Surgical resection for hepatic space occupying lesions: a histopathological analysis

Background: Hepatic resections are done for both neoplastic and non-neoplastic diseases of liver with malignancies constituting a major share of cases. The objective of this study was to assess the various neoplatic and non-neoplastic lesions in hepatic resection specimens and to categorize the various histopathological types of primary and secondary liver tumors.Methods: The study was conducted in the Department of Pathology, Academy of Medical sciences, Pariyaram. This was a hospital based study which included 79 patients who underwent hepatic resection for space occupying lesions over a period of 5 years from January 2012 to December 2016. IHC was performed in cases with diagnostic dilemma.Results: Of the 79 cases, there were 45 males and 34 females with the age range of 22-85 years. There were 70 neoplastic lesions out of which 11 were benign with 6 cavernous hemangiomas, 3 hepatic adenomas and one each of intraductal papillary neoplasm and mucinous cystic neoplasm. Among the 59 malignant lesions, hepatocellular carcinomas predominated followed by metastatic malignancies and cholangiocarcinomas. Of the metastatic malignancies, adenocarcinoma from gastrointestinal primary was the commonest followed by metastatic gastrointestinal stromal tumor.Conclusions: Liver is a frequent site for many neoplastic and non-neoplastic diseases with malignant neoplasms forming the major bulk. Non-neoplastic lesions like simple liver cysts and focal nodular hyperplasia showed female predominance while benign neoplasms like cavernous hemangioma and hepatic adenomas were seen exclusively in females. Of the malignant liver tumors, hepatocellular carcinoma was the commonest followed by metastatic malignancy, gastrointestinal tract being the commonest source of primary tumor.

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Horizons of development of immunotherapy for malignant liver tumors

Experimental and Clinical Gastroenterology ◽

10.31146/1682-8658-ecg-191-7-81-89 ◽

2021 ◽

pp. 81-89

Author(s):

V. E. Mukhin ◽

Yu. S. Konstantinova ◽

R. R. Gimadiev ◽

N. V. Mazurchik

Keyword(s):

Liver Tumors ◽

Surgical Excision ◽

Malignant Neoplasms ◽

Therapeutic Approaches ◽

Liver Malignancies ◽

Primary Liver Tumors ◽

Malignant Liver Tumors ◽

Malignant Liver ◽

Methods Of Treatment ◽

New Strategies

Primary liver tumors are one of the most common types of malignant neoplasms. Surgical excision is still the most effective treatment in the early stages of the disease, however in most cases early diagnosis is difficult. Moreover, even if the treatment is carried out according to a radical program, the risk of relapse remains extremely high. In this regard, the search for new strategies for the treatment of liver malignancies that differ from traditional methods of treatment is not terminated. One of such promising approaches is immunotherapy. The present review is devoted to the current understanding of the mechanisms of action and the available clinical experience in the use of immunotherapy approaches in the treatment of liver malignancies. Combining different types of immunotherapy or combining immunotherapy with traditional therapeutic approaches can facilitate a synergistic effect and contribute to the development of personalized medicine.

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Accuracy of computerized tomography in determining hepatic tumor size in patients receiving liver transplantation or resection.

Journal of Clinical Oncology ◽

10.1200/jco.1984.2.6.637 ◽

1984 ◽

Vol 2 (6) ◽

pp. 637-642 ◽

Cited By ~ 18

Author(s):

R Mittal ◽

C Kowal ◽

T Starzl ◽

D Van Thiel ◽

K Bron ◽

...

Keyword(s):

