A ciliated hepatic foregut cyst (CHFC) is a rare foregut developmental malformation usually diagnosed in adulthood. Five percent of reported cases of CHFC transform into squamous cell carcinoma. We report the presenta...A ciliated hepatic foregut cyst (CHFC) is a rare foregut developmental malformation usually diagnosed in adulthood. Five percent of reported cases of CHFC transform into squamous cell carcinoma. We report the presentation, evaluation, and surgical management of a symptomatic 45-year-old male found to have a 6.2 cm CHFC. Contrast tomography-guided fine-needle aspiration demonstrated columnar, ciliated epithelium consistent with the histologic diagnosis of CHFC. The intracystic levels of carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) were extremely high (978118 U/mL and 973 μg/L, respectively). Histologically, the wall of the cyst showed characteristic pseudopapillae lined with a ciliated stratified columnar epithelium, underlying smooth muscle, an outer fibrous layer and no atypia. Immunohistochemistry for CA19-9 and CEA was positive. This is the first case report of a CHFC in which levels of CA 19-9 and CEA were measured. Our findings suggest that a large sized multilocular cyst and elevated cyst CA19-9 and CEA levels do not exclude a CHFC from consideration in the diagnosis. CHFCs should be included in the differential diagnosis of hepatic lesions. Accurate diagnosis of a CHFC is necessary given its potential for malignant transformation, and surgical excision is recommended.展开更多
Background:Two-stage hepatectomy(TSH)with portal vein embolization(PVE)is associated with high morbidity and mortality and may result in liver failure due to insufficient future liver remnant.The objectives of this in...Background:Two-stage hepatectomy(TSH)with portal vein embolization(PVE)is associated with high morbidity and mortality and may result in liver failure due to insufficient future liver remnant.The objectives of this investigation were to evaluate the short-term outcomes of patients with colorectal cancer liver metastasis who underwent TSH with PVE,and to critically review the selection criteria for TSH-PVE.Methods:A retrospective review of all patients who were operated due to bi-lobar CRLM during the years 2007–2017 was performed.Patients who underwent TSH-PVE were compared to those who underwent right hepatectomy(RH)only.Results:Twenty-nine patient underwent TSH,25 of whom(86.2%)completed both stages.These patients demonstrated a major complication rate of 17%,and a 90-day mortality rate of 3.4%.Most complications(80%)were related to the colonic resection,and one patient developed liver failure.Patients who suffered complications had a trend towards more baseline comorbidities and more liver lesions.Ablative techniques were utilized in 76%.When compared to 35 patients who underwent sole RH,no significant difference was demonstrated in major complication rate(20%)or mortality(0%).Conclusions:TSH is a relatively safe procedure in selected patients.Ablative techniques can reduce the occurrence of liver insufficiency and should be used liberally when possible.Factors such as number of lesions,comorbidities and the timing of colonic resection should be considered and evaluated in order to improve the outcomes of the procedure.展开更多
A 52-year-old woman,previously healthy was admitted to another hospital due to right upper quadrant abdominal pain,fever and leukocytosis.An ultrasound demonstrated acute cholecystitis and lesion 8 cm.in diameter near...A 52-year-old woman,previously healthy was admitted to another hospital due to right upper quadrant abdominal pain,fever and leukocytosis.An ultrasound demonstrated acute cholecystitis and lesion 8 cm.in diameter near the gallbladder.An abdominal CT scan showed the lesion in close proximity to the gallbladder,with fat infiltration.A percutaneous drainage of the lesion under CT guidance yielded a substance which was bloody and purulent in content.The patient improved clinically under antibiotics and was discharged from hospital with a recommendation for elective exploratory laparoscopy.展开更多
Pylephlebitis is an inflamed thrombosis of the portal vein,or of its branches,and is a rare but potentially lethal complication of an intra-abdominal infection.In adults,it is commonly associated with acute appendicit...Pylephlebitis is an inflamed thrombosis of the portal vein,or of its branches,and is a rare but potentially lethal complication of an intra-abdominal infection.In adults,it is commonly associated with acute appendicitis and diverticulitis.It is often missed due to its non-specific clinical presentation.Usually the diagnosis is done with doppler ultrasonography and computed tomography(CT)scans.展开更多
文摘A ciliated hepatic foregut cyst (CHFC) is a rare foregut developmental malformation usually diagnosed in adulthood. Five percent of reported cases of CHFC transform into squamous cell carcinoma. We report the presentation, evaluation, and surgical management of a symptomatic 45-year-old male found to have a 6.2 cm CHFC. Contrast tomography-guided fine-needle aspiration demonstrated columnar, ciliated epithelium consistent with the histologic diagnosis of CHFC. The intracystic levels of carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) were extremely high (978118 U/mL and 973 μg/L, respectively). Histologically, the wall of the cyst showed characteristic pseudopapillae lined with a ciliated stratified columnar epithelium, underlying smooth muscle, an outer fibrous layer and no atypia. Immunohistochemistry for CA19-9 and CEA was positive. This is the first case report of a CHFC in which levels of CA 19-9 and CEA were measured. Our findings suggest that a large sized multilocular cyst and elevated cyst CA19-9 and CEA levels do not exclude a CHFC from consideration in the diagnosis. CHFCs should be included in the differential diagnosis of hepatic lesions. Accurate diagnosis of a CHFC is necessary given its potential for malignant transformation, and surgical excision is recommended.
文摘Background:Two-stage hepatectomy(TSH)with portal vein embolization(PVE)is associated with high morbidity and mortality and may result in liver failure due to insufficient future liver remnant.The objectives of this investigation were to evaluate the short-term outcomes of patients with colorectal cancer liver metastasis who underwent TSH with PVE,and to critically review the selection criteria for TSH-PVE.Methods:A retrospective review of all patients who were operated due to bi-lobar CRLM during the years 2007–2017 was performed.Patients who underwent TSH-PVE were compared to those who underwent right hepatectomy(RH)only.Results:Twenty-nine patient underwent TSH,25 of whom(86.2%)completed both stages.These patients demonstrated a major complication rate of 17%,and a 90-day mortality rate of 3.4%.Most complications(80%)were related to the colonic resection,and one patient developed liver failure.Patients who suffered complications had a trend towards more baseline comorbidities and more liver lesions.Ablative techniques were utilized in 76%.When compared to 35 patients who underwent sole RH,no significant difference was demonstrated in major complication rate(20%)or mortality(0%).Conclusions:TSH is a relatively safe procedure in selected patients.Ablative techniques can reduce the occurrence of liver insufficiency and should be used liberally when possible.Factors such as number of lesions,comorbidities and the timing of colonic resection should be considered and evaluated in order to improve the outcomes of the procedure.
文摘A 52-year-old woman,previously healthy was admitted to another hospital due to right upper quadrant abdominal pain,fever and leukocytosis.An ultrasound demonstrated acute cholecystitis and lesion 8 cm.in diameter near the gallbladder.An abdominal CT scan showed the lesion in close proximity to the gallbladder,with fat infiltration.A percutaneous drainage of the lesion under CT guidance yielded a substance which was bloody and purulent in content.The patient improved clinically under antibiotics and was discharged from hospital with a recommendation for elective exploratory laparoscopy.
文摘Pylephlebitis is an inflamed thrombosis of the portal vein,or of its branches,and is a rare but potentially lethal complication of an intra-abdominal infection.In adults,it is commonly associated with acute appendicitis and diverticulitis.It is often missed due to its non-specific clinical presentation.Usually the diagnosis is done with doppler ultrasonography and computed tomography(CT)scans.
