Von Meyenburg complex clinically presenting as metastatic liver nodule: A rare finding in an elderly male

Von Meyenburg complex is a benign biliary hamartoma observed in approximately 3% of the autopsies conducted. These hamartomas are small, multiple and can be seen anywhere in the liver. There is usually no abnormality in liver function tests, and the patient is mostly asymptomatic. They serve as a diagnostic dilemma, particularly during metastatic workup in suspected cancer patients. Imaging studies are usually noncontributory, and biopsy is necessary for a definite diagnosis. We present here a middle-aged North Indian male who underwent liver biopsy to rule out metastasis.

Incidental Hepatic Tissue Obtained via Routine Cholecystectomy

Background. The hepatic tissue that may occupy specimens from routine cholecystectomies has yet to be studied. Our objectives were to determine the prevalence of hepatic tissue obtained at routine cholecystectomy, to determine whether such hepatic tissue can histologically withstand technical artifacts commonly associated with cholecystectomy, and to determine whether examining such hepatic tissue has diagnostic utility. Materials and Methods. We retrospectively reviewed 50 specimens from routine cholecystectomies that were performed by surgeons who lacked knowledge of our study. All 50 specimens were grossed according to standard protocol, with only limited, nontargeted sampling of the rough nonperitonealized margin, and were received without fixative. Results. Twelve specimens (24.0%) contained hepatic tissue. The hepatic tissue measured up to 44.5-mm long and 1.8-mm wide and contained up to 11 complete portal tracts. Hepatic tissue in 3 specimens satisfied criteria for adequacy established for core biopsies based on number of portal tracts or size. Despite cautery and delayed fixation, all hepatic tissue had surprisingly well-preserved histology. Pathologic findings included nonalcoholic fatty liver disease, von Meyenburg complex, chronic cholestasis, and senescence. Conclusions. The hepatic tissue that accompanies specimens from routine cholecystectomies may be relatively common, can be large, is well preserved, and can harbor diagnostically useful information.

Percutaneous Liver Biopsy in the Diagnosis of Pediatric Liver Diseases

Background: Liver is prone to different diseases including congenital, infections, metabolic and malignancies. Liver biopsy is an aggressive but definitive way to diagnose liver diseases.Objective: To diagnose different types of liver diseases and to determine the safety of percutaneous liver biopsy by disposable Tru-Cut needle.Materials & Methods: A descriptive study was done in the department of Pediatric Gastroenterology, Hepatology & Nutrition, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh from January 2014 to January 2016. After getting history, physical examination and ultrasonogram, the biopsy was done with the help of Tru-Cut needle of different sizes under local anesthetics (2% lidocaine) with 3 hours fasting. The biopsy specimens were immediately fixed in 10% formal-saline and alcohol. The tissues were processed in automatic tissue processor under standard condition.Results: Age of the children was 1 month to 12 years with mean age of 3.1 years (3.1±0.763) with a range from 1 month to 12 years and male:female ratio was 1.1:1. The most common histological diagnosis was neonatal hepatitis (23.3%) followed by biliary atresia (16.7%). There were chronic hepatitis (10.0%), glycogen storage disease (10.0%), cirrhosis (6.7%) and hepatoblastoma (6.7%) in moderate frequency. Other cases of least frequency (3.3%) were fatty change, lipid storage disease, intra-hepatic bile duct paucity, congenital hepatic fibrosis and Von Meyenburg complex. Neonatal hepatitis & biliary atresia were common among ?1 year age group and glycogen storage disease, hepatoblastoma & non-specific changes in 1-5 year age group. In the older children (>5 years), chronic hepatitis (10.0%) & cirrhosis (6.6%) were the common causes. Consanguinity was present in storage disease, neonatal hepatitis, congenital hepatic fibrosis, von meyenburg complex and intra-hepatic bile duct paucity. After biopsy, mild pain and discomfort was present in 23 (38.3%) children, while diffuse pain which required analgesics in 11 (18.3%) children without any major complications.Conclusion: Liver biopsy is a useful and practical tool for the diagnosis of pediatric liver diseases. Neonatal hepatitis, biliary atresia, storage disorders and chronic hepatitis were common entities in our set up. Consanguinity was more common in hereditary and metabolic liver diseases. Liver biopsy is safe having minimal complications.Bangladesh J Child Health 2016; VOL 40 (2) :72-78