Liver Transplantation ◽

Hepatic Resection ◽

Computerized Tomography ◽

Liver Tumors ◽

Imaging Techniques ◽

Hepatic Metastases ◽

Response To Treatment ◽

Preoperative Ct ◽

Malignant Liver ◽

The Impact

Computerized tomography (CT) of liver is used in oncologic practice for staging tumors, evaluating response to treatment, and screening patients for hepatic resection. Because of the impact of CT liver scan on major treatment decisions, it is important to assess its accuracy. Patients undergoing liver transplantation or resection provide a unique opportunity to test the accuracy of hepatic-imaging techniques by comparison of findings of preoperative CT scan with those at gross pathologic examination of resected specimens. Forty-one patients who had partial hepatic resection (34 patients) or liver transplantation (eight patients) for malignant (30 patients) or benign (11 patients) tumors were evaluable. Eight (47%) of 17 patients with primary malignant liver tumors, four (31%) of 13 patients with metastatic liver tumors, and two (20%) of 10 patients with benign liver tumors had tumor nodules in resected specimens that were not apparent on preoperative CT studies. These nodules varied in size from 0.1 to 1.6 cm. While 11 of 14 of these nodules were less than 1.0 cm, three of 14 were greater than 1.0 cm. These results suggest that conventional CT alone may be insufficient to accurately determine the presence or absence of liver metastases, extent of liver involvement, or response of hepatic metastases to treatment.

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Su1490 CHARACTERIZATION OF PANCREATIC INTRADUCTAL PAPILLARY NEOPLASM-DERIVED CANCER, MUCINOUS CYSTIC NEOPLASM-DERIVED CANCER, AND ADENOCARCINOMA: NATIONAL SURVIVAL OUTCOMES DATA

Gastroenterology ◽

10.1016/s0016-5085(20)32204-6 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-600-S-601

Author(s):

Daryl Ramai ◽

Mohamed Barakat ◽

Amaninder J. Dhaliwal ◽

Mohamed M. Abdelfatah

Keyword(s):

Mucinous Cystic Neoplasm ◽

Cystic Neoplasm ◽

Survival Outcomes ◽

Intraductal Papillary Neoplasm ◽

National Survival ◽

Papillary Neoplasm

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Pancreatic Lymphoepithelial Cyst Showing Multiple Floating Ball-like Appearances

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.252.lym ◽

2016 ◽

Vol 25 (2) ◽

pp. 239-242 ◽

Cited By ~ 4

Author(s):

Hiroyuki Matsubayashi ◽

Yoshiko Aikawa ◽

Teiichi Sugiura ◽

Keiko Sasaki ◽

Kinichi Hotta ◽

...

Keyword(s):

Mucinous Cystic Neoplasm ◽

Carbohydrate Antigen ◽

Cystic Neoplasm ◽

Lymphoid Tissues ◽

Lymphoepithelial Cyst ◽

Pancreatic Lesion ◽

Multilocular Cyst ◽

Intraductal Papillary Neoplasm ◽

Diffusion Weighted ◽

Floating Ball

A lymphoepithelial cyst (LEC) is a rare pancreatic lesion, histologically showing squamous epithelia, dense lymphoid tissues, and a keratin substance. Cross-section images of the pancreatic LEC typically show a well demarcated unilocular or multilocular cyst without a solid component. Here we report a rare case of pancreatic LEC in which multiple floating ball-like components were depicted via endoscopic ultrasound. The ball-like components were also depicted by various imaging methods such as computed tomography (CT) showing low-density components, T1-weighted magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) showing high-intensity components, and T2-weighted MRI showing low-intensity components. The ball-like components in all images were not well enhanced. Laparotomic cyst resection was performed, and the surgical material revealed keratin balls inside the pancreatic LEC. Keratin components of a pancreatic LEC can take a liquid, sludge, or solid form. Clinicians must be aware of the variations in imaging to facilitate the differentiation and management of pancreatic cystic lesions. Abbreviations: CA 19-9: carbohydrate antigen 19-9; CEA: carcinoembryonic antigen; DWI: diffusion-weighted image; LEC: lymphoepithelial cyst; IPMN: intraductal papillary neoplasm; MCN: mucinous cystic neoplasm.

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Mucinous cystic neoplasm of the liver with biliary communication: an exception to the current classification

BMJ Case Reports ◽

10.1136/bcr-2018-227063 ◽

2019 ◽

Vol 12 (1) ◽

pp. bcr-2018-227063 ◽

Cited By ~ 5

Author(s):

Santhosh Anand ◽

Sandip Chandrasekar ◽

Kalayarasan Raja ◽

Biju Pottakkat

Keyword(s):

Who Classification ◽

Mucinous Cystadenoma ◽

Mucinous Cystic Neoplasm ◽

Cystic Neoplasm ◽

Cystic Neoplasms ◽

Intraductal Papillary Neoplasm ◽

Rare Tumours ◽

Current Classification ◽

Biliary Communication ◽

Papillary Neoplasm

Cystic neoplasms of the liver are rare tumours. According to the recent WHO classification, they are classified into mucinous cystic neoplasm and intraductal papillary neoplasm based on the presence of ovarian-like stroma and biliary communication. We report two rare cases of mucinous cystadenoma of the liver with biliary communication and discuss the shortcomings of current classification.

