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Zhu K, Wang W, Luo R, Song D, Wang X, Gao Q, Fan J, Zhou J, Rao S, Wang X. Newly detected liver nodules with a history of colorectal cancer: are they metastatic? Review of 2,632 cases in a single center. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1079. [PMID: 34422991 PMCID: PMC8339815 DOI: 10.21037/atm-20-8153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/05/2021] [Indexed: 12/13/2022]
Abstract
Background The diagnosis of newly detected liver nodules in patients with colorectal cancer (CRC) is crucial for determining prognosis and treatment. Accurate identification of benign nodules can help avoid unnecessary therapy. The aim of our study was to retrospectively review patients with CRC who underwent liver resection for benign liver nodules misdiagnosed as CRC metastasis (CRLM) in our institution. Methods We reviewed all patients with a history of CRC who underwent liver resection from January 2012 to December 2019 in our institution. We specifically focused on nodules pathologically confirmed as benign. The pathology was rechecked by an independent pathologist. The clinicopathological characteristics of these patients were collected. Preoperative imaging examinations, including ultrasound (US), magnetic resonance imaging (MRI), and positron emission tomography-computed tomography (PET-CT) were reviewed. Results From 2012 to 2019, a total of 2,632 patients with CRC who were preoperatively diagnosed CRLM received liver resection, among which 2,584 (98.2%) cases were proven to be malignant, and 48 (1.8%) cases were benign. Among these 48 cases, 24 were pathologically confirmed as focal nodular hyperplasia (FNH), 9 were peliosis, 10 were inflammatory lesions, and 5 were hemangioma. At least one preoperative imaging examination indicated CRLM, with a median size of 2.0 cm (range, 0.4–8.0 cm). Before liver resection, ten patients received chemotherapy after the discovery of liver nodules. Conclusions It should be noted that newly detected liver nodules in patients with a history of CRC could be benign. Accurate diagnosis of liver nodules in CRC is necessary to avoid overtreatment and to identify cost-effective medication.
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Affiliation(s)
- Kai Zhu
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.,Key Laboratory of Organ Transplantation, Shanghai, China
| | - Wentao Wang
- Department of Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China
| | - Rongkui Luo
- Department of Pathology, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Danjun Song
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
| | - Xi Wang
- Department of Ultrasound, Zhong Shan Hospital, Fudan University, Shanghai, China
| | - Qiang Gao
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
| | - Jia Fan
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.,Key Laboratory of Organ Transplantation, Shanghai, China.,Key Laboratory of Medical Epigenetics and Metabolism, Institute of Biomedical Sciences, Fudan University, Shanghai, China.,State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
| | - Jian Zhou
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China.,Key Laboratory of Organ Transplantation, Shanghai, China.,Key Laboratory of Medical Epigenetics and Metabolism, Institute of Biomedical Sciences, Fudan University, Shanghai, China.,State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, China
| | - Shengxiang Rao
- Key Laboratory of Organ Transplantation, Shanghai, China
| | - Xiaoying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University; Key Laboratory of Carcinogenesis and Cancer Invasion (Fudan University), Ministry of Education, Shanghai, China
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Downes RO, Cambridge CL, Diggiss C, Iferenta J, Sharma M. A case of intra-abdominal hemorrhage secondary to peliosis hepatis. Int J Surg Case Rep 2014; 7C:47-50. [PMID: 25576958 PMCID: PMC4336394 DOI: 10.1016/j.ijscr.2014.12.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION peliosis hepatis (PH) is a rare vascular condition of the liver characterized by the presence of cystic blood filled cavities distributed randomly throughout the liver parenchyma Tsokos and co-workers [1-6]. Peliosis is most commonly found in the liver but can also involve the spleen, bone marrow, lungs, and abdominal lymph nodes Tsokos and Erbersdobler [1]. PRESENTATION OF CASE We report a case of peliosis hepatis diagnosed post laparotomy. She required a re-look laparotomy with removal of packs peritoneal lavage, placement of intraseed and subhepatic drain. The patient was discharged after an 11-day recovery period. CONCLUSION We examine the literature and subsequently discuss the etiology and management of peliosis. Peliosis is a rare vascular condition of the liver characterized by the presence of cystic blood filled cavities. Causes are associated with a number of conditions, however, etiology is largely unknown. Management is overwhelmingly conservative except in a handful of cases.
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Affiliation(s)
- Ross O Downes
- General Surgery, Laparoscopy Bsc MB BS DM Doctors Hospital, Nassau, Bahamas.
| | - Craig L Cambridge
- Medical Student/Research Assistant Doctors Hospital, Nassau, Bahamas.
| | - Charles Diggiss
- General Surgery, Bariatrics FRCS CMO Doctors Hospital, Nassau, Bahamas.
| | - James Iferenta
- Emergency Services, FRCS F IAS Doctors Hospital, Nassau, Bahamas.
