Giant liver hemangioma resected by trisectorectomy after efficient volume reduction by transcatheter arterial embolization: a case report

<p>Abstract</p> <p>Introduction</p> <p>Liver hemangiomas are the most common benign liver tumors, usually small in size and requiring no treatment. Giant hemangiomas complicated with consumptive coagulopathy (Kasabach-Merritt syndrome) or causing severe incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. Here, we present the case of a giant hemangioma, which was, to the best of our knowledge, one of the largest ever reported.</p> <p>Case presentation</p> <p>A 38-year-old Asian man was referred to our hospital with complaints of severe abdominal distension and pancytopenia. Examinations at the first visit revealed a right liver hemangioma occupying the abdominal cavity, protruding into the right diaphragm up to the right thoracic cavity and extending down to the pelvic cavity, with a maximum diameter of 43 cm, complicated with "asymptomatic" Kasabach-Merritt syndrome. Based on the tumor size and the anatomic relationship between the tumor and hepatic vena cava, primary resection seemed difficult and dangerous, leading us to first perform transcatheter arterial embolization to reduce the tumor volume and to ensure the safety of future resection. The tumor volume was significantly decreased by two successive transcatheter arterial embolizations, and a conventional right trisectorectomy was then performed without difficulty to resect the tumor.</p> <p>Conclusions</p> <p>To date, there have been several reports of aggressive surgical treatments, including extra-corporeal hepatic resection and liver transplantation, for huge hemangiomas like the present case, but because of its benign nature, every effort should be made to avoid life-threatening surgical stress for patients. Our experience demonstrates that a pre-operative arterial embolization may effectively enable the resection of large hemangiomas.</p

Liver Transplantation and Hepatitis C

Hepatitis-C-virus- (HCV-) related end-stage cirrhosis is the primary indication for liver transplantation in many countries. Unfortunately, however, HCV is not eliminated by transplantation and graft reinfection is universal, resulting in fibrosis, cirrhosis, and finally graft decompensation. The use of poor quality organs, particularly from older donors, has a highly negative impact on the severity of recurrence and patient/graft survival. Although immunosuppressive regimens have a considerable impact on the outcome, the optimal regimen after liver transplantation for HCV-infected patients remains unclear. Disease progression monitoring with protocol biopsy and new noninvasive methods is essential for predicting patient/graft outcome and starting antiviral treatment with the appropriate timing. Antiviral treatment with pegylated interferon and ribavirin is currently considered the most promising regimen with a sustained viral response rate of around 30% to 35%, although the survival benefit of this regimen remains to be investigated. Living-donor liver transplantation is now widely accepted as an established treatment for HCV cirrhosis and the results are equivalent to those of deceased donor liver transplantation

Validation of novel Japanese indication criteria and biomarkers among living donor liver transplantation recipients with hepatocellular carcinoma - a single center retrospective study

Aim: To validate a novel Japanese indication criteria for liver transplantation (LT) for hepatocellular carcinoma (HCC), i.e., the 5-5-500 criteria (nodule size ≤ 5 cm in diameter, nodule number ≤ 5, and alfa-fetoprotein (AFP) value ≤ 500 ng/mL) and the Japanese double eligibility criteria (DEC) (patients meeting the Milan or the 5-5-500 criteria) in the University of Tokyo cohort. The usefulness of biomarkers in predicting the recurrence of HCC was also verified.Methods: The overall survival and recurrence rates of patients meeting the Milan, 5-5-500, and the Japanese DEC were compared among 153 patients who underwent living donor LT (LDLT) between 1996 and 2019. A receiver-operating characteristics curve analysis was conducted to evaluate the usefulness of AFP, lens culinaris agglutinin-reactive fraction of AFP, des-gamma-carboxy prothrombin, neutrophil-lymphocyte ratio, and the platelet-lymphocyte ratio to detect recurrence.Results: The 5-year recurrence rate for all patients, those meeting the Japanese DEC, 5-5-500 criteria, and the Milan criteria was 10.9%, 9.2%, 7.4%, and 7.6%, respectively. Compared with the conventional Milan criteria, the 5-5-500 criteria and the Japanese DEC could increase the number of eligible LDLT candidates by 6.1% and 11.4%. Among five biomarkers, the area under the curve value of AFP was the highest (0.852).Conclusion: The results suggest that the 5-5-500 criteria and the Japanese DEC are the appropriate selection criteria for patients with HCC in LDLT. Among five biomarkers investigated, AFP was most reliable to predict HCC recurrence, which justified the utilization of AFP in the 5-5-500 criteria and the Japanese DEC

Pancreatic lipoma with a solid nodule mimicking invasion from adjoining intraductal papillary mucinous neoplasm

AbstractA 74-year-old man was referred to our hospital for a mass in the pancreatic head found during screening chest computed tomography. Contrast computed tomography showed a 5-cm multicystic mass with an irregular border containing a solid component showing contrast enhancement. Caudal to this mass, a 5-cm solid mass of fat density with a nodular soft-tissue component was found. Cytology of the aspirated pancreatic fluid revealed malignant cells, and surgery was performed for suspected intraductal papillary mucinous carcinoma. Pathologic analysis of the resected specimen revealed a collision tumor of intraductal papillary mucinous neoplasm (IPMN) with high-grade dysplasia and pancreatic lipoma. The soft-tissue component within the lipoma was a nodule consisting of pancreatic tissue with inflammatory infiltration and hyalinization and was not associated with IPMN invasion