Ectopic Liver Research Articles

Accessory Hepatic Lobe in Paediatric Patients: Case Report and a Comprehensive Literature Review

Background: Accessory Hepatic Lobe (AHL) is a rare congenital anomaly that consists of the presence of a supernumerary lobe of hepatic parenchyma. The incidence of AHL is less than 1%, with only 27 cases having been reported in the paediatric population to date. Aim: To identify studies in the literature on accessory hepatic lobe and present our experience with this condition. Material and methods: We report the case of a patient who underwent surgery for intestinal occlusion and was found to have an accessory liver lobe with an embedded gallbladder. We reviewed published articles on accessory hepatic lobes accessed via PubMed, Google Scholar, Science Direct and Web of Science. Keywords included accessory hepatic lobe, ectopic liver tissue, ectopic liver lobe, accessory liver lobe. The search included articles published before August 2021 in English. Results: We identified 27 published cases of paediatric accessory hepatic lobe. Of these 27, 14 were female and 13 were male, and the age range was 1 day to 19 years. We report the case of a female patient with intestinal occlusion found to have an accessory hepatic lobe with an embedded gallbladder. Of the 28 published cases, including ours, 11 are associated with abdominal wall defects including Umbilical Hernia, Omphalocele, Cloacal Exstrophy and Beckwith Wiedemann syndrome. Conclusion: Accessory hepatic lobe is a rare entity usually detected incidentally. A total of 28 cases were reported, including our own. Paediatric surgeons should be aware of this condition in children with a history of abdominal wall defects.

A higher-protein nut-based snack product suppresses glycaemia and decreases glycaemic response to co-ingested carbohydrate in an overweight prediabetic Asian Chinese cohort: the Tū Ora postprandial RCT.

Nut-based products may aid low-glycaemic dietary strategies that are important for diabetes prevention in populations at increased risk of dysglycaemia, such as Asian Chinese. This randomised cross-over trial assessed the postprandial glycaemic response (0-120 min) of a higher-protein nut-based (HP-NB) snack formulation, in bar format (1009 kJ, Nutrient Profiling Score, NPS, -2), when compared with an iso-energetic higher-carbohydrate (CHO) cereal-based bar (HC-CB, 985 kJ, NPS +3). It also assessed the ability to suppress glucose response to a typical CHO-rich food (white bread, WB), when co-ingested. Ten overweight prediabetic Chinese adults (mean, sd: age 47⋅9, 15⋅7 years; BMI 25⋅5, 1⋅6 kg/m2), with total body fat plus ectopic pancreas and liver fat quantified using dual-energy X-ray absorptiometry and magnetic resonance imaging and spectroscopy, received the five meal treatments in random order: HP-NB, HC-CB, HP-NB + WB (50 g available CHO), HC-CB + WB and WB only. Compared with HC-CB, HP-NB induced a significantly lower 30-120 min glucose response (P < 0⋅05), with an approximately 10-fold lower incremental area under the glucose curve (iAUC0-120; P < 0⋅001). HP-NB also attenuated glucose response by approximately 25 % when co-ingested with WB (P < 0⋅05). Half of the cohort had elevated pancreas and/or liver fat, with 13-21 % greater suppression of iAUC0-120 glucose in the low v. high organ fat subgroups across all five treatments. A nut-based snack product may be a healthier alternative to an energy equivalent cereal-based product with evidence of both a lower postprandial glycaemic response and modulation of CHO-induced hyperglycaemia even in high-risk, overweight, pre-diabetic adults.

Ectopic Liver Nodule in an Infant with Pyloric Stenosis Presentation: First Detailed Case Report of Laparoscopic Resection in a Pediatric Patient

Ectopic Liver Nodule in an Infant with Pyloric Stenosis Presentation: First Detailed Case Report of Laparoscopic Resection in a Pediatric Patient

Ectopic Liver Tissue on Gallbladder (Choristoma): Two Case Reports.

Ectopic Liver Tissue on Gallbladder (Choristoma): Two Case Reports.

