A case of ectopic liver tissue adherent to the gallbladder

Ectopic Liver Tissue Encountered Incidentally During a Laparoscopic Cholecystectomy: A Case Report

A 60-year-old male patient who presented with right upper quadrant (RUQ) pain was diagnosed with acute cholecystitis after an ultrasound of the abdomen revealed multiple gallstones, gallbladder wall thickening, pericholecystic fluid, and a positive sonographic Murphy sign. The patient was admitted, administered IV fluids, antibiotics, and pain relief, and scheduled for laparoscopic cholecystectomy. During surgery, an incidental finding of ectopic liver tissue attached to the gallbladder was noted. Histopathology confirmed the presence of chronic cholecystitis and multifaceted cholesterol stones. Normal liver tissue was noted in the ectopic mass. Ectopic liver tissue is defined as liver tissue located outside the main liver parenchyma and is usually asymptomatic. They are usually detected at the time of autopsies, incidentally during surgeries, or during imaging done for other etiologies. They can occur at various sites in the body. Ectopic liver tissue can cause potential complications such as hepatocellular carcinoma and torsion, and in the event that they are incidentally detected, it is advised to remove them. The case report highlights the importance of dealing with incidental findings during laparoscopic cholecystectomy and creating awareness about it.

The First Case Report of Ectopic Hepatic Tissue in a Guinea Pig

Ectopic hepatic tissue is an extremely rare developmental abnormality in human beings. Although this lesion is likewise rare in veterinary medicine and there were sparse reports in several species such as dogs, cats, cows, and calves, we incidentally encountered ectopic hepatic tissue in a guinea pig. In the case of guinea pigs, we report for the first time the occurrence of ectopic hepatic tissue implanted in the gallbladder. The healthy guinea pig remained asymptomatic, and its macroscopic findings also showed no abnormalities. Hematological examinations exhibited moderate decreases in white cell counts, hemoglobin concentrations, and packed cell volume ratio. Serum biochemical examinations showed decreases in total protein and albumin and increases in glucose levels, alkaline phosphatase, lactate dehydrogenase, creatine kinase, and γ-glutamyl transpeptidase. There were slight changes in electrolytes (Cl, Ca, and Mg) and inorganic phosphorus, indicating minor deviations from physiologic ranges. An increase in TBIL concentrations was not found in this examination. Histopathological examination revealed the presence of normal hepatic structures (hepatocytes and hepatic cords) within the wall of the normal gallbladder. The vascular and bile duct structures and portal triads were not observed in the ectopic hepatic tissue. In conclusion, this microectopic hepatic tissue in a guinea pig was characterized by the embedded structures of hepatic tissues, without foreign body reaction.

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

BACKGROUND

Liver 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.

AIM

To identify studies in the literature on ectopic liver tissue located on the gallbladder surface or mesentery.

METHODS

We 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.

RESULTS

A 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.

CONCLUSION

Ectopic 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.

Case Report on a Rare Intraoperative Finding of Ectopic Liver Tissue Attached to Gallbladder Wall during Laparoscopic Cholecystectomy

Introduction

Ectopic liver is a rare finding (Corsy, 1922; Kubota et al., 2007) that is usually discovered intraoperatively or during an autopsy (Bassis and Izenstark, 1956). Preoperative diagnosis of ectopic liver is also uncommon. The most common site of ectopic liver is on the gall bladder, although there are reports of other sites such as the adrenal glands and esophagus. The management of ectopic liver is en-bloc resection due to the high risk of hepatocellular carcinoma.

Case Presentation

We describe the case of a 42-year-old female who presented with recurrent abdominal pain. She was found to have a smooth fragment of a reddish brown tissue attached to the anterior surface of the gallbladder during an elective laparoscopic cholecystectomy. The tissue was removed with the gallbladder, and histopathology showed normal ectopic liver tissue.

Conclusion

Due to the possibility of malignant transformation into hepatocellular carcinoma, en-bloc resection is the choice of management.