Neuroendocrine tumor incidentally detected during living donor hepatectomy: A case report and review of literature

To our best knowledge, no case of a tumor that was incidentally detected during living donor hepatectomy(LDH) has been reported in the English language medical literature. We present two cases in which grade Ⅰ neuroendocrine tumors(NET) were incidentally detected during our twelve-year LDH experience. First Case: A 26-yearold male underwent LDH for his brother suffering from HBV-related chronic liver disease(CLD). After right lobe LDH, intestinal length was measured as part of a study concerning the relationship between small intestinal lengths and surgical procedure. At this stage, a mass lesion with a size of 10 mm × 10 mm was detected on the antimesenteric surface, approximately 90 cm proximal to the ileocecal valve. A wedge resection with primary intestinal anastomosis was performed. Second Case: A 29-year-old male underwent right lobe LDH for his father with hepatitis B virus(HBV)-related CLD. An abdominal exploration immediately prior to the closure of the incision revealed that the appendix vermiformis was edematous and had firmness with a size of 8-10 mm at its tip. An appendectomy was performed. The pathological examinations of the specimens of both patients revealedgrade 1 NET. In conclusion, even if patients undergoing LDH are healthy individuals, whole abdominal cavity should be gently palpated and all findings recorded after completing laparotomy. Suspected masses or lesions should be confirmed by frozen section examination. Such an approach would avert potential medicolegal issues.

Discordance among aggressiveness characteristics of hepatocellular carcinoma:Portal vein thrombosis and multifocality,related to tumor size,but not to serum alpha-fetoprotein level

Background and aims:Hepatocellular carcinoma(HCC)is characterized by several clinically important prognostic parameters,including portal vein thrombosis(PVT),tumor multifocality,and serum alphafetoprotein(AFP)levels,in addition to maximum tumor diameter(MTD).However,associations among these parameters have not been thoroughly examined.Thus,the study aimed to investigate the correlations among these HCC characteristics in a prospectively collected database.Methods:An 8080 HCC patient database derived from our weekly HCC council meeting was examined with respect to the correlations at baseline patient presentation between increases in MTD and changes in the percentage of patients with PVT,multifocality,or AFP levels.Results:The percentage of patients with PVT and with multifocality(tumor nodule numbers≥3)significantly increased with enlarging MTD,regardless of the serum AFP level,showing the independence of PVT and multifocality on AFP.The percentage of patients with multifocality increased with enlarging MTD,in the presence or absence of PVT,showing the independence of multifocality from PVT.Therefore,discordance was found between different tumor parameters.Conclusions:A statistically significant association was found between PVT and MTD and between multifocality and MTD,all three of which are independent of AFP.PVT and multifocality appeared to be independent of each other.Although PVT and multifocality were independent of AFP,they were also augmented with high serum AFP levels.The results suggest the possibility of multiple pathways of tumor progression in the later stages of HCC development.