Gallbladder- associated ectopic liver tissue: Case Report

Introduction: Ectopic liver tissue is a rare entity. It can be found in various organs of the body but the most common reported location is the gallbladder. The incidence is varying between 0.27% and 0.47%. Most of the cases are asymptomatic and diagnosed intra-operatively or during autopsy. We report a case of Gallbladder-Associated ectopic liver tissue that was encountered during a laparoscopic cholecystectomy. Case presentation: A 40-year-old female patient was admitted to the hospital for laparoscopic cholecystectomy for symptomatic gallstones, intra-operatively we found an ectopic liver tissue attached to the gallbladder wall. Cholecystectomy was performed and the patient was discharged home the day after surgery in good condition. The histopathological examination of the specimen was confirmed to be an ectopic liver tissue without signs of malignant transformation. Discussion: Ectopic liver tissue is a rare congenital anomaly. It is defined as the presence of liver tissue outside the native liver. It occurs due to a failure of embryological liver development and it can be found in various organs of the body but the most common reported location is the gallbladder. Ectopic liver tissue is found to be functionally handicapped and more vulnerable to carcinogens and it is strongly associated with the development of hepatocellular carcinoma. Conclusion: Although it is a rare condition, ectopic liver tissue may pose a challenge to surgeons. When encountered, a surgical excision with histopathological examination is recommended because of its serious complications and the potential risk of malignant transformation.

Ectopic liver tissue (choristoma) on the gallbladder: A comprehensive literature review

BACKGROUNDLiver tissue situated outside the liver with a hepatic connection is usually called an accessory liver, and that without a connection to the mother liver, is called ectopic liver tissue. AIMTo identify studies in the literature on ectopic liver tissue located on the gallbladder surface or mesentery. METHODSWe present two patients and review published articles on ectopic liver tissue located on the gallbladder surface accessed via PubMed, MEDLINE, Google Scholar, and Google databases. Keywords used included accessory liver lobe, aberrant liver tissue, ectopic liver tissue, ectopic liver nodule, heterotopic liver tissue, hepatic choristoma, heterotopic liver tissue on the gallbladder, and ectopic liver tissue on the gallbladder. The search included articles published before June 2020 with no language restriction. Letters to the editor, case reports, review articles, original articles, and meeting presentations were included in the search. Articles or abstracts containing adequate information on age, sex, history of liver disease, preliminary diagnosis, radiologic tools, lesion size, surgical indication, surgical procedure, and histopathological features of ectopic liver tissue were included in the study.RESULTSA total of 72 articles involving 91 cases of ectopic liver tissue located on the gallbladder surface or mesentery were analyzed. Of these 91 patients, 62 were female and 25 were male (no gender available for 4 patients), and the age range was 5 d to 91 years. Forty-nine patients underwent surgery for chronic cholecystitis or cholelithiasis, and 14 patients underwent surgery for acute cholecystitis. The remaining 28 patients underwent laparotomy for other reasons. Cholecystectomy was laparoscopic in 69 patients and open in 11 patients. The remaining 19 patients underwent various other surgical procedures such as autopsy, liver transplantation, living donor hepatectomy, Whipple procedure, and liver segment V resection. Histopathologically, hepatocellular carcinoma was detected in the ectopic liver tissue of one patient. CONCLUSIONEctopic liver tissue is a rare developmental anomaly which is usually detected incidentally. Although most studies suggest that ectopic liver located outside the gallbladder has a high risk of hepatocellular carcinoma, this is not reflected in statistical analysis.

Ectopic liver on gall bladder serosa a case report and brief review of literature

Ectopic liver is a very rare developmental anomaly of liver , it is rairly diagnosed preoperatively because of rairrity of condition and very scarcely produces any symtom,it is missed in radiology .we report a case of ectopic liver which was diagnosed intraoperatively on laparoscopy as a incidental finding while doing a right radical nephrectomy,it is not clear in literatur what is to be done for this incidentaly diagnosed normal ecctopic liver while doing other surgery. A brief review of its prevalance, embriology, diagnosis, and pathology which develop in ectopic liver will be disccused in this review. Keyword: Ectopic liver, Renal cell carcinoma, Laprosocpy, Incidental.

Congenital diaphragmatic hernia with hepatic heterotopia

Abstract The association of congenital diaphragmatic hernia with hepatic heterotopia is a rare one that has been scarcely reported. We present a case of a female neonate with an antenatally diagnosed left congenital diaphragmatic hernia. Intra-operatively she was found to have ectopic liver tissue within the hernia sac. This case report discusses the presentation, classification, and significance of this rare association.

Psoriatic arthritis is associated with adverse body composition predictive of greater coronary heart disease and type 2 diabetes propensity - a cross-sectional study.

