Huge Liver Research Articles

PF2-047 - A case of peripheral T-cell lymphoma of the thyroid gland with Hashimoto's disease

Background: Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue lymphoma occupy the majority of malignant lymphoma of the thyroid gland, and the frequency of T-cell lymphoma is very rare. We experienced a case of peripheral T-cell lymphoma (PTCL) of the thyroid gland with Hashimoto's disease and report this with literature review. Case: A 71-year-old woman was diagnosed as subclinical hypothyroidism with an autoantibody. She began to take oral levothyroxine due to progressive diffuse goiter and an elevated serum level of thyroid stimulating hormone (TSH) and the dose was increased up to 100 µg/day. Because her white blood cell count increased to 52,600, bone marrow aspiration was performed and it revealed T-cell lymphoma involvement. After visiting our hospital, CT and PET-CT showed huge diffuse goiter, liver and multiple pulmonary lesions and she was diagnosed as PTCL by core needle biopsy of the thyroid gland. She was hospitalized and underwent 80% dose of cyclophosphamide/adriamycin/vincristine/PSL (CHOP) therapy. The size of thyroid gland was decreased and she experienced Grade 4 neutropenia. She was discharged and is still under total eight-course chemotherapy. After sixth cycle of CHOP therapy, CT showed remaining diffuse goiter due to Hashimoto's disease. Serum TSH level is lowered at the same dose of levothyroxine. Discussion: There are some case reports but no review articles in PTCL of the thyroid gland. Most of them have a background of Hashimoto's disease. Yoshida et al reported six cases and that tumor cells were positive for CD3, CD4 and CXCR3, suggesting they are originated from type-1 helper T cell, and that 10-year survival rate was 83% (Br J Haematol, 2013, 161, 214-223). As PTCL usually has worse prognosis than DLBCL, this good prognosis seems interesting. This type of lymphoma needs more case accumulation and analysis to be a new category of disease classification.

Percutaneous Microwave Ablation Liver Partition and Portal Vein Embolization for Rapid Liver Regeneration: A Minimally Invasive First Step of ALPPS for Hepatocellular Carcinoma.

Percutaneous Microwave Ablation Liver Partition and Portal Vein Embolization for Rapid Liver Regeneration: A Minimally Invasive First Step of ALPPS for Hepatocellular Carcinoma.

術前補助療法で縮小し完全切除しえた胃GISTの1例

A 53-year-old man was referred to our hospital because of abdominal fullness. Abdominal CT revealed a huge gastric tumor, invading spleen, liver and pancreas. Gastroscopy showed submucosal tumor (SMT) . It was diagnosed GIST by staining positively for c-kit. Administration of imatinib was begun as neoadjuvant chemotherapy during three-month period. As a result we estimated partial response (PR) in accordance with RECIST guideline. After that we underwent total gastrectomy with splenectomy and partial pancreatectomy as a total excision of the huge tumor. A few viable cells were observed in the tumor. He was doing well after surgery. We decided not to give the adjuvant dosage after consultation with him. There is no sign of recurrence for ten months after operation. Imatinib as neoadjuvant chemotherapy was effective for huge GIST on this case. We hope to build up further prospective study.

An Elderly Man with a Huge Liver

A 71-year old male presented with generalised gradual onset abdominal distension for 15 days accompanied by abdominal discomfort without any history of loss of appetite or weight. He was a chronic tobacco chewer and a non-alcoholic. Systemic examination revealed a nodular firm liver and presence of ascites but no splenomegaly. Rest of his systemic examination was normal. His liver function tests were deranged with total bilirubin: 1.6 mg/dL (normal, 0.3–1.0 mg/dL), alanine transaminase: 74.8 (Normal, 2–45 IU/L), aspartate transaminase: 90.7 (Normal, 2–35 IU/L), serum alkaline phosphatase: 868 (Normal, 42–128 IU/L) and serum albumin 3.1 mg/dL (normal, 3.5–5 mg/dL). Alpha-fetoprotein levels were normal. A triphasic computerised tomography scan was performed, which revealed the findings depicted in Figure 1A, B, C and D respectively. Figure 1 What is the diagnosis? Answers in the page 380.

