No abstract

There has been an ongoing confusion among pathologists in their attempt to accurately identify lesions of Reinke's space. Nodules, polyps and Reinke's edema fall in the same basket and differentiation between them relies largely on the clinical description of the pathologic specimen by the operating surgeon than on their distinct pathologic features. By revising the pertinent literature, the need for an establishment of the aforementioned term still remains and is further stressed out, as confusion among the various pathologic descriptions of these lesions still exists. This is further verified by a study conducted in the Department of Otorhinolaryngology-Head and Neck Surgery of the University Hospital of Louvain at Mont-Godinne