ObjectivesTo compare body composition in PsA with metabolic disease free (MDF) controls and type 2 diabetes and assess body-composition predicted propensity for cardiometabolic disease.MethodsDetailed MRI body composition profiles of 26 PsA participants from the IMAPA study were compared with 130 age, sex and BMI-matched MDF controls and 454 individuals with type 2 diabetes from UK Biobank. The body-composition predicted propensity for coronary heart disease (CHD) and type 2 diabetes was compared between PsA and matched MDF controls.ResultsPsA participants had a significantly greater visceral adipose tissue (VAT) volume [mean 5.89 l (s.d. 2.10 l)] compared with matched-MDF controls [mean 4.34 l (s.d. 1.83 l)] (P <0.001) and liver fat percentage [median 8.88% (interquartile range 4.42–13.18%)] compared with MDF controls [3.29% (1.98–7.25%)] (P <0.001). These differences remained significant after adjustment for age, sex and BMI. There were no statistically significant differences in VAT, liver fat or muscle fat infiltration (MFI) between PsA and type 2 diabetes. PsA participants had a lower thigh muscle volume than MDF controls and those with type 2 diabetes. Body composition-predicted propensity for CHD and type 2 diabetes was 1.27 and 1.83 times higher, respectively, for PsA compared with matched-MDF controls.ConclusionIndividuals with PsA have an adverse body composition phenotype with greater visceral and ectopic liver fat and lower thigh muscle volume than matched MDF controls. Body fat distribution in PsA is more in keeping with the pattern observed in type 2 diabetes and is associated with greater propensity to cardiometabolic disease. These data support the need for greater emphasis on weight loss in PsA management to lessen CHD and type 2 diabetes risk.

Development of Ectopic Livers by Hepatocyte Transplantation Into Swine Lymph Nodes.

Orthotopic liver transplantation continues to be the only effective therapy for patients with end‐stage liver disease. Unfortunately, many of these patients are not considered transplant candidates, lacking effective therapeutic options that would address both the irreversible progression of their hepatic failure and the control of their portal hypertension. In this prospective study, a swine model was exploited to induce subacute liver failure. Autologous hepatocytes, isolated from the left hepatic lobe, were transplanted into the mesenteric lymph nodes (LNs) by direct cell injection. At 30‐60 days after transplantation, hepatocyte engraftment in LNs was successfully identified in all transplanted animals with the degree of ectopic liver mass detected being proportional to the induced native liver injury. These ectopic livers developed within the LNs showed remarkable histologic features of swine hepatic lobules, including the formation of sinusoids and bile ducts. On the basis of our previous tyrosinemic mouse model and the present pig models of induced subacute liver failure, the generation of auxiliary liver tissue using the LNs as hepatocyte engraftment sites represents a potential therapeutic approach to supplement declining hepatic function in the treatment of liver disease.

141 Poster - A comprehensive analysis of cetuximab combinatorial polymeric nanocomplexes with potent radionuclide uptake to combat metastatic liver cancer

Background: Herein, we have determined the anticancer effects of Cetuximab targeted combinatorial polymeric nanocomplexes comprising either combretastatin A4 or methoxyestradiol in ectopic and orthotopic metastatic liver cancer SCID mice models.

S1497 Hepatoid What/Where?

