Improved outcomes have been shown in liver transplantation (LT) with portal vein thrombosis (PVT). However, PVT is still discovered incidentally during surgery despite careful preoperative imaging. Data are limited comparing the outcomes of incidental PVT with PVT diagnosed via preoperative imaging before LT. This study aims to compare the overall outcomes of patients with PVT. From 2008 to 2012, 369 patients had LT, and 58 patients with PVT were identified. They were divided into those with non-PVT (group 0; n 5 311), preoperatively identified PVT (group 1; n 5 28), and incidental PVT (group 2; n 5 30). The demographics, characteristics, preoperative assessment, and postoperative outcomes were compared. A survival analysis was also performed. Baseline characteristics and preoperative evaluations of all 3 groups were comparable (P > 0.05) except for Model for End-Stage Liver Disease score, tumor status, platelet levels, and serum bilirubin. A multivariate analysis only showed a high serum bilirubin level to be a predictor of PVT (P 5 0.004; odds ratio, 3.395; 95% confidence interval, 1.467-7.861). Postoperative outcomes were also comparable (P > 0.05). Compared to group 2, group 1 had more patients with a Yerdel classification of 3 or 4 with more extensive surgical intervention required (P 5 0.02). The survival analysis in all 3 groups was comparable with 5-year survival rate of 87.4%, 84.6%, and 91.8% in group 0, 1, and 2, respectively (P 5 0.66). In conclusion, recipients with PVT undergoing LT can have similar outcomes as the non-PVT patients even if PVTs were discovered incidentally. Discovery of incidental PVT only requires thrombectomy with no substantial change of treatment strategy, and the outcome is not adversely affected because most incidental PVTs are of a lower Yerdel grade. Preoperative imaging is useful to identify those with a higher Yerdel grade to allow planning of surgical strategy during transplantation. Liver Transpl 21:944-952, 2015. V C 2015 AASLD.Received December 7, 2014; accepted April 12, 2015.Recent studies have shown that portal vein thrombosis (PVT) is feasible in liver transplantation (LT) compared to the past, where it was once considered a contraindication because of technical difficulty and was associated with a high mortality and morbidity. The early era of PVT management in LT showed significant mortality and morbidity. However, with improved surgical techniques, technical capabilities, and surgical innovations, we have seen a marked improvement in the management of PVT with lower mortality and morbidity as shown in recently published data. 1,2 The incidence of PVT has been reported to be approximately 2%-26% in various studies. 3,4 Therefore, a good preoperative plan and strategy for identifying patients undergoing LT with PVT are vital to ensure good perioperative outcome and long-term consequences. Despite careful preoperative planning

HCC is most common among Chinese, followed by Malays and Indians in Malaysia. The etiology of HCC shows a peculiar racial pattern.

RFA and TACE may be equally effective for intrahepatic recurrence after hepatectomy when the tumour size is ≤ 5 cm and ≤ 3 lesions when re-resection or salvage transplantation is not considered feasible.

A 48-year-old woman was investigated because of a 6-month history of pain in the upper abdomen and progressive abdominal distension. On examination, she had a large mass in the right upper quadrant that extended to the umbilicus. Routine blood tests including liver function tests and a serum level of alpha fetoprotein were within the reference range. A computerized tomography (CT) scan of the abdomen revealed a large mass in the right upper quadrant, approximately 12 ¥ 18 ¥ 18 cm in size. There was contrast enhancement at the periphery of the mass consistent with a cavernous hemangioma. A coronal view of the mass is shown in Figure 1. As a major liver resection was proposed, she underwent embolization of the right portal vein. A repeat CT scan did not demonstrate any reduction in the size of the tumor or hypertrophy of the left lobe of the liver. At laparotomy, she had a huge pedunculated mass arising from the inferior surface of segments 5 and 6 of the liver (Figure 2). Histological features were consistent with a paraganglioma and this was supported by immunohistochemical studies which showed positive staining for neuronspecific enolase, synaptophysin and glial fibrillary acidic protein. However, S100 was equivocal and immunohistochemical staining was negative for chromogranin, MNF 116, vimentin, actin and CD68.Paragangliomas are neoplasms of the sympatho-adrenal neuroendocrine system. The most common site for these neoplasms is the adrenal medulla (pheochromocytoma). Extra-adrenal paragangliomas are unusual and mostly follow the distribution of the sympathetic nervous system. Paragangliomas in abdominal organs are rare but have been reported in a number of sites including the bladder and gallbladder. Atypical features in the above case included the site of the tumor (liver) and the size of the tumor (many are relatively small). Clinical features of excess catecholamine secretion have been reported in 20-80% of patients. Only a minority undergo malignant change as determined by the development of metastases. Another notable feature in the above case was the presence of centripetal contrast enhancement that is normally thought to be a typical feature of a cavernous hemangioma.