Prognostic factors for patients who underwent surgical treatment for huge liver cancer

Objective To analyze the prognostic factors for patients who underwent surgical resection for huge liver cancer so as to improve the medical results of comprehensive therapy.Methods We retrospectively arlaysed the data of 51 patients who underwent surgical resection for huge liver cancer.Fifteen clinicopathologic factors possibly influencing survival were selected,and multivariate analysis of these parameters was performed using the Cox proportional hazards model.Survival analysis was done using the KaplanMeier method.Results The overall 1-,3-,5-year survival rates of 50 patients were 75.8％,37.9％ and 21.1％,respectively.Univariate analysis showed that AFP over 400 μg/L,tumor diameter over 12 cm,tumor boundary,vascular invasion and TNM staging significantly affected postoperative survival.Cox multivariate analysis indicated that tumor diameter of ≥ 12 cm,tumor boundary and vascular invasion were independent prognostic factors.Univariate analysis showed that tumor boundary,vascular invasion and TNM staging were the independent factors affecting recurrence,Cox multivariate analysis showed that vascular invasion was an independent factor influencing recurrence of tumor.Conclusions Surgical resection for patients with huge liver cancer could be safely performed with reasonable long-term survival.For patients having tumors with poor prognostic factors,there is a need for effective adjuvant therapy. Key words: Liver cancer; Hepatectomy ; Prognosis

Pancreatic body adenocarcinoma with neuroendocrine tumor characteristics: A case report.

A 61-year-old female with pancreatic body cancer underwent a distal pancreatectomy. The tumor was a moderately- to poorly-differentiated adenocarcinoma. Tumor growth filled the dilated main pancreatic duct (MPD) and infiltrated the surrounding area. Six months later, metastases to the left diaphragm and MPD of the remnant pancreatic head were detected. Chemoradiotherapy was administered, but the patient succumbed 22 months after surgery. An autopsy demonstrated that a moderately- to poorly-differentiated adenocarcinoma had arisen from the pancreatic head and infiltrated the duodenum and bile duct. Huge liver metastases and multiple peritoneal disseminations were also present. Microscopically, a portion of the tumor had a pseudo-rosette appearance in the adenocarcinoma component, while another section showed characteristics of a neuroendocrine tumor (NET) immunohistochemically. The original surgically-resected tumor also showed NET characteristics immunohistochemically. It is therefore necessary to search for NET components in pancreatic cancer with atypical growth and metastases, even when adenocarcinoma has been diagnosed histologically.

Glycogen storage disease type III in Egyptian children: A single centre clinico-laboratory study

Background and study aimsGlycogen storage disease type III (GSD III) is an autosomal recessive disorder caused by deficiency of glycogen debrancher enzyme and is characterised by clinical variability. Patients and methodsWe herein describe the clinical and laboratory findings in 31 Egyptian patients with GSD III presenting to the Paediatric Hepatology Unit, Cairo University, Egypt. ResultsEighteen patients (58%) were males. Their ages ranged between 6months to 12years. The main presenting complaint was progressive abdominal distention in 55%. Twelve patients (38.7%) had a history of recurrent attacks of convulsions; four had an erroneous diagnosis of hypocalcaemia and epilepsy. Doll-like facies was noted in 90%. Abdominal examination of all cases revealed abdominal distention and soft hepatomegaly which had bright echogenicity by ultrasound. Hypertriglyceridaemia was present in 93.6%, hyperlactacidaemia in 51.6% and hyperuricaemia in 19.4%. Liver biopsy showed markedly distended hepatocytes with well distinct cytoplasmic boundaries and 32% had macrovesicular fatty changes. Serum creatine kinase was elevated in 64.6% of patients and correlated positively and significantly with age (r=0.7 and P=<0.001), while serum triglycerides correlated negatively with age (r=−0.4 and P=0.05). ConclusionBlood glucose assessment and search for hepatomegaly in an infant with recurrent seizures may prevent delay in the diagnosis. A huge soft liver reaching the left midclavicular line that appears echogenic on ultrasonography is characteristic of GSD III. A distended hepatocyte with rarified cytoplasm is pathognomonic but not diagnostic. Hypertriglyceridaemia correlates negatively with age, in contrary to CK level.