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Motoki T, Fukuda M, Nakano T, Matsukage S, Fukui A, Akiyoshi S, Hayashi YK, Ishii E, Nishino I. Fatal hepatic hemorrhage by peliosis hepatis in X-linked myotubular myopathy: a case report. Neuromuscul Disord 2013; 23:917-21. [PMID: 24011703 DOI: 10.1016/j.nmd.2013.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Revised: 05/04/2013] [Accepted: 06/11/2013] [Indexed: 12/30/2022]
Abstract
We report a 5-year-old boy with X-linked myotubular myopathy complicated by peliosis hepatis. At birth, he was affected with marked generalized muscle hypotonia and weakness, which required permanent ventilatory support, and was bedridden for life. He died of acute fatal hepatic hemorrhage after using a mechanical in-exsufflator. Peliosis hepatis, defined as multiple, variable-sized, cystic blood-filled spaces through the liver parenchyma, was confirmed by autopsy. To avoid fatal hepatic hemorrhage by peliosis hepatis, routine hepatic function tests and abdominal imaging tests should be performed for patients with X-linked myotubular myopathy, especially at the time of using artificial respiration.
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Affiliation(s)
- T Motoki
- Department of Pediatrics, Uwajima City Hospital, Uwajima, Ehime, Japan.
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Yeh SS, Lovitt S, Schuster MW. Pharmacological Treatment of Geriatric Cachexia: Evidence and Safety in Perspective. J Am Med Dir Assoc 2007; 8:363-77. [PMID: 17619035 DOI: 10.1016/j.jamda.2007.05.001] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Revised: 04/16/2007] [Indexed: 01/12/2023]
Abstract
Anticachexic or antisarcopenic medications are prescribed worldwide for geriatric patients with poor appetite and associated weight loss. They represent a valuable treatment option for managing cachexia. However, the well-publicized adverse reports about these medications in acquired immunodeficiency syndrome (AIDS) and in the cancer population has led to some concern and much subsequent discussion over the safety of these medications being used in geriatric population. This review looks at the evidence in relation to the benefits and risks of these medications and discusses what we know about their use in the geriatric population.
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Affiliation(s)
- Shing-Shing Yeh
- Northport VAMC, Geriatric division, Northport, NY 11768, USA.
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Corpa MVN, Bacchi MM, Bacchi CE, Coelho KIR. Peliosis hepatis associated with lymphoplasmacytic lymphoma: an autopsy case report. Arch Pathol Lab Med 2005; 128:1283-5. [PMID: 15504065 DOI: 10.5858/2004-128-1283-phawll] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 72-year-old man with no previous history of liver disease was admitted to our university hospital with severe dyspnea, edema of the lower limbs, and weight loss. Within a few days of hospitalization, he died due to severe bleeding in the upper digestive tract. At autopsy, the liver displayed typical gross features of peliosis hepatis. In addition, a diffuse infiltration of liver, spleen, bone marrow, and lymph nodes by lymphoplasmacytic lymphoma was disclosed by light microscopy. In the liver, the neoplastic cells partially filled the peliotic cavities. Peliosis hepatis is a rare liver disease characterized by multiple blood-filled, dilated cavities within the liver parenchyma. Association of lymphoplasmacytic lymphoma and peliosis hepatis has rarely been reported in the literature. The pathologic findings of such an unusual association and a review of the literature are presented.
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Affiliation(s)
- Marcus V N Corpa
- Department of Pathology, Faculdade de Medicina de Botucatu, State University of Sao Paulo, Botucatu, Sao Paulo, Brazil.
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NAKANISHI SEIJI, MIYATA TOMOSHI, MURATA YOSUKE, OHNO YOSHINORI, HATAKEYAMA YUKO, KUMAGI TERU, ABE MASANORI, MATSUI HIDETAKA, IUCHI HIDEHITO, MICHITAKA KOJIRO, HORIIKE NORIO, ONJI MORIKAZU. PELIOSIS HEPATIS: IMPROVEMENT OF ESOPHAGEAL VARICES AFTER THE SURGICAL TREATMENT OF PLACENTAL SITE TROPHOBLASTIC TUMOR OF THE UTERUS. Dig Endosc 2003. [DOI: 10.1046/j.1443-1661.2003.00218.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- SEIJI NAKANISHI
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - TOMOSHI MIYATA
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - YOSUKE MURATA
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - YOSHINORI OHNO
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - YUKO HATAKEYAMA
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - TERU KUMAGI
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - MASANORI ABE
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - HIDETAKA MATSUI
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - HIDEHITO IUCHI
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - KOJIRO MICHITAKA
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - NORIO HORIIKE
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
| | - MORIKAZU ONJI
- Third Department of Internal Medicine, Ehime University School of Medicine, Shigenobu‐Cho, Ehime, Japan
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Affiliation(s)
- H Parmar
- Department of Radiology, King Edward VII Memorial Hospital, Parel, Mumbai, India
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Jacquemin E, Pariente D, Fabre M, Huault G, Valayer J, Bernard O. Peliosis hepatis with initial presentation as acute hepatic failure and intraperitoneal hemorrhage in children. J Hepatol 1999; 30:1146-50. [PMID: 10406195 DOI: 10.1016/s0168-8278(99)80271-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Peliosis hepatis, a condition characterized by the presence of blood-filled lacunar spaces in the liver, usually has a chronic presentation pattern and is mainly reported in adult patients in association with chronic wasting disorders and after administration of various drugs. The present report concerns two previously healthy young children in whom peliosis hepatis initially presented as acute hepatic failure and who had Escherichia coli pyelonephritis. Both patients had active intraperitoneal hemorrhage from the peliotic liver lesions, and liver ultrasonography showed multiple hypoechoic areas of different sizes, which in this context should suggest the diagnosis. One child died from hypovolemic shock and the other recovered. This study indicates that acute peliosis hepatis can be a serious life-threatening disease in children.
