Clinicopathological features and management of hepatic vascular tumors. A 20-year experience in a Greek University Hospital.

PURPOSE: The aim of this study was to review the clinical features, diagnostic modalities, treatment options and pathological characteristics of various types of hepatic vascular tumors treated in our Institution over the last 20 years. METHODS: From 1991 to 2011, 761 cases of various hepatic lesions, benign and malignant, were surgically treated in our hospital. Among these, 56 (7.35%) hepatectomy specimens referred to vascular tumors. The records of these patients were retrieved and demographics , tumor characteristics, treatment, and actuarial survival were analyzed. The various therapeutic procedures, postoperative complications, follow-up data and the pre-and postoperative diagnostic difficulties were registered and analyzed. RESULTS: Pathological examination showed: hepatic hemangiomas in 35 (62.5%) patients (80% females), hepatic angiosarcomas in 7 patients (12.5%; males 71.4%), hepatic epithelioid hemangioendotheliomas in 9 (16%; females 50%) and hepatic angiomyolipomas in 5 patients (9%; females 60%). CONCLUSIONS: Vascular tumors of the liver comprise a heterogeneous group of neoplasms, benign, malignant and of intermediate degree of malignant behavior. These lesions can create great diagnostic difficulties, pre- and postoperative considerations, but the correct pathological diagnosis and classification of vascular hepatic tumors are most of the times mandatory in order to choose the proper therapeutic actions.

Management of retroperitoneal sarcomas: main prognostic factors for local recurrence and survival.

PURPOSE: Retroperitoneal sarcomas (RPs) are characterized by slow indolent growth and metastasize at a late point in their natural course. The purpose of this study was to review our experience in the management of RSs and identify prognostic factors for local control and survival. METHODS: Between January 1990 and December 2010, the hospital records of 75 patients with RSs were retrospectively studied. Sixty-four (85.3%) patients had undergone surgical resection in our hospital for primary RS, whereas 11 (14.7%) were referred to our department for recurrent disease. RESULTS: The patient median age was 57 years. Median tumor size was 18.5 cm. The most common histologic type was liposarcoma (44%) followed by leiomyosarcoma (17%), paraganglioma (10%), malignant fibrous histiocytoma (6.5%) and rare tumors such as 2 chondrosarcomas and 1 pecoma. Complete initial resection with negative macroscopic margins (R0) was achieved in 39 (60.9%) patients. En bloc resection of adjacent organs was required in 8 (12.5%) patients with primary RS and in 8 (72.9%) with recurrent disease. Mortality rate was 4%. For the group of patients initially treated in our hospital, 1-year recurrence rate was 34.3%. The 3- and 5-year overall survival rates were 56.2% and 53.1%, respectively. Satellite tumors were recognised in 13 (20.3%) patients treated for primary RS, from whom 11 (84%) recurred within one year. Seven patients received adjuvant chemotherapy. CONCLUSION: Radical surgical resection is the treatment of choice for patients with primary and locally recurrent RSs.

Iatrogenic liver trauma managed with mesh-wrapping and ligation of portal vein branch: A case report.

INTRODUCTION: Liver trauma is a critical condition that requires swift multidisciplinary approach. In complex hepatic injuries perihepatic packing is an established life-saving procedure. The aim of this study is to evaluate and highlight the value of absorbable mesh wrapping of the injured liver, combined with ipsilateral ligation of portal vein branch. CASE PRESENTATION: An 82-year-old patient underwent an open cholocystectomy, for gallbladder empyema. The second postoperative day he was re-operated on due to active hemorrhage. The bleeding was controlled by suturing the bed of the gallbladder fossa. During this maneuver a portal vein branch was torn resulting in a rapidly expanding subcapsular liver hematoma which led to the formation of two deep lacerations on the liver parenchyma. This life-threatening condition was treated by wrapping an absorbable mesh around the right liver lobe and subsequently ligating the right portal vein branch extrahepaticaly. CONCLUSION: Mesh wrapping of the fragmented liver with absorbable mesh constitutes a safe and effective method, in treating grade IV and V liver injuries, especially when combined with ipsilateral ligation of the bleeding vessel.