Reduced port surgeryによる腹腔鏡下開窓術を施行した肝嚢胞（径19.9cm）の1例

Reduced port surgeryによる腹腔鏡下開窓術を施行した肝嚢胞（径19.9cm）の1例

Secondary Hepatocellular Carcinoma Following Hepatic Infiltration of Chronic Lymphocytic Leukemia

Purpose: A 75-year-old Hispanic female from Puerto Rico, who presented to our hospital in 2008 for oncology evaluation. She had been diagnosed of chronic lymphocytic leukemia (CLL) 4 months earlier. This was confirmed by a sternal bone marrow aspiration. At that time, she was completely asymptomatic and had no palpable lymphadenopathy. Other pertinent past medical histories were diabetes mellitus, hypertension, hyperlipidemia, and migraine headaches. Laboratory exams were notable for mild lymphocytosis. Flow cytometry showed typical CLL with CD 19+/CD5+ (co-expression), CD20+ (dim), CD23+, CD38- and kappa light chain+ (dim), 0% of ZAP 70 positive. Bone marrow cytogenetics showed normal karyotype. Since her presentation, she had an abnormal elevation in alkaline phosphatase that ranged from 288 U/L to 440 U/L. Hepatitis C antibody and hepatitis B surface antigen were negative. All work-up for chronic liver disease was negative. She underwent a liver biopsy, which showed liver parenchyma with a patchy infiltrate of small lymphocytes expressing CD20, PAX-5, CD5, CD23, CD43, and BCL-2 characteristic of B-small lymphocytic lymphoma/chronic lymphocytic leukemia. Serial CT scans showed progressive intra-abdominal lymph node affectation; however, she did not meet criteria for treatment for her CLL, as her WBC count, as well as other markers of disease activity remained stable. In 2012, as part of the routine evaluation of her progressive intra-abdominal lymphadenopathy, an abdominal CT scan showed an 8-cm liver mass. Though initially asymptomatic, she developed a right upper quadrant pain that was severe, associated with malaise, constipation, and loss of appetite. Physical examination showed submandibular lymphadenopathy and right upper quadrant tenderness. She had no peripheral stigmata of chronic liver disease. The presence of a large liver mass with an underlying history of liver biopsy being positive for CLL/B-lymphocytic lymphoma made a suspicion of a rapidly growing lymphoma likely. Alpha fetoprotein was also normal. She underwent a second liver biopsy that now revealed grade II hepatocellular carcinoma (HCC). Being Child-Pugh stage B, with a huge liver mass and maintaining a good functional status, she only met the Barcelona Clinic Liver Cancer (BCLC) criteria for treatment with sorafenib, which she was started on, but tolerated for only few weeks. Unfortunately, she continued to decline while the tumor increased exponentially. She was eventually placed in a hospice, and died 3 weeks later. There may be a real association between HCC and CLL. Future studies are required to establish evidence and the goals of treatment.

An approach to the intra-thoracic inferior vena cava through the abdominal cavity preparing for total hepatic vascular exclusion by sagittal diaphragmotomy.

For resection of advanced liver tumors with tumor thrombus/invasion extending into the intra-thoracic inferior vena cava (IVC) above the diaphragm as well as huge liver tumors located at the root of hepatic vein, an appropriate approach to the intra-thoracic IVC through the abdominal cavity is the key to control the intraoperative massive bleeding. The pericardium and diaphragm are separated by using fingers without injury of the pericardium. From just below the xiphoid process to the IVC, the diaphragm is vertically dissected without cutting the pericardium and doing median sternotomy. Then the intra-thoracic IVC is exposed easily and encircled with an umbilical tape. This technique was applied in four patients (hepatocellular carcinoma: n = 3, cholangiocellular carcinoma: n = 1). The mean patient's age was 69 (59-81) year old, and three were male. The median duration of surgery and blood loss was 490 min and 3600 mL, respectively. The median peaked aspartate aminotransferase and total bilirubin was 428 IU/mL and 2.75 mg/dL, respectively. The median duration of hospital stay was 22 days. This approach to intra-thoracic IVC through the abdominal cavity is very beneficial and helpful for many liver surgeons.