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Affiliation(s)
- E Jacquemin
- Department of Pediatrics, Unit of Hepatology, Bicêtre Hospital, Le Kremlin Bicêtre, France
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Selby DM, Stocker JT. Focal peliosis hepatis, a sequela of asphyxial death? PEDIATRIC PATHOLOGY & LABORATORY MEDICINE : JOURNAL OF THE SOCIETY FOR PEDIATRIC PATHOLOGY, AFFILIATED WITH THE INTERNATIONAL PAEDIATRIC PATHOLOGY ASSOCIATION 1995; 15:589-96. [PMID: 8597845 DOI: 10.3109/15513819509026994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Focal peliosis hepatis seen incidentally in five children succumbing to an asphyxiating death is described. The patients include four females and one male, with age range from 10 months to 15 years. Autopsy liver findings include speckled yellow foci to large (multiple centimeters) yellow tumor-like tissue, which fade upon standing. Microscopically, the lesions are composed of multiple cystic lacunae, which appear to be dilated hepatic sinusoids, lined by reticulin fibers, Kupffer cells, and hepatocytes. Immunohistochemical stains for factor VIII-related antigen and Ulex europaeus are negative. The lesion may represent an early form of peliosis; the possibility of interstitial/sinusoidal air cannot be ruled out.
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Affiliation(s)
- D M Selby
- Department of Pediatric Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000, USA
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Abstract
Peliosis is an uncommon condition characterized by multiple-blood-filled cavities mostly involving the liver. Although the etiology is unknown the condition may be associated with several disease states and medications. We report the MR findings of peliosis hepatis in a patient with Fanconi anemia who had been treated with anabolic androgenic steroids for 3 years. The MR examination of the upper abdomen was performed on a 0.5 T system. The signal intensity of the right lobe of the liver was diffusely increased in all sequences. Within the enlarged liver, multiple foci of brighter signal were seen involving both right and left lobes. The lesions showed contrast enhancement. A cystic cavity with an enhancing rim was seen representing a haematoma cavity. The spleen was spared the patient died of sepsis and the postmortem examination confirmed the diagnosis of peliosis hepatis.
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Affiliation(s)
- I Saatci
- Department of Diagnostic Radiology, Hacettepe University Hospital, Ankara, Turkey
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Jamadar DA, D'Souza SP, Thomas EA, Giles TE. Case report: radiological appearances in peliosis hepatis. Br J Radiol 1994; 67:102-4. [PMID: 8298863 DOI: 10.1259/0007-1285-67-793-102] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Peliosis hepatis is an unusual disorder characterized by blood filled hepatic spaces. We describe the appearances of this entity on ultrasonography, computed tomography and magnetic resonance imaging. The importance of peliosis hepatis is that it may be an indicator of a treatable underlying condition.
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Affiliation(s)
- D A Jamadar
- Department of Radiology, Broadgreen Hospital NHS Trust, Liverpool, UK
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Ferrell L, Bass N, Roberts J, Ascher N. Lipopeliosis: fat induced sinusoidal dilatation in transplanted liver mimicking peliosis hepatis. J Clin Pathol 1992; 45:1109-10. [PMID: 1479038 PMCID: PMC495007 DOI: 10.1136/jcp.45.12.1109] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A distinct peliosis-like lesion arose in the liver allograft of a 51 year old man. This lesion was caused by necrotic, fat-laden hepatocytes that released fat globules into the sinusoids. These then became strikingly distended with cysts, thus mimicking peliosis hepatitis. It is suggested that this lesion be called lipopeliosis.
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Affiliation(s)
- L Ferrell
- Department of Pathology, School of Medicine, University of California, San Francisco 94143
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