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Infrequent intrahepatic cystic neoplasm: dilemmas in diagnosis and management

BMJ Case Reports ◽

10.1136/bcr-2018-229058 ◽

2019 ◽

Vol 12 (5) ◽

pp. e229058 ◽

Cited By ~ 4

Author(s):

Dattaraj Pradeep Budkule ◽

Gunjan Shailesh Desai ◽

Prasad Pande ◽

Dattaprasanna R Kulkarni

Keyword(s):

Frozen Section ◽

Mucinous Cystic Neoplasm ◽

Carbohydrate Antigen ◽

Hepatic Cyst ◽

Cystic Neoplasm ◽

Intravenous Contrast ◽

Female Population ◽

Intraductal Papillary Neoplasm ◽

Abdominal Symptoms ◽

Cystic Liver

Biliary mucinous cystic neoplasm (BMCN) is a rare intrahepatic neoplasm comprising approximately 5% of cystic liver lesions. It can cause diagnostic dilemmas with most common differentials being complex hepatic cyst, hydatid cyst and intraductal papillary neoplasm of the bile duct. Affecting middle-aged female population, BMCN presents variedly ranging from vague abdominal symptoms to obstructive jaundice. Preoperative diagnosis is difficult. Preoperative CT scan with intravenous contrast and carbohydrate antigen 19.9 levels may give a clue towards the diagnosis. Intraoperative frozen section or cyst fluid aspiration cytology might help confirm the diagnosis. Fine needle aspirations should not be performed if BMCN is suspected, and intraoperative cyst spillage should be avoided to prevent tumour dissemination. We present here a case with a very atypical presentation of BMCN and review its present literature in brief.

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Case Report: Incidentally Discovered a Rare Cystic Lesion of Liver: Multicystic Biliary Hamartoma

Pathology & Oncology Research ◽

10.3389/pore.2021.628323 ◽

2021 ◽

Vol 27 ◽

Author(s):

Wentao Mu ◽

Peng Su ◽

Shanglei Ning

Keyword(s):

Cystic Lesion ◽

Histopathological Examination ◽

Mucinous Cystic Neoplasm ◽

Carbohydrate Antigen ◽

Cystic Neoplasm ◽

Connective Tissues ◽

Abdominal Ultrasonography ◽

Intraductal Papillary Neoplasm ◽

Contrast Enhanced ◽

Enhanced Computed Tomography

Multicystic biliary hamartoma (MCBH) is an extremely rare cystic lesion of the liver. A 37-year old male patient was admitted to our hospital for incidentally discovered hepatic cystic lesions on abdominal ultrasonography. Abdominal contrast-enhanced computed tomography (CT) showed a multilocular cystic lesion in the segment VI, with mild enhancement in the septae and peripheral wall within the lesion. Only alanine transaminase (ALT) and carbohydrate antigen 19–9 (CA19–9) increased slightly above normal value. Preoperative tests suggested possibility of a benign mucinous cystic neoplasm (MCN) or intraductal papillary neoplasm of the bile duct (IPNB). Laparoscopic complete resection of the lesion was performed. Histopathological examination showed numerous variably sized ductal structures surrounded by periductal glands and fibrous connective tissues containing small blood vessels and smooth muscle bundles. Immunohistochemical staining (IHC) revealed that dilated ducts were positive for cytokeratin CK19, characteristic for biliary tract. Histopathological findings confirmed diagnosis of multicystic biliary hamartoma (MCBH). No recurrence occurred during 6 months follow-up. In conclusion, MCBH should be differentiating from hepatic cystic lesion and could be resected laparoscopically safely.

