ABSTRACT
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.
ABSTRACT
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.
Subject(s)
Humans , Aged , Choristoma/diagnostic imaging , Abdomen/pathology , Liver/pathology , Tomography, X-Ray Computed , Abdomen/diagnostic imagingABSTRACT
The liver lies mainly in the right upper quadrant of the abdomen where it is protected by the thoracic cage and diaphragm. Externally, the liver is divided into two anatomical lobes and two accessory lobes.During autopsyof a 25- year oldmale, an ectopic liver tissue was found attached to the serosa of gallbladder. Morphological variations of liver are irregularities in form, occurrence of one or more accessory lobe. The exact reason for the origin of ectopic liver in man isstill unknown. It may also simulate tumor.
ABSTRACT
Most hepatocellular carcinomas arise in orthotopic liver tissue as a result of chronic hepatitis B or C infection or cirrhosis secondary to other chronic liver disease. There have been reports of ectopic liver tissue located in an extrahepatic organ such as the gallbladder, spleen, hepatoduodenal ligament and subdiaphragm. However, the incidence of hepatocellular carcinoma originating from ectopic liver is very low. There have been 22 cases of ectopic HCCs (hepatocellular carcinoma) reported in the literature, and ruptured HCC has not yet been reported in the literature. As for the pathogenesis, the development of an ectopic HCC may be result of a compromised vascular supply or biliary drainage. We report here on a case of ruptured ectopic hepatocellular carcinoma arising in the left subdiaphragm in a 76-year-old man who was treated with surgical resection. The patient was followed up for 1 year after surgery and he remained free of recurrence. Therefore, the unique localization and growth pattern of ruptured ectopic HCC may give the physician and patient the chance to achieve a curative resection.
Subject(s)
Aged , Humans , Carcinoma, Hepatocellular , Drainage , Fibrosis , Gallbladder , Hepatitis B, Chronic , Incidence , Ligaments , Liver , Liver Diseases , Recurrence , SpleenABSTRACT
PURPOSE: The case of ectopic liver and accessory liver lobe have been rarely reported. A hepatic rudiment appears in the ventral angle between the foregut and the yolk sac; pars hepatica and pars cystica. The close connection between them explains accessory lobe on the Gall bladder surface wall. And the displacement of migration of a portion of the pars hepatica explains the ectopic liver. Difference between ectopic liver and accessory liver lobe can be defined whether the connection with hepatic proper exists or not. But, the definite discrimination of the type is very difficult clinically. Recently, we experienced cases of ectopic liver and accessory liver. CASES: In one patient, 43-year-old woman was referred to our department with left upper quadrant abdominal pain. Abdominal sonogram revealed a mass below the diaphragm attached to the superior pole of the spleen. On the operation, tumor mass was reddish gray colored and measured 10 7 3 cm. There were no direct connections with the liver proper except fibrous tissue, and its blood supply was considered from the left diaphragm. The pathologic result proved hepatocellular carcinoma(HCC). In the other patient, a 68-year-old woman complained right upper quadrant abdominal pain and was diagnosed as chronic cholecystitis on sonogram. During the laparoscopic cholecystectomy, a small bean sized mass, appearing as liver tissue, attached GB body portion was detected. The Mass was measured 1.0 1.0 3.0 cm in size and glistening dark brown colored, smooth surfaced. Streaky stalk connected with liver proper was visible. Pathologic finding confirmed the mass as an accessory liver. Both patients discharged without complications. DISCUSSION: Although the clinical problems are rare in the ectopic liver, it has been reported that ectopic liver is prone to be a cancer and accessory liver can induce symptoms. The larger the size becomes, the more it can be Symptomatic. Surgical treatment should be considered whenever they are diagnosed. More investigations are nedeed to know their clinical importance on the basis of the case accumulation.
Subject(s)
Adult , Aged , Female , Humans , Abdominal Pain , Carcinoma, Hepatocellular , Cholecystectomy, Laparoscopic , Cholecystitis , Diaphragm , Discrimination, Psychological , Liver , Ranunculaceae , Spleen , Urinary Bladder , Yolk SacABSTRACT
Ectopic liver in the umbilicus is very rare, and a few cases have been reported in the world. It is thought that an increased intraabdominal pressure resulting in entrapment of liver cell nests causes the presence of liver in the umbilicus. It relates to neonatal problem such as infection. We report a case of ectopic umbilical liver in a stillborn male of 28 gestational weeks. His mother discovered loss of fetal movement 2 days before admission, and intrauterine fetal death was diagnosed by ultrasonography. Grossly, the umbilical cord was markedly swollen. On cut section, a well circumscribed, oval round, tan-colored soft mass was noted within the cord. Histologically, it consisted of hepatic cords without bile ducts. The umbilical vessels were distorted by the ectopic liver, and contained thrombi. These findings suggest that ectopic umbilical liver results in the intrauterine fetal death