Hepatobiliary and Pancreatic: A huge liver paraganglioma

Hepatobiliary and Pancreatic: A huge liver paraganglioma

The Effects of Bile Duct Obstruction on Liver Volume: An Experimental Study

Objectives. This study is aimed at investigating alterations in liver volume during obstructive jaundice in rat liver. Materials and Methods. Thirty-six rats were divided into four groups. Abdominal tomography was performed for baseline volumetric analyses. The main bile ducts were ligated (BDL). Volumetric analyses were repeated 3 days after BDL in group 1, 7 days after BDL in group 2, 15 days after BDL in group 3, and 25 days after BDL in group 4, and total hepatectomy was performed in all animals. Control group (n = 4) was created with the rats that died before bile duct ligation. Results. There was no difference found in liver volume in group 1 compared to control animals. The liver volume was increased 7 days after BDL (P = 0.01). It was increased up to 60% of baseline values 25 days after BDL (P = 0.002). Wet liver weights of animals were also increased compared to control group. Liver weights were increased up to 40% percent of baseline values in group 4 (P = 0.002). Conclusions. Liver volume and weight were increased after BDL. Liver surgery in patients with huge liver mass is generally associated with significant difficulty. The surgeon should be aware of the time-dependent alteration in liver volume after obstructive jaundice.

Pediatric hepatic angiosarcoma treated with chemotherapy and partial hepatectomy: A case report.

e21001 Background: Hepatic angiosarcoma is a high-grade malignant neoplasm, extremely rare in children and associated with a poor prognosis. It is reported in English language less than fifty cases in children between 2 months and 15- year-old at presentation. Due to the rarity of this tumor type, little is known about effective systemic therapy. Many diferent schedules have been reported, comprising surgery only, neoadjuvant chemotherapy, surgery wih adjuvant radiotherapy and hepatic transplantation. The median survival rate stays between 10 to 48 months, independently of the treatment chosen, with inconsistent results. Methods: retrospective medical records review. Objective: We present our experience wih a female 3-year-old child presenting wih a huge unressectable liver angiosarcoma at diagnosis, treated with neoadjuvant intensive chemotherapy based on ifosfamide, carboplatine and etoposide and right hepatectomy. The child remained in complete remission for 5 years, after that presenting with local relapse treated again with the same intensive chemotherapy, resulting in a very good response. Conclusion: the children is alive after a relapsed hepatic angiosarcoma treated with neoadjuvant chemotherapy and partial hepatectomy. In this case, neoadjuvant chemotherapy based in carboplatine, ifofamide and etoposide was an effective strategy to treat pediatric hepatic angiosarcoma.

Double KRAS and BRAF mutations in colorectal cancer in a single oncologic department series.

e14657 Background: KRAS and BRAF mutations have prognostic and predictive value in colorectal cancer and are predominantly mutually exclusive. Only a few cases of double mutations (DM) have been reported so far but the actual incidence and presumed role in worsening prognosis is still unknown. Here we report on a series of KRAS and BRAF mutations, focusing on three cases of KRAS and BRAF DM. Methods: since May 2010, 316 consecutive colorectal cancer samples were collected by our Oncology Department; ten patients (3%) had high risk localized disease and 306 (97%) metastatic disease. Genome DNA from formalin-fixed paraffin embedded samples with tumor cells &gt; 50% was analyzed by reverse dot blot with KRAS-BRAF StripAssay kit (Nuclear Laser Medicine). Results: KRAS point mutations were found in 141 patients (44.6%): 32% G12V, 30.5% G12D, 14.9% G13D, 6.4% G12S, 5.7% G12C, 4.9% G12A, 4.9% G12R, 0.7% G13C; V600E BRAF point mutation was found in 21 patients (6.6%). Three patients (1%) displayed DM: 2 KRAS G13D + BRAF V600E (A and B) and 1 KRAS G12V + BRAF V600E (C). Patients A and C, both aged 59, presented with metastatic disease. Patient A had a rectal primary, a single lung lesion and mediastinal nodes. He failed first line FOLFOX4 plus bevacizumab and underwent salvage surgery both on primary and metastatic disease. He relapsed in 3 months with liver and brain metastasis and died after one year from diagnosis. Patient B had huge liver lesions at presentation. She progressed after 3 courses of FOLFIRI and died after 6 months from diagnosis. Patient C was operated on for a right colon cancer, G3, pT2N2, stage IIIB with lymph vascular invasion and had adjuvant FOLFOX 4. The 6-month assessment did not show relapse. Conclusions: in our series KRAS mutation incidence was in line with literature, but G12V was far more frequent. KRAS-BRAF DM accounted for 1% of all cases and the 2 patients with metastatic disease had an aggressive course with a much lower than expected survival. To our knowledge no series of DM have been described, hindering the understanding of their biological meaning. According to our experience, metastatic double mutated patients do not respond to standard therapy and should be treated with new drugs combinations in clinical trials.

