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The liver, gallbladder and pancreas
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Dina G. Tiniakos, Alastair D. Burt
Atresia of the extrahepatic ducts presents in neonates with signs of biliary obstruction. It may be partial or complete. As noted above there are some inherited disorders (e.g. Alagille syndrome) in which there is paucity or atresia of intrahepatic bile ducts. Solitary cysts, multiple cysts in association with some forms of renal cystic disease, and congenital hepatic fibrosis are part of a spectrum of abnormal duct development (ductal plate malformations). Von Meyenberg complexes (bliary microhamartomas) are small nodules, often subcapsular, formed by groups of bile duct-like structures in a fibrous stroma. Focal nodular hyperplasia is a rare tumour-like malformation most probably caused by abnormal blood flow. It is composed of nodules of regenerating hepatocytes separated by fibrous bands which often form characteristic stellate scars visible by imaging. Although this lesion is more common in females, contraceptive steroids are not implicated in its pathogenesis.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Environmental exposure to vinyl chloride is associated with the later development of hepatic angiosarcoma. Focal nodular hyperplasia and hepatic fibroma are not linked to any defined underlying carcinogen exposure. Hepatic adenomas occur sporadically in the setting of exogenous steroid hormone use. Hepatocellular carcinoma is associated with cirrhosis, chronic viral hepatitis, and aflatoxin exposure.
Paediatrics
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
Are the following statements regarding the paediatric liver true or false? Focal nodular hyperplasia is a common diagnosis.Bile duct dilatation is seen in chronic granulomatous disease.Hepatoblastoma is rarely calcified.The lesser omentum is thickened in portal hypertension.Epidermoid cysts of the spleen are usually multilocular.
Recent advances in PET probes for hepatocellular carcinoma characterization
Published in Expert Review of Medical Devices, 2019
Luca Filippi, Orazio Schillaci, Oreste Bagni
Another fluorinated analog of choline, 18F-fluorocholine (FCH), has been applied by Talbot et al. for the PET imaging of HCC with promising results in a firstly published study [59]. These findings were subsequently confirmed in phase III prospective study aimed to compare the diagnostic performance of FCH and FDG for detecting and staging HCC in patients with chronic liver disease and suspected liver nodules: in 70 sites, sensitivity resulted in 84% for FCH, significantly better than the 67% for FDG [60]. It has to be stressed that one false-positive case was registered due to FCH uptake in focal nodular hyperplasia. Of note, in the aforementioned study, all the FCH photopenic areas were histologically assessed and resulted to be malignant lesions: poorly differentiated HCC, hepato-cholangiocarcinoma or metastases from other tumors. As concerns the effect of lesion size on the rate of detection, among 12 subcentimetric lesions 10 were correctly visualized by PET scan with FCH with a detection rate superior to that shown by 11C-acetate for lesions of the same size [40], most probably due to the better spatial resolution of PET with 18F-fluorine as compared to 11C-carbon.
Pedunculated focal nodular hyperplasia in a healthy toddler
Published in Baylor University Medical Center Proceedings, 2018
Juhi Koolwal, Krista L. Birkemeier, Riyam T. Zreik, Kelly D. Mattix
Focal nodular hyperplasia (FNH) is a benign subcapsular hepatic neoplasm that most commonly occurs in adult women and is only rarely found in the pediatric population. When seen in children, the median age is 8.7 years with a female predominance and it is associated with chemotherapy, radiation, hematopoietic stem cell transplantation, and underlying liver disease.1,2 The etiology of FNH is unclear; however, it is thought to arise from local disruption of blood flow in the liver resulting in a hyperplastic response of the surrounding hepatic parenchyma.1 The diagnosis of FNH can be made with confidence when the lesion demonstrates classic magnetic resonance imaging (MRI) features, particularly when using hepatocyte-specific contrast agents. We report a case of a pedunculated FNH arising in a healthy toddler. Because 75% of pediatric liver tumors are malignant, confirmation by tissue diagnosis is important in cases with unusual presentation or imaging features.2 Thus, optimizing imaging to identify FNH in children with an atypical presentation can help avoid unnecessary invasive procedures.1
Neonate with Congenital Duodenal Obstruction and Ectopic Hepatic Parenchyma
Published in Fetal and Pediatric Pathology, 2022
Shishir Kumar, Parveen Kumar, Khushboo Jha, Arti Khatri
Clinically, ELT is usually silent but may present with an acute abdomen due to torsion of a pedunculated tissue, hemorrhage, or as a tumor [12, 13]. Ectopic liver has been associated with benign and malignant lesions. Benign lesions may include hemangioma, adenoma or focal nodular hyperplasia [14–16]. Hepatocellular carcinoma (HCC) and hepatoblastoma have been reported to develop in the ectopic liver [17, 18]. Few authors have suggested that ectopic liver tissue is more predisposed to malignancy than normal liver tissue, which may be due to lack of metabolic functioning, insufficient biliary drainage and/or reduced blood supply [12, 16, 17].