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Cystic and Papillary Neoplasm at the Hepatic Hilum Possibly Originating in the Peribiliary Glands

Case Reports in Pathology ◽

10.1155/2016/9130754 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Takashi Miyata ◽

Katsuhiko Uesaka ◽

Yasuni Nakanuma

Keyword(s):

Mucinous Cystic Neoplasm ◽

Cystic Tumor ◽

Cystic Neoplasm ◽

Endoscopic Retrograde ◽

Cystic Neoplasms ◽

Intraductal Papillary Neoplasm ◽

Hepatic Hilum ◽

Left Hepatic Trisectionectomy ◽

Peribiliary Glands ◽

Papillary Neoplasm

Cystic neoplasms of the liver are divided into two types: mucinous cystic neoplasm and cystic intraductal papillary neoplasm of the bile duct. We herein report two cases of cystic and papillary neoplasm of the liver which differed from the abovementioned types.Case 1.A 70-year-old man. Radiologically, a cystic tumor measuring 20 mm in diameter was found at the hepatic hilum. Right hepatectomy was performed under a diagnosis of intrahepatic cholangiocarcinoma (iCCA) based on the imaging findings.Case 2.A 70-year-old man. Radiologically, a cystic tumor measuring 60 mm in diameter was found at the hepatic hilum. Under a diagnosis of iCCA, left hepatic trisectionectomy was performed. In both cases, endoscopic retrograde cholangiography did not demonstrate communication between the cystic tumor and adjacent bile ducts. Pathologically, these two tumors were cystic neoplasms located at the hepatic hilum and were morphologically characterized by an intracystic papillary neoplasm composed of diffuse high-grade dysplasia and associated with an invasive carcinoma. Ovarian-like stroma was not found in the capsule of these tumors. Interestingly, there were peribiliary glands near these tumors, and MUC6 was expressed in these papillary neoplasms as well as in the peribiliary glands. These neoplasms might have arisen from the peribiliary glands.

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Efficacy evaluation of the CEUS-LI-RADS-v2017 system in differential diagnosis of liver tumors

Medical Visualization ◽

10.24835/1607-0763-2019-4-57-67 ◽

2019 ◽

pp. 57-67

Author(s):

A. N. Katrich ◽

V. A. Porkhanov ◽

N. S. Ryabin

Keyword(s):

Risk Factors ◽

Differential Diagnosis ◽

Liver Tumors ◽

Morphological Data ◽

Malignant Neoplasms ◽

Diagnostic Efficiency ◽

Efficacy Evaluation ◽

General Group ◽

Group 2 ◽

Group 1

Objective: efficacy evaluation of the CEUS LI RADS v2017® system for differential diagnosis of liver tumors in patients with and without cirrhosis.Materials and methods. Retrospective analysis of diagnostic results of the 165 patients with liver tumors (177 nodules) was done. All patients underwent CEUS with results interpretation in accordance to the CEUS LIRADSv2017 ® criteria. Patients were divided into 2 groups based on clinical and morphological data. Group 1 included 62 patients with cirrhosis and/or CVH. Group 2 included 110 patients without risk factors for HCC.Results. Diagnostic efficiency of CEUS LI RADS v2017® for HCC identification was: group 1 – Se – 100%, Sp – 88%, Ac – 95.5%; group 2 – Se – 100%, Sp – 68.8%, Ac – 72.7%; general group Se – 100%, Sp – 72.2%, Ac – 81.4%. In the 2nd group, 21 out of 22 neoplasms, confirmed morphologically as FNH, we classified as LR 4. By applying benign character and specific contrasting patterns of FNG, they were transferred from LR 4 to LR 3. This allowed to increase sensitivity and specificity of differential diagnosis in group 2 (Se – 100%, Sp – 90.6%, Ac – 91.8%) and in general group (Se – 100%, Sp – 90.1%, Ac – 93.2%). Diagnostic efficiency of the criteria for non hepatocellular malignant neoplasms (LR M) was: group 1 – Se – 77.8%, Sp – 100%, Ac – 97%; group 2 – Se – 90%, Sp – 96.7%, Ac – 93.6%; general group- Se – 88.1%, Sp – 98.3%, Ac – 94.9%.Conclusion. Our study confirmed high accuracy of the CEUS LI RADS v2017® system in the differential diagnosis of focal liver tumors. Modification of the system (in particular, transfer of typical FNG forms from the LR 4 category) will make it possible to increase the accuracy of diagnostics by 20%. It will allow to use the LI RADS v2017® system for interpretation CEUS not only among patients with liver cirrhosis, but also in a general group without risk factors of GCC.

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