepatic lesion incidentally diagnosed during acute cholangitis. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed a well delimited 70 mm mass, with a predominant cystic component and hyperenhancement of papillary internal branching, consistent with a hydatid cyst. However, malignancy could not be excluded. The patient rapidly developed an acute abdomen syndrome, thus precluding a liver biopsy. A new urgent CT was performed to rule out a complication of the cystic lesion. A left hepatectomy was performed and the anatomopathological study confirmed the diagnosis of IPNB with a focus of cholangiocarcinoma therein. During follow up, the patient developed peritoneal carcinomatosis, received palliative chemotherapy and finally died.
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Neoplasias de los Conductos Biliares , Colangiocarcinoma , Neoplasias de los Conductos Biliares/diagnóstico por imagen , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares , Conductos Biliares Intrahepáticos/diagnóstico por imagen , Conductos Biliares Intrahepáticos/patología , Colangiocarcinoma/diagnóstico por imagen , Colangiocarcinoma/patología , Colangiocarcinoma/cirugía , Femenino , Hepatectomía , Humanos , Persona de Mediana EdadRESUMEN
A 53-year-old female with a history of HLA-B27 positive polyarthritis underwent a splenectomy due to an incidental splenic lesion, which was confirmed as an inflammatory pseudotumor (IPT). Afterwards, two liver lesions were found and histopathological examination revealed inflammatory pseudotumor-like follicular dendritic cell sarcoma (IPT-like FDCS). The patient received NSAIDs, corticosteroids, antibiotics and azathioprine, with no response. Within the next few months, there was an abrupt clinical worsening due to rapid progression of the hepatic lesions and a massive hepatomegaly. New biopsies were obtained, showing undifferentiated sarcoma. The patient started chemotherapy with doxorubicin and eventually died.
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Sarcoma de Células Dendríticas Foliculares , Granuloma de Células Plasmáticas , Enfermedades del Bazo , Sarcoma de Células Dendríticas Foliculares/diagnóstico por imagen , Sarcoma de Células Dendríticas Foliculares/cirugía , Femenino , Granuloma de Células Plasmáticas/diagnóstico por imagen , Granuloma de Células Plasmáticas/tratamiento farmacológico , Granuloma de Células Plasmáticas/cirugía , Humanos , Hígado , Persona de Mediana Edad , EsplenectomíaRESUMEN
INTRODUCTION: Peripherally inserted central catheters (PICC) are increasingly used in patients who require intravenous access for a long time. We present a 53-year-old male patient with an advanced distal esophageal cancer who suffered a potentially serious mechanical complication after insertion of a PICC.
INTRODUCCIÓN: Los catéteres venosos centrales de inserción periférica (PICC) son cada vez más utilizados en pacientes que requieren un acceso intravenoso durante un tiempo prolongado. Presentamos un paciente de 53 años de edad con cáncer de esófago distal avanzado que sufrió una complicación mecánica potencialmente grave tras la inserción de un PICC.