Carcinosarcoma of the liver: report of a case

A 64-year-old Japanese woman without a history of viral hepatitis was admitted for investigation of a huge liver mass. The tumor, measuring 14 × 12 × 22 cm, had invaded the diaphragm, right lung, and inferior vena cava. Serum examinations demonstrated high levels of carbohydrate antigen 19-9 (CA19-9), and the Child-Pugh score was A. She underwent right lobectomy of the liver and partial resection of the right diaphragm, right lung, and inferior vena cava. Radio- and chemotherapy were also given, but she died of recurrence 3 months after surgery. Microscopically, the tumor exhibited intermingled adenocarcinomatous and atypical mesenchymal components. The carcinomatous component was positive for cytokeratins 7, 19, and 20, chromogranin A, epithelial membrane antigen, c-KIT, and vimentin. The sarcomatous component was positive for vimentin and c-KIT. A review of 36 cases of hepatic carcinosarcoma revealed the following: chronic hepatitis or cirrhosis in 57 % of the patients; increased serum CA19-9 levels in 30 %; a mean tumor diameter of 10 cm; invasion of the adjacent organs or metastasis to distant organs in 47 %; wide intrahepatic infiltration in 44 %; and 50 % survival of only 5 months. Significant differences were seen according to tumor diameter (diameter >5 cm; p < 0.05), wide intrahepatic infiltration (p < 0.05), and extrahepatic invasion/metastasis (p < 0.01). Neither chemotherapy nor radiotherapy contributed to prognosis, but surgical resection resulted in some improvement (p < 0.05).

Primary hepatic carcinoid tumors: A case report and literature review

Primary hepatic carcinoid is a rare disease and requires meticulous workup for the search of primary in other organs. A 56-year-old male, known hypertensive, presented in November 2007 with epigastric discomfort and indigestion on and off for 2 months. There was no history of diarrhea, flushing attacks, or cardiac symptoms. He had no family history of carcinoids or any other chronic disease. On examination, he was afebrile, pulse rate was 83/min, and BP was 166/95 mm Hg. Per-abdominal examination revealed mild tenderness in the epigastrium and enlarged liver. Computerized tomography abdomen showed a capsulated huge liver lesion (11 × 10 × 13 cm) in the left lobe of the liver, displacing the left hepatic artery, while rest of the liver was normal. There was no evidence of carcinoid tumor in any other organ. He was operated and left hepatic lobectomy was done. Histology showed primary hepatic carcinoid. He is being followed up in our OPD till date and has shown no recurrence. Primary hepatic carcinoid is a rare disease which is not associated with the symptoms of carcinoid syndrome in majority of patients, and therefore should be diagnosed after extensive search for primary in the other organs. Ultimate diagnosis should be made by histology and immunohistochemistry.

