BACKGROUND Hepatocellular adenoma(HCA) is a rare benign liver tumor usually affecting young women with a history of prolonged use of hormonal contraception.Although the majority is asymptomatic, a low proportion may h...BACKGROUND Hepatocellular adenoma(HCA) is a rare benign liver tumor usually affecting young women with a history of prolonged use of hormonal contraception.Although the majority is asymptomatic, a low proportion may have significant complications such as bleeding or malignancy. Despite responding to the hormonal stimulus, the desire for pregnancy in patients with small HCA is not contraindicated. However, through this work we demonstrate that intensive hormonal therapies such as those used in the treatment of infertility can trigger serious complications CASE SUMMARY A 33-year-old female with a 10-year history of oral contraceptive use was diagnosed with a hepatic tumor as an incidental finding in an abdominal ultrasound. The patient showed no symptoms and physical examination was unremarkable. Laboratory functional tests were within normal limits and tests for serum tumor markers were negative. An abdominal magnetic resonance imaging(MRI) was performed, showing a 30 mm × 29 mm focal lesion in segment VI of the liver compatible with HCA or Focal Nodular Hyperplasia with atypical behavior. After a total of six years of follow-up, the patient underwent ovulation induction treatment for infertility. On a following MRI, a suspected malignancy was warned and hence, surgery was decided. The surgical specimen revealed malignant transformation of HCA towards trabecular hepatocarcinoma with dedifferentiated areas. There was non-evidence of tumor recurrence after three years of clinical and imaging follow-up.,CONCLUSION HCAs can be malignant regardless its size and low-risk appearance on MRI when an ovultation induction therapy is indicated.展开更多
To the Editor:Liver procurement(LP)from a neurologically deceased donor(NDD)is one of the most important spotlights in liver transplanta-tion(LT)[1,2].The commonly used approaches include the“rapid”en-bloc dissectio...To the Editor:Liver procurement(LP)from a neurologically deceased donor(NDD)is one of the most important spotlights in liver transplanta-tion(LT)[1,2].The commonly used approaches include the“rapid”en-bloc dissection,the in vivo normothermic dissection,or a com-bination of both,according to the preferences and/or the experi-ence of the LP/LT team.A correct LP is essential to achieve optimal results.On the counterpart,defective execution of any of its steps can leave the liver graft unusable and/or cause severe complica-tions in the recipient[3].展开更多
Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)approach emerged as a promising surgical strategy for rapid and large hypertrophy of the future liver remnant(FLR)when a major liver re...Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)approach emerged as a promising surgical strategy for rapid and large hypertrophy of the future liver remnant(FLR)when a major liver resection is necessary.Colorectal liver metastasis(CRLM)is their main indication.However,the promising results published so far,are very difficult to interpret since they usually focus on the technique and not on the underlying disease.Moreover,they are usually made up of complex populations,which received different chemotherapy schemes,with the ALPPS technical variations implemented over time and without consistent long-term follow-up results as well.Whereby,its role in CRLM should be analyzed as carefully as possible to indicate and select the best candidates who will benefit the most from this approach.We conducted a computerized search using PubMed and Google Scholar for reports published so far,using mesh headings and keywords related to the ALPPS and CRLM.展开更多
background Common bile duct injuries(CBDIs)remains a rare but serious complication in children undergoing laparoscopic cholecystectomy(LC),with an incidence of 0.44%.In severe lesions,a major liver resection may be ne...background Common bile duct injuries(CBDIs)remains a rare but serious complication in children undergoing laparoscopic cholecystectomy(LC),with an incidence of 0.44%.In severe lesions,a major liver resection may be necessary as a definitive treatment.The current principles for safe hepatectomy are mainly focused on the liver parenchyma that remains after resection.Therefore,one of the main factors related to posthepatectomy hepatic insufficiency is the quantity and quality of the future liver remnant(FLR).To achieve an optimal FLR,techniques such as portal vein embolization(PVE)are available.Case presentation We present the case of a 5-year-old child with a severe CBDI after LC,treated with preoperative PVE followed by a right hepatectomy as definitive treatment.No reports of liver resections and PVE are described in the literature concerning the pediatric population.展开更多
文摘BACKGROUND Hepatocellular adenoma(HCA) is a rare benign liver tumor usually affecting young women with a history of prolonged use of hormonal contraception.Although the majority is asymptomatic, a low proportion may have significant complications such as bleeding or malignancy. Despite responding to the hormonal stimulus, the desire for pregnancy in patients with small HCA is not contraindicated. However, through this work we demonstrate that intensive hormonal therapies such as those used in the treatment of infertility can trigger serious complications CASE SUMMARY A 33-year-old female with a 10-year history of oral contraceptive use was diagnosed with a hepatic tumor as an incidental finding in an abdominal ultrasound. The patient showed no symptoms and physical examination was unremarkable. Laboratory functional tests were within normal limits and tests for serum tumor markers were negative. An abdominal magnetic resonance imaging(MRI) was performed, showing a 30 mm × 29 mm focal lesion in segment VI of the liver compatible with HCA or Focal Nodular Hyperplasia with atypical behavior. After a total of six years of follow-up, the patient underwent ovulation induction treatment for infertility. On a following MRI, a suspected malignancy was warned and hence, surgery was decided. The surgical specimen revealed malignant transformation of HCA towards trabecular hepatocarcinoma with dedifferentiated areas. There was non-evidence of tumor recurrence after three years of clinical and imaging follow-up.,CONCLUSION HCAs can be malignant regardless its size and low-risk appearance on MRI when an ovultation induction therapy is indicated.
文摘To the Editor:Liver procurement(LP)from a neurologically deceased donor(NDD)is one of the most important spotlights in liver transplanta-tion(LT)[1,2].The commonly used approaches include the“rapid”en-bloc dissection,the in vivo normothermic dissection,or a com-bination of both,according to the preferences and/or the experi-ence of the LP/LT team.A correct LP is essential to achieve optimal results.On the counterpart,defective execution of any of its steps can leave the liver graft unusable and/or cause severe complica-tions in the recipient[3].
文摘Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)approach emerged as a promising surgical strategy for rapid and large hypertrophy of the future liver remnant(FLR)when a major liver resection is necessary.Colorectal liver metastasis(CRLM)is their main indication.However,the promising results published so far,are very difficult to interpret since they usually focus on the technique and not on the underlying disease.Moreover,they are usually made up of complex populations,which received different chemotherapy schemes,with the ALPPS technical variations implemented over time and without consistent long-term follow-up results as well.Whereby,its role in CRLM should be analyzed as carefully as possible to indicate and select the best candidates who will benefit the most from this approach.We conducted a computerized search using PubMed and Google Scholar for reports published so far,using mesh headings and keywords related to the ALPPS and CRLM.
文摘background Common bile duct injuries(CBDIs)remains a rare but serious complication in children undergoing laparoscopic cholecystectomy(LC),with an incidence of 0.44%.In severe lesions,a major liver resection may be necessary as a definitive treatment.The current principles for safe hepatectomy are mainly focused on the liver parenchyma that remains after resection.Therefore,one of the main factors related to posthepatectomy hepatic insufficiency is the quantity and quality of the future liver remnant(FLR).To achieve an optimal FLR,techniques such as portal vein embolization(PVE)are available.Case presentation We present the case of a 5-year-old child with a severe CBDI after LC,treated with preoperative PVE followed by a right hepatectomy as definitive treatment.No reports of liver resections and PVE are described in the literature concerning the pediatric population.