INTRODUCTION: Hepatoid carcinoma (HC) of the pancreas is a rare malignancy with only 34 cases reported in the literature. HC displays morphological and serological features similar to hepatocellular carcinoma and may arise in organs derived from the foregut endoderm, such as the pancreas. We present a case of a gentleman with unresectable HC of the pancreatic head who presented with painless jaundice and weight loss. CASE DESCRIPTION/METHODS: A 58-year-old Caucasian male presented acutely to our facility with a history of painless jaundice, scleral icterus, and 20 pound unintentional weight loss. Laboratory tests revealed a total bilirubin of 31.6 mg/dL and an alkaline phosphatase of 424 mg/dL. A 6 cm mass in the pancreatic head was seen on computed tomography. The patient underwent endoscopic ultrasound with fine needle aspiration of the mass and endoscopic retrograde cholangiography with biliary stenting to relieve the obstruction. Immunohistochemical studies revealed the mass to be CK7, PASD, CEA, and HepPar-1 positive, consistent with HC of the pancreas. Imaging studies demonstrated involvement of the portal vein with mediastinal lymphadenopathy and staged his tumor as T3N2M0. He therefore was not a candidate for surgical resection. FOLFIRINOX chemotherapy was started, however follow-up imaging displayed progression of disease, including metastatic disease to the left lung and the surrounding lymph nodes. He subsequently developed recurrent biliary obstruction and gastric outlet obstruction due to tumor growth. This was treated with repeat biliary stenting and placement of a duodenal stent. Unfortunately, he had continued disease progression and died 10 months after his initial presentation. DISCUSSION: Hepatoid carcinoma of the pancreas is a rare and aggressive cancer with no known etiology or standardized treatment regimen. Explanations in the literature include origin from ectopic liver tissue or transdifferentiation. Patient prognosis depends on the stage at diagnosis. To date, all documented cases of unresectable HC led to patient death within one year of diagnosis. Diagnosis is made with a combination of clinical, laboratory, imaging, and immunochemical features. Further study is required to more fully understand the etiology of hepatoid carcinoma to help develop guidelines for adjuvant therapy options if the cancer is unresectable. DISCLAIMER: The views expressed are the authors and do not reflect the official policy of the Department of the Army, the Department of Defense or the U.S. Government.Figure 1.: Fluoroscopic image of esophagogastroduodenoscopy post biliary stent placement.Figure 2.: Endoscopic ultrasound image of pancreatic head mass.Figure 3.: Computed tomographic image with IV contrast at the time of initial presentation showing the 4.6 × 5.3 × 6 cm mass in the pancreatic head abutting the portal vein.

Profiling the Discordant Visceral Adipose Tissue–Ectopic Liver Fat Phenotype: Results from the Dallas Heart Study

The accumulation of visceral adipose tissue (VAT) and ectopic liver fat (ELF) generally parallel each other, but a proportion of individuals have discordant fat deposition. The cardiometabolic profile of individuals with a discordant phenotype is unknown.

Pulmonary Embolus of Benign Liver Tissue Following Partial Hepatectomy

Abstract We report the case of a 55-year-old man with metastatic well-differentiated neuroendocrine tumor involving the liver and lung. He underwent a left hepatectomy to resect a large mass in the liver followed by a right lung lower lobectomy 4 months later to resect a smaller mass in the lung. The histologic evaluation of the lung specimen revealed a 0.1-cm nodule of ectopic benign liver tissue within a lumen of a small pulmonary artery. Histochemical and immunohistochemical stains were consistent with benign liver and did not provide support for metastatic well-differentiated hepatocellular carcinoma. To our knowledge, this is the first documented case of pulmonary arterial embolization by benign liver tissue as a complication of hepatectomy.

144-OR: The Antirheumatic Drug Auranofin Improves the Metabolic Phenotype of Obesity

Obesity is associated with chronic low-grade inflammation, reflecting significant alterations in the composition of immune cell populations that reside in white adipose tissue (WAT). The ensuing pro-inflammatory environment likely impinges on the metabolic functions of adipocytes and may partially explain the insulin resistance that characterizes type 2 diabetes mellitus (T2DM). We recently demonstrated ectopic expression of the microRNA miR-30a in the subcutaneous fat pad of diabetic mice coupled improved insulin sensitivity and increased energy expenditure with decreased ectopic fat deposition in the liver and reduced WAT inflammation. We subsequently pursued the notion that pharmacological inhibitors of inflammation that exhibit a gene expression profile similar to ectopic miR-30a expression in WAT should represent new drugs for insulin resistance and T2DM. To this end, we used the Broad Connectivity Map to analyze a library of small molecules that induce mRNA profiles similar to that of exogenous miR-30a expression in WAT. Through this process, we nominated the rheumatoid arthritis compound auranofin. Treatment of obese mice with auranofin improved insulin sensitivity and glucose tolerance. Auranofin treatment also normalized other obesity-associated abnormalities, including hepatic steatosis, serum insulin and leptin. Mechanistically, a combination of proteomics and immunophenotyping established auranofin likely exerts antidiabetic activities by opposing low-grade inflammation in WAT and ectopic liver fat accumulation. These studies reveal important metabolic properties of anti-inflammatory treatments that may be re-purposed as therapies for insulin resistance and T2DM. Disclosure A. Cox: None. P.M. Masschelin: None. N. Chernis: None. P. Saha: None. Z. Lian: None. J.B. Felix: None. K. Kim: None. H. Wu: None. S.M. Hartig: None. Funding American Diabetes Association (1-18-IBS-105 to S.M.H.); National Institutes of Health (R01DK114356)