Effects of selective hepatic vascular occlusion on the prognosis of patients undergoing hepatic resection for huge liver cancer

Objective To evaluate the effects of selective hepatic vascular occlusion SHVO) on the prognosis of patients undergoing hepatic resection for huge liver cancer.Methods The clinical data of 49 patients who received huge liver cancer resection at the Zhejiang People's Hospital from January 2005 to January 2010 were retrospectively analyzed.Based on the type of hepatic vascular occlusion,all patients were divided into Pringle's maneuver group (24 patients) and SHVO group (25 patients).The intraoperative condition,postoperative recovery of hepatic and renal function,incidence of complications,survival rate and recurrence rate of liver cancer of the 2 groups were compared.All data were analyzed by using the t test or Fisher exact probability.The survival curve was drawn by using the Kaplan-Meier method and the survival of the 2 groups was compared by using the Log-rank test.Results Hepatectomy was successfully performed on all the patients.Time for blood occlusion were (32 ±19) minutes in the Pringle's maneuver group and (34 ± 22)minutes in the SHVO group,with no significant difference between the 2 groups (t =2.45,P ＞ 0.05).The volume of blood loss of the Pringle's maneuver group was (736 ± 543) ml,which was significantly greater than (273 ± 298) ml of the SHVO group (t =6.87,P ＜0.05).The incidences of hepatic vein rupture were 21％ (5/24) in the Pringle's maneuver group and 24％ (6/25)in the SHVO group,with no significant difference (x2=1.45,P＞0.05).The course of 3 patients was complicated by hepatic vein rupture and hemorrhage and 1 by air embolism in the Pringle's maneuver group,while no hemorrhage or air embolism happened in the SHVO group.Four patients in the Pringle's maneuver group and 3 in the SHVO group were found with vascular invasion,while the resection margins were negative.There was no significant difference in the hepatic function in the 2 groups before operation.The levels of alanine aminotransferase in the SHVO group at postoperative day 1 and 3 were significantly lower than those in the Pringle's maneuver group (t=7.12,6.35,P ＜ 0.05).There was no significant difference in the levels of blood urea nitrogen and creatinine between the 2 groups (P ＞ 0.05).Acute hepatic dysfunction was found in 4 patients in the Pringle's maneuver group,but no patients with acute hepatic dysfunction was found in the SHVO group.The 1-and 3-year tumor-free survival rates were 58％ and 21％ in the Pringle's maneuver group,which were significantly lower than 72％ and 30％ in the SHVO group (x2 =5.32,6.07,P ＜ 0.05).The 5-year tumor-free survival rates were 21％ in the Pringle's maneuver group and 20％ in the SHVO group,with no significant difference between the 2 groups (x2 =1.78,P ＞ 0.05).Conclusion SHVO is safe,feasible and effective to prevent hemorrhage and postoperative acute hepatic dysfunction,and it is also helpful in reducing early-stage tumor recurrence and improving the tumor-free survival rate in patients with huge liver cancer. Key words: Liver neoplasms; Hepatectomy ; Hepatic vascular occlusion ; Recurrence

P2-051 - Impressive Cases of Advanced Gastric Cancer Successfully Managed with Trastuzumab Containing Chemotherapy

ABSTRACT As a result of the ToGA trial, trastuzumab in combination with capecitabine–cisplatin (XP) chemotherapy is now considered a new standard option for patients with HER2-positive advanced gastric cancer. We report three cases that showed marked tumor shrinkage with the induction of XP–trastuzumab chemotherapy in a practical setting. Case 1: A 68-year-old man with gastric papillary adenocarcinoma (HER2 status IHC 3 + , FISH positive) and huge liver metastases producing a- phetoprotein, received four cycles of XP–trastuzumab therapy. Tumor response was PR and the toxicity (G3 neutropenia) was manageable. Case 2: A 65-year-old man with advanced gastric adenocarcinoma (IHC 3 + , FISH positive) had not only numerous liver metastases, but a liver abscess with a diameter of 5 cm. He initially received two cycles of s-1–trastuzumab concurrently with the systemic administration of antibiotics. Then followed by two cycles of XP–trastuzumab, metastatic liver lesions almost disappeared. There was no adverse event. Case 3: A 68-year-old man with gastric mucinous adenocarcinoma (IHC 2 + , FISH negative), turned out to be inoperable because of tumor invasion to the pancreas. Although seven cycles of XP–trastuzumab cause febrile neutropenia and severe hand-hoot syndrome, CT and endoscopy revealed a good treatment effect and suggested the potential for resection.

