Ectopic hepatic tissue misdiagnosed as a tumor of lung

Abstract

The ectopic or accessory liver lobe is an uncommon congenital anatomic abnormality. It is considered to be the outcome of an abnormal development of liver tissue during embryologic period. In some cases, it may be secondary to a trauma or a surgical operation. Literature reports only anecdotal cases; there are not series. The most common localization is the abdominal cavity, but very rarely it can also be found in the thoracic cavity. In most cases, preoperative correct diagnosis is very difficult because it is unlikely to consider this rare condition in course of differential diagnosis. Most cases are misdiagnosed, and patients undergo surgical intervention with suspect of lung lesion. Some times the intrathoracic accessory lobe is an intraoperative incidental finding. In this report, we present the case of a young female patient who underwent surgical treatment for a suspect pulmonary lesion that at histological examination resulted to be an intrathoracic accessory hepatic lobe.

Accessory lobes of the liver: A report of 3 cases and review of the literature

“…Currently, there are two hypotheses of the mechanism of an ALL: (i) the embryonic liver curls outwards and forms an accessory lobe during the embryonic stage of development (10) or (ii) an accessory lobe arises from intra-abdominal hypertension caused by the development of the tunica muscularis recti and the enlargement of the liver (11). normal liver tissue that is most often seen in the thorax or pelvic cavity (4,13,14); or (iv) a pinpoint atopic ALL (< 10 g) that is most often located at the margins of the liver or even gallbladder wall. An abdominal ALL, and especially a right abdominal ALL, is reported relatively frequently.…”

“…There are several types of ALL that are classified by volume and weight (4,6,12): (i) a bulky ALL (> 31 g) connected to the liver via a stalk of tissue or wide base in the subphrenic or perihepatic zone; (ii) a small ALL (11-30 g) connected to the liver via a wide base on the surface of the liver or around the right posterior lobe; (iii) a completely separate ALL with no connection to The mass had the same density as normal hepatic tissue and was demarcated from normal liver tissue by an enhanced line.…”

“…An ALL is typically detected and diagnosed via plain films, contrast enhancement, radioactive species, type-B ultrasound, CT, or MRI (5,(26)(27)(28). Most previous cases of ALL were diagnosed by pathology after surgery (23,26,29), though a few were diagnosed by imaging before surgery (4,27,28,30). Rapid advances in medical imaging equipment such as that used for ultrasound, CT, MRI, PET, and especially multislice spiral CT (MSCT) and MRI multiplane imaging provides more accurate information for diagnosis of an ALL, including its size, shape, classification, position, and blood supply.…”

“…In order to make an accurate diagnosis, factors such as size, shape, position, whether complications are present or not, and the type of complication should be considered. In terms of position, (i) an ALL in the thorax should be differentiated from a tumor of the pleura, lungs, chest wall, or diaphragm (1,4,24,26) while (ii) an ALL in the pelvic cavity should be differentiated from a benign or malignant tumor of the pelvic organs (33) and (iii) an ALL on the surface of the liver or abdominal organs should be differentiated from pathological changes in the liver, gall bladder, pancreas, spleen, or adrenal glands (13,22). Most patients with an ALL have no clinical manifestations and the ALL may be large enough to jostle surrounding organs.…”

Hepatopulmonary fusion: a rare and potentially lethal association with right congenital diaphragmatic hernia

“…Most of the times this condition is an intraoperative surprise for surgeons while operating for right diaphragmatic hernia. The differential diagnosis of this condition may include presence of ectopic liver tissue in thorax which is often misdiagnosed as a pulmonary mass 9. Another more common differential diagnosis can be pulmonary sequestration which is known to be associated with diaphragmatic hernia, where the collapsed lower lobe appears similar to liver tissue and is adherent to the diaphragm secondary to infection.…”