A 62-year-old man was referred to our hospital because of pain in the right upper quadrant. Laboratory tests revealed normal levels of tumor markers. Abdominal ultrasonography showed a hypoechoic mass of approximately 9 cm in diameter in the right lobe of the liver. Computed tomography revealed a low-density mass with peripheral enhancement in the posterior segment of the right lobe. Magnetic resonance imaging showed a low-intensity mass on T 1 -weighted images and a high-intensity mass on T 2 -weighted images. Abdominal angiography showed enhanced staining only at the periphery of the tumor. An open biopsy was performed and intraoperative examination of frozen sections indicated malignant lymphoma. The histopathologic diagnosis was malignant T-cell lymphoma. After combined chemotherapy, the tumor shrank to 4 cm in diameter. To our knowledge, only 15 cases of malignant T-cell lymphoma have been reported previously. Diagnosis is particularly challenging because this type of tumor has no distinctive imaging characteristics or signs or symptoms. This case emphasizes the need to include malignant T-cell lymphoma in the differential diagnosis and demonstrates the importance of open biopsy in patients with a suspected liver tumor.

Background We evaluated the impact of the Japanese board certification system for expert surgeons (JBCSES) on complications and survival outcomes in hepatectomy for hepatocellular carcinoma. Methods The postoperative outcomes of 493 patients who underwent high-level liver surgery involving one-segment (OSeg) hepatectomy and more-than-one-segment (MOSeg) resection were compared before and after JBCSES establishment. After the establishment of the JBCSES, the patients’ postoperative outcomes were compared using propensity score matching (PSM) to determine the influence of expert surgeons. Results The establishment of the JBCSES was associated with a decrease in the overall postoperative complication rates after high-level liver surgery from 50.2 to 38.1% (P = 0.008) and a decrease in Clavien–Dindo class ≥ IIIb complications from 10.2 to 5.0% (P = 0.035). The 90-day mortality rate decreased from 5.1 to 0.7% (P = 0.003), and the 5-year survival rate increased from 51.4 to 63.9% (P = 0.009). Using PSM, a comparison of OSeg hepatectomies that involved expert surgeons (n = 48) and those that did not (n = 48) showed significantly lower intraoperative blood loss in surgeries involving an expert surgeon (mean, 340 vs. 473 mL; P = 0.033). There were no significant differences in complication rates or long-term prognosis between these groups. A comparison of MOSeg hepatectomies that involved expert surgeons (n = 26) and those that did not (n = 26) showed no significant difference in surgical factors, complications, or overall survival between the two groups. Conclusions After establishment of the JBCSES, postoperative complication rates and mortality rates decreased and survival rates increased following liver surgery. Expert surgeon participation significantly decreased intraoperative blood loss during OSeg hepatectomies.

Aims: We aimed to develop a computer-assisted system for the gross classification of resected hepatocellular carcinoma (HCC) and to evaluate whether this objective classification can be used to predict patient outcomes.Methods: This study included 236 patients diagnosed with solitary HCC who underwent initial resection. We analyzed photographed images of the cut surface of HCCs using a new software to establish a novel gross classification system. Survival curves in each of the classified groups were compared. Results: The median (range) values for the equivalent diameter, circularity, and complexity of tumors were 2.63 cm (0.72–14.49), 0.49 (0.00–0.84), and 0.51 (0.16–1.00), respectively. HCCs were classified into three groups using hierarchical cluster analysis: Type I (circular type, n=130), Type II (rough type, n=92), and Type III (disordered type, n=14). Microscopic portal invasion was observed in 14.6%, 23.9%, 71.4% patients in the Type I, II, and III groups, respectively. The 5-year recurrence-free survival rates of patients with Type I, II, and III HCC were 31.5%, 24.7%, and 14.3%, respectively. The 5-year overall survival rates of patients with Types I, II, and III HCC were 65.4%, 54.7%, and 28.6%, respectively. Type II or III HCC were independently associated with death and an increased risk of recurrence. The conventional classification was not adopted due to its weaker power than the above-mentioned contributors.Conclusion: Our computer-assisted gross classification system for HCC indicated that this classification is closely associated with microscopic portal invasion, suggesting aid in predicting patient outcomes than that of conventional subjective classification.