A rare cause of nephrotic syndrome in a 14-year-old boy: Answers

Detection of a cystic lesion in the liver suggests simple cysts, multiple cysts arising in the setting of polycystic liver disease (PCLD), parasitic or hydatid (echinococcal) cysts, cystic tumors, and abscesses. These conditions can usually be distinguished on the basis of the patient’s symptoms and the radiographic appearance of the lesion [1]. The presence of constitutional symptoms, such as pallor, anorexia, fever or weight loss, may point toward a malignant lesion or infection, but our patient had no medical history or signs of these upon physical examination. Ultrasound of his abdomen revealed a huge liver cyst of 90 mm occupying almost the whole left lobe with mild internal echoes all suggestive of hydatid cyst. The kidneys, spleen and pancreas appeared normal. Abdominal computed tomography (CT) was used to delineate the cystic lesion within the liver. Indeed, the CT confirmed a huge, thick-walled cyst of 90 mm in diameter, occupying the left lobe of the liver in segment I. Hydatid disease (HD), or echinococcosis, is a zoonotic infection caused by the larval stages of the cestodes belonging to the genus Echinococcus. Cystic echinococcosis (CE) is the most common form of HD, and occurs as the result of infection by the larval stages of E. granulosus, which has a worldwide distribution and continues to be a major health problem in developing countries [2–4]. Oncosphere larvae hatch in the duodenum and are carried to the liver through blood vessels or lymphatics. About 65 % are trapped in the liver (first filter), which is the most commonly involved organ (52–77 % of cases); the remaining 25 % are trapped in the lungs (second filter) and less than 10 % reach various organs through the systemic circulation [5]. The symptoms of liver hydatid cysts differ depending on the size and number of cysts, but also on the mass effect within the liver and upon surrounding structures. Patients are usually asymptomatic, but may present with right/epigastric pain, nausea, and vomiting [1]. Considering that the early stages of infection are usually asymptomatic, the diagnosis of hydatid cyst depends on clinical suspicion. Diagnosis is made by history of exposure, by radiological and ultrasound cyst detection, and by serology [6]. The diagnosis of hydatid disease in our patient was confirmed by a strongly positive serum ELISA and indirect hemagglutination test (IHA) for Echinococcus. Treatment This article refers to the article that can be found at http://dx.doi.org/ 10.1007/s00467-012-2282-x.

Caudate Iobectomy for huge liver neoplasms: a comparative study

Objective To evaluate the optimal surgical approach for huge liver neopiasms in the caudate lobe.Methods Thirty-three patients with huge liver neplasms（≥10cm) underwent caudate lobectomy at a single tertiary referral center between January 2001 and June 2007.The surgical out-comes of pateints who underwent isolated caudate lobectomy or caudate lobectomy combined with partial hepatectomy were compared.Result Fifteen（45.5％）of 33 patients underwent isolated total or partial caudate lobectomy（group A）,whereas 18（54.5％) had total or partial caudate lobectomy cellular carcinoma (HCC) (51.5％),followed by hemangioma(21.2％),intrahepatic cholangiocarcinoma(9.1％),angiomyolipoma(6.1％),hepatic adenoma (3％),focal nodular hyperplasia(3％),colorectal liver metastases(3％)and sarcoma(3％).The median diameter of the tumour was 12.3 (range,10.2-21)cm.Patients in group A had significantly longer operative time (280 minutes vs.170 minutes),longer length of hospital stay (17 days vs.12 days)and more blood loss(1250 ml vs.670 ml) than patients in group B.There was no perioperative death in the 2 groups of pateints.Complication rates in group A and group B were 26.7％ and 16.7％ respectively.There was no disease-related death in patients with benign lesions.The1-,3- and 5-year disease-free survivals of patients with malignant lesions in group A and group B were 25.9％,0％,0％and 74.3％,46.7％,31.2％,respectively.The 1-,3- and 5-year overrall survivals were 68.6％,19.7％,0％ and 100％,66.5％,41.8％,respecively.Conclusion The approach to caudate lobectomy depends on the size and location of the lesion and the liver functional reserve.For patients with sufficient liver functional reserve,caudate lobectomy combined with partial hepatectomy is preferred because it is technically less demanding.For patienls with marginal liver functional reserve,isolated caudate lobectomy is the only viable surgical option. Key words: Liver neopasm; Hepatectomy; Caudate lobe