Ex vivo liver resection for liver tumors: Last resort when conventional technique is not applicable

1. Purpose: The treatment of hepatic neoplasms has undergone, in recent years, various evolution of the surgical technique and extension to the indication for resection. Many patients with liver tumors cannot benefit from resection due to the difficulty of the anatomical site of the lesion.Of these patients, only some can benefit from ex vivo hepatic resection, which consists of a complete hepatectomy, bench tumor resection and self-transplant. 2. Materials and methods: We have retrospectively evaluated PUBMED databases. Studies was evaluated from 2010 to 2020.Only very few studies analyzed “Ex situ liver resection”, “Extracorporeal liver resection”, “Liver auto-transplantation”. Conclusion: Ex vivo liver resection and autotransplantation is fesible in very few patients with unresectable hepatic tumor fit for surgery. R0 resection accounts about 60%-90% but outcomes are less satisfactory due to high complications rate of about 25% and low survival in 3 years.

Congenital Absence of the Portal Vein

A 59-year-old woman presented with abdominal bloating, elevated alkaline phosphatase and transaminases, and computed tomography abdomen/pelvis demonstrating large right-sided hepatic masses. A percutaneous fine needle aspiration demonstrated hepatocellular neoplasm concerning for hepatocellular carcinoma. Preoperative imaging demonstrated possible porto-caval shunt. She underwent uneventful right hepatic lobectomy with confirmation of porto-systemic shunt. Congenital porto-systemic shunt, or Abernethy malformation, is rare and is associated with congenital cardiac and gastrointestinal abnormalities. Additionally, congenital porto-systemic shunt is associated with increased risk of hepatic neoplasms including hepatocellular carcinoma. Recommended surveillance for these patients is not well defined.

Precise microwave ablation in hepatic neoplasms adjacent to high-risk structures: a prospective pilot study

Objective To evaluate the safety and efficiency of ultrasound (US)-guided precise MWA assisted by artificial pleural effusion and/or ascites in hepatic neoplasms adjacent to high-risk structures based on a 3D preoperative planning system. Methods Twenty-five patients with hepatic neoplasms adjacent to high-risk structures were enrolled. CT images of all patients were reconstructed with 3D visualization software for preoperative planning. The puncture path and needle layout were estimated. US-guided precise MWA assisted by artificial pleural effusion and/or ascites was performed. Patients were followed by clinical and imaging examinations at 3, 6, and 12 months after the MWA. Study outcomes including complications, liver function, AFP level, and ablation lesion volumes were evaluated. Results Thirty-two tumors in 25 patients underwent precise MWA. Except for 4 patients with tumors near the macrovascular, 21 patients received artificial pleural effusion and/or ascites, achieving a complete separation. Based on preoperative 3D planning, patients with tumors near the diaphragmatic dome underwent administration of artificial pleural effusion and ascites, while patients with tumors near the gastrointestinal tract or gallbladder received artificial ascites. Of the 32 tumors, 30 achieved complete ablation in the first MWA session, and 29 achieved conformal ablation with a safe boundary of 0.5-1 cm. No severe complications were observed. Only one tumor exhibited local progression. Moreover, serum levels of ALT, AST and AFP were significantly decreased during the follow-up period. Conclusion Based on the 3D preoperative planning system, US-guided precise MWA assisted by artificial pleural effusion and ascites, is a safe and effective tool to treat hepatic neoplasms adjacent to high-risk structures.

Primary hepatic neoplasms in cattle

ABSTRACT: Primary hepatic neoplasms are mostly detected in cattle as incidental findings in slaughterhouses or diagnosed at the necropsy, wherein it may be related to the cause of death. A proper characterization of primary hepatic neoplasms is essential to provide an accurate diagnosis, especially at the slaughter lines, in order to reduce erroneous condemnations. This work aimed to characterize the gross, histological, and immunohistochemical features of primary liver neoplasms detected in slaughtered cattle in Southern Brazil. Nineteen primary hepatic neoplasms were identified. Grossly, these lesions were classified according to their distribution, as focal, multifocal, or diffuse. Histologically, the shape and arrangement of the cells, as well as possible malignant features were evaluated. Immunohistochemistry (IHC) was also performed for biliary epithelium (anti-CK7) and hepatocytes (anti-Hep Par-1) markers. Hepatocellular carcinoma (84.2%) was the most frequently detected hepatic neoplasm, followed by cholangiocarcinoma (15.8%), and these were only identified in adult cows. Hepatocellular carcinomas occurred as solitary masses or multifocal nodules, which on the cut surface were often green. Cholangiocarcinomas occurred as multifocal nodules, occasionally showing an umbilicated appearance. Histologically, hepatocellular carcinomas had mostly trabecular and solid patterns, while cholangiocarcinomas presented mostly a solid arrangement. Upon IHC, all hepatocellular carcinomas were immunolabeled for anti-Hep Par-1, ranging from mild (25%), moderate (31.2%) to marked (43.7%), while immunolabeling for anti-CK7 was detected only in one case of cholangiocarcinoma.

Gross and microscopic changes of liver neoplasms and background hepatic structures following neoadjuvant therapy

Liver transplantation is a surgical option with curative intent used in the management of some cases of hepatocellular carcinoma and cholangiocarcinoma (hilar, rarely intrahepatic). A number of different therapeutic modalities including ablative techniques, arterially directed therapies, radiation and chemotherapy are used in the neoadjuvant setting prior to liver transplantation with the goals of preventing tumour progression, decreasing post-transplant recurrence and possibly downstaging patients with tumour burden beyond what is acceptable by current transplant criteria. Pathologists evaluating hepatic explants must be aware of these neoadjuvant therapies and the alterations induced by them in both tumourous and non-tumourous tissue. In this review, we discuss common neoadjuvant therapies used in in this setting, as well as the gross and microscopic changes induced by these presurgical treatments within hepatic neoplasms as well as the background hepatic parenchyma and nearby structures. Select secondary tumours involving the liver which are pretreated will also be discussed. Finally, proper reporting of these changes will be mentioned.