Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors.

BACKGROUND: Cholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD). METHODS: Data from 2577 LLDs who underwent living donor hepatectomy (n = 2511) or aborted living donor hepatectomy (n = 66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study. RESULTS: A total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n = 446; 17.9%), adenomyomatosis (n = 9), and papillary hyperplasia (n = 6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n = 207; 0.4%), cholelithiasis (n = 53), cholesterol polyp (n = 31), and noncholesterol polyp (n = 19), respectively. Significant differences were detected between the male and female genders in terms of age (P < .001), height (P < .001), weight (P < .001), body mass index (P < .001), gallbladder width (P = .001), gallbladder length (P < .001), histopathological finding (content) (P < .001), and lymph node around the gallbladder (P = .015). CONCLUSIONS: The results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women.

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.

Laparoscopic management of giant gastrointestinal stromal tumor masquerading as infected mesenteric cyst.

Gastrointestinal stromal tumors (GISTs) are the most common non-epithelial (mesenchymal) tumors of the gastrointestinal tract. Although GISTs appear as solid and well-circumscribed lesions in most patients, they may also appear as solid- cystic (mixed) or pure cystic lesions due to reasons like intra-tumor hemorrhage and necrosis in a very small percentage of patients. Hence, cystic GISTs mostly lead to a diagnostic dilemma. In this paper we aimed to report a case of pure cystic giant GIST that was drained percutaneously twice after being misdiagnosed as a mesenteric cyst. An 83-yearold man was operated for a pre-diagnosis of a recurrent mesenteric cyst. The operation was started with the three-trocar laparoscopic technique. Six thousand milliliters of purulent fluid were drained from the cystic lesion. Then, a mini incision was performed above the umbilicus and the cyst and the distal ileal segment where it was originated were removed from the abdominal cavity. After the resection of a 15-cm ileal segment together with the cystic lesion, an intestinal anastomosis was performed. The histopathological and immunohistochemical findings showed that the mass was a GIST (size: 20 cm, mitosis: 3/50 HPF, Ki 67: %15, CD117: positive, DOG-1: positive). The patient was closely followed without imatinib therapy. KEY WORDS: Abscess, Cystic Degeneration, GIST, Mistreatment.

Spleen preserving distal pancreatectomy in isolated pancreatic trauma.

INTRODUCTION: Isolated pancreatic trauma is a rare condition and commonly come up in children or young adults.The poor initial symptoms lead to delay diagnosis and treatment. The treatment of isolated distal pancreatic trauma including the Wirsung's duct is generally distal pancreatectomy. In an emergency setting, splenectomy is a common additional organ resection requirement with the distal pancreatectomy. However, in circumstances, spleen preserving distal pancreatectomy can provide advantages in these age groups even in emergency conditions. CASE REPORT: Twenty-four-year old male was referred two days after a traffic accident. Acute abdominal findings required laparotomy and preoperative computed tomography revealed a isolated distal pancreatic trauma including the Wirsung. In the hemodynamically stable patient, a spleen preserving distal pancreatectomy (SPDP) was performed uneventfully. CONCLUSION: Spleen preserving distal pancreatectomy is a beneficial and safe surgical option in isolated distal pancreatic trauma. We propose this surgical procedure for children and young patients, who have good general condition, stable vital findings and without another intraabdominal injury. KEY WORDS: Distal pancreatectomy, Isolated pancreatic injury, Spleen preservation.