Abstract MP35: Discordant Visceral and Liver Fat Phenotypes are Differentially Associated With Incident Cardiovascular Disease and Type 2 Diabetes

Background: Visceral adipose tissue (VAT) and ectopic liver fat (ELF) are linked with cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) but little is known about their joint associations when they are discordant in an individual. Objective and Hypothesis: This study aims to evaluate cardiometabolic health outcomes associated with discordant VAT-ELF phenotypes in a multi-ethnic, population-based cohort of adults. We hypothesized that high VAT-low ELF, but not low VAT-high ELF, would be associated with incident cardiovascular disease, but both would be associated with incident T2DM. Methods: Participants of the Dallas Heart Study with no history of CVD or T2DM had assessments of VAT and ELF by MRI and MRS, respectively, between 2000 and 2002 and were followed for a median (IQR) of 12.0 (11.5-12.7) years for the incidence of CVD or T2DM. Associations between VAT-ELF phenotypes (high/low based on sex- and race-specific median values) and outcomes were evaluated using multivariable adjusted Cox proportional hazards and logistic regression models, as appropriate. Results: The study cohort included 1731 participants (mean age 43, 54% female, 44% black, 18% Hispanic, 41% obese). 128 (7.4%) participants had incident CVD and 95 (5.5%) had incident T2DM during follow-up. In unadjusted models, those with high VAT-low ELF had the highest hazard for CVD ( Table ), but associations were attenuated after multivariable adjustment. In both unadjusted and adjusted models, high VAT and/or high ELF phenotypes were associated with T2DM, with the high VAT-high ELF phenotype demonstrating the highest odds for T2DM ( Table ). Conclusions: In conclusion, we found that the heterogeneous manifestations of abdominal obesity impact cardiometabolic health outcomes. Elevated liver fat in the presence of low or normal VAT is associated with incident T2DM but not CVD.

PROFILING THE DISCORDANT VISCERAL ADIPOSE TISSUE – ECTOPIC LIVER FAT PHENOTYPE: RESULTS FROM THE DALLAS HEART STUDY

The accumulation of visceral adipose tissue (VAT) and ectopic liver fat (ELF) generally parallel each other, but a proportion of individuals have discordant fat deposition. The cardiometabolic profile of individuals with a discordant phenotype is unknown. Among participants in the multiethnic

Ectopic Liver Tissue in the Left Hypocondrium: A Case Report and a Literature Review

Ectopic Liver Tissue in the Left Hypocondrium: A Case Report and a Literature Review

Not a Pancreatic Tumor after All - A Rare Case Report

Background: Hepatocellular carcinoma (HCC) accounts for most of the hepatic neoplasms and is the third leading cause of cancer related deaths in the world. HCC is mainly found in patients with chronic liver disease, being an aggressive neoplasm with poor prognosis and that historically presented as a stage IV disease at diagnosis. Regarding ectopic liver tissue, this entity is reported to occur mostly in the gallbladder, followed by hepatic ligaments and omentum, which are all susceptible sites to HCC.

Incidental Finding of Ectopic Liver during Laparoscopic Cholecystectomy

Case seriesPatients: Female, 44-year-old • Female, 62-year-oldFinal Diagnosis: Ectopic liverSymptoms: AsymptomaticMedication: —Clinical Procedure: Laparoscopic excision during cholecystectomySpecialty: SurgeryObjective:Rare co-existance of disease or pathologyBackground:Incidental finding of ectopic liver is gaining more attention especially during laparoscopic cholecystectomy. It is reported to be found in different locations as gallbladder, stomach, spleen, umbilical ligament and other intra-peritoneal and intra-thoracic sites.Case Reports:We present 2 cases of ectopic liver found on gallbladder during elective laparoscopic cholecystectomy for 2 Lebanese females. Our findings were consistent with previous reports. The ectopic liver tissues measured 0.9 cm and 0.5 cm respectively, which were smaller than other reports. The liver tissue lacked a biliary system, which was similar to what has been previously reported in the literature. However, no malignant histological signs were seen when excised.Conclusions:These 2 cases highlight the fact that ectopic liver tissue may be encountered on the gallbladder during laparoscopic cholecystectomy. Awareness of this potential entity is beneficial to widen the differential diagnosis when identified on imaging studies pre-operatively or when found incidentally during surgery as in this case.