1/54. An antenatally-diagnosed solitary, non-parasitic hepatic cyst with duodenal obstruction.Congenital solitary, non-parasitic liver cysts are uncommon lesions that are rarely diagnosed antenatally. The cystic nature of the antenatally-diagnosed abdominal cyst in our case was confirmed postnatally by ultrasound. Partial excision with marsupialisation and release of extrinsic bands on the second part of the duodenum was done.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/54. Solitary necrotic nodule of the liver misinterpreted as malignant lesion: considerations on two cases.In our experience, we document 2 cases of a rare and non-tumoral lesion of the liver misinterpreted as necrotic tumor: necrotic solitary nodule. In the first clinical case, ultrasound (US) showed a polylobated lesion (35 x 35 x 38 mm) at segment 8. color-doppler identified a compression of celiac axis (Dunbar syndrome). Arteriography revealed a subtotal stenosis of celiac tripod soon after the emergence of the left gastric artery. FNAB-CT showed a highly cellulated tissue with a necrotic core surrounded by a fibersclerotic tissue. The patient underwent surgery: cholecystectomy and correction of Dunbar syndrome. US follow-up showed a progressive reduction in diameter of the lesion (24 x 25 x 25 mm at 24 months), suggesting in this case the role of ischemic injury in the pathogenesis of the lesion. In the second clinical case, a hypoechoic lesion (32 x 32 x 30 mm) of segment 6 as occasional US finding during the staging for prostate cancer was shown. FNAC-CT showed a positive result for necrotic cells. Surgical treatment consisted in a wide excision of the lesion. Histologically the lesion was solitary necrotic nodule. The diagnosis of this rare lesion is accidental. In accordance with the literature (50% of cases), we founded an associated tumor. radiology doesn't differentiate solitary necrotic nodule and other solid lesions. diagnosis is histological (in our second case, FNAC-CT misinterpreted the tumor as a malignant lesion, while histology showed the real nature of it).- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/54. lipoma of the liver associated with hepatocellular carcinoma and polycystic liver disease.BACKGROUND/AIMS: We report on a patient with lipoma of the liver associated with hepatocellular carcinoma (HCC) and polycystic liver disease. methods: Clinical features of a patient with lipoma, HCC and polycystic liver disease are presented. A right liver lobectomy was performed. RESULTS: Histological examination revealed a poorly differentiated multicentric HCC, as well as bile duct cysts and an encapsulated tumor of adipose tissue. The postoperative course was uncomplicated. The patient died 4 years after surgery with local recurrence of HCC. CONCLUSION: We find the report to be of interest because of the unusual nature of this association and the low prevalence of lipoma of the liver. The association of liver polycystic disease with other types of tumor is discussed and the literature dealing with lipomas of the liver reviewed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/54. Bleeding hepatic adenoma: expectant treatment to limit the extent of liver resection.Hepatic adenomas (HAs) are benign but can present as an acute surgical emergency. The relationship between HA and oral contraceptives (OCs) has been well documented and there have been several reports of tumor regression after the withdrawal of hormonal agents. However, not all HAs regress in this manner; have been reported to remain stable, increase in size, hemorrhage, or rarely, undergo malignant transformation. Given the unpredictable nature of these lesions they are generally treated surgically. In July 1995 a patient with a 6-year history of OC use was admitted with a history of sudden-onset right upper quadrant abdominal pain of 2 days' duration. The clinical picture and imaging studies led to the diagnosis of a bleeding hepatic adenoma without rupture. She was treated expectantly for a period of 14 months before surgery. This allowed the tumor to significantly decrease in size and thus limit the extent of resection. If the patient presented in this case had undergone surgery at the time of initial diagnosis a right hepatic lobectomy as opposed to a wedge resection would have been required. Treating this patient expectantly significantly decreased the potential morbidity associated with a larger resection.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/54. pseudomonas aeruginosa liver abscesses after diagnostic endoscopic retrograde cholangiography in two patients with sphincter of oddi dysfunction type 2.patients with sphincter of oddi dysfunction have a significantly increased rate of pancreatitis after manometry or sphincterotomy, but septic complications after diagnostic endoscopic retrograde cholangiopancreatography (ERCP) in patients with sphincter of oddi dysfunction type 2 have not been reported. We describe two patients with sphincter of oddi dysfunction type 2 in whom pseudomonas aeruginosa serotype 10 septicemia and multiple small hepatic abscesses developed, all within 48 h after they underwent diagnostic ERCP. The sepsis and hepatic abscesses resolved after successful intravenous antibiotic administration. Despite scrupulous examination of the duodenoscope washing machine and the bottle of water, the bacteria responsible for the sepsis could not be isolated. It is possible that despite disinfection, a nondetectable colony of P. aeruginosa remained in a part of duodenoscope and proliferated to reach a potentially hazardous level the following day. This report highlights the importance administering antibiotic prophylaxis to patients with sphincter Oddi dysfunction type 2 who undergo ERCP, despite the functional nature of the disease.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/54. methimazole-induced hepatotoxicity.OBJECTIVE: To present the case of a patient with Graves' hyperthyroidism in whom treatment with methimazole led to severe cholestasis. methods: A detailed case report and an overview of previously published cases of methimazole- and carbimazole-induced hepatotoxicity, found in a medline search with use of methimazole, carbimazole, thionamides and antithyroid agents as subject headings, are provided. RESULTS: In a 36-year-old woman with severe hyperthyroidism, treatment with methimazole (20 mg twice daily) was initiated. Nineteen days later, pruritus, scleral icterus, dark urine, and abdominal discomfort prompted discontinuation of the therapy. Laboratory investigations and abdominal ultrasonography showed findings consistent with a cholestatic reaction to methimazole. Recovery was slow but complete. Of the 30 previously published cases of hepatotoxicity related to treatment with methimazole or carbimazole in which the nature of the hepatic injury was described, 19 were also cholestatic. CONCLUSION: physicians should be aware that thionamide drugs can be associated with hepatotoxicity. Analysis of the known cases suggests that older age of the patient and higher dose of the drug are risk factors for cholestatic injury.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/54. Ciliated hepatic foregut cyst.Ciliated hepatic foregut cyst is a rare, benign, most often solitary and unilocular, rarely multilocular cyst made up of a ciliated pseudostratified columnar epithelium, a subepitheial connective tissue layer, a smooth muscle layer and an outer fibrous capsule. The lesion is usually found incidentally by ultrasonography, during surgical exploration or autopsy. Recent publications characterizes of its fine needle aspiration biopsy features. The lesion is mostly asymptomatic, however one case caused portal vein compression and another which showed malignant trasformation through squamous metaplasia which warns to examine these lesions cautiously. As the lesion is extremely rare it is difficult to estimate its prevalence and its nature, so every single case presentation could be important.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/54. Xanthogranulomatous choledochitis: a previously undescribed mass lesion of the hepatobiliary and ampullary region.Solid liver and pancreatic masses are commonly neoplastic in nature; however, inflammatory lesions mimicking carcinoma are at times encountered in these sites. We report two cases of previously undescribed inflammatory mass lesions of the liver and pancreas that originated in the biliary tract. Detailed clinical and histologic evaluations were performed in two patients who underwent right partial hepatic lobectomy and Whipple's resection for presumed hepatic and pancreatic neoplasms. In case 1, with a remote history of cholecystectomy and recent extraction of a stone from the common bile duct, a liver mass in segment 6 was discovered incidentally. In case 2, a periampullary pancreatic mass was diagnosed radiographically following papillotomy and stent insertion for stricture and biliary calculous disease. The histologic findings in both cases were similar, localized around a part of the biliary tract, and consisted of inspissated bile, acute and chronic inflammation, abundant lipid-laden macrophages, fibrosis, and giant cell reaction. No neoplasm was identified. On the basis of the close resemblance of these features to those seen in xanthogranulomatous cholecystitis, the lesions seen here were termed xanthogranulomatous choledochitis. In conclusion, xanthogranulomatous choledochitis is a benign inflammatory process involving the biliary tract that can form a mass lesion within the liver or pancreas and thus mimic a neoplasm. Extensive sampling of the lesion is required to rule out an underlying neoplastic process. In our patients a propensity to form lithogenic bile and a prior history of biliary tract operative procedure were present.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/54. Solitary necrotic nodule of the liver: a riddle that is difficult to answer.Solitary necrotic nodule of the liver is an unusual lesion that is often an incidental finding on abdominal imaging, intraoperative examination, or post mortem. Most reported cases of solitary necrotic nodule have been in males, and over three quarters of these lesions have occurred in the right lobe of the liver. Pathologically, solitary necrotic nodule is a benign lesion characterized by a completely necrotic core that is often partly calcified, surrounded by a dense hyalinized fibrous capsule containing elastin fibres. The ultrasound appearance of solitary necrotic nodule is usually of a "target" lesion with a hyperechoic center, while on CT scan they appear as non-enhancing hypodense lesions that are typical of metastatic adenocarcinoma or peripheral cholangiocarcinoma. The impression of malignancy is further enforced with the finding of necrotic cellular material on biopsy and the macroscopically hard and "gritty" nature of the nodules. Currently, permanent histopathology of solitary necrotic nodules is the only accurate method of diagnosis. However, solitary necrotic nodules are usually of a bilobed or lobulated shape that is unusual for malignant liver lesions, and they often lie in close proximity to hepatic inflow structures. Solitary necrotic nodule should be suspected in liver lesions with this configuration, location, and on a biopsy showing a large amount of necrosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/54. Reproducible hepatic dysfunction following separate anesthesia with sevoflurane and desflurane.Both desflurane and sevoflurane have individually been reported to induce hepatic dysfunction; however hepatic dysfunction after administration of both of them separately in a single patient has not previously been reported. As their metabolites differ in nature, we considered that it would be unlikely that their combined use would cause sensitization and induce hepatic dysfunction. We report on the first patient with reproducible liver dysfunction after sevoflurane and desflurane. This 54-year-old man sequentially received 3 anesthetics over a 1-year period. The first anesthetic was isoflurane, and the course was uneventful. The second anesthetic was sevoflurane, and this resulted in fever with chills and elevated aspartate aminotransferase (543 U/l) 17 days later. The third anesthetic was desflurane which resulted in a similar clinical picture after 17 days. The symptoms improved, and the serum transaminase level returned to normal after conservative therapy. The similar time interval between the operation date and the onset of hepatic dysfunction, after excluding other possibilities, made us highly suspicious that the hepatic dysfunction was induced by sevoflurane on 1 occasion and desflurane on the other. We suggest that inhaled anesthetics should be totally replaced by intravenous anesthetics for future operations in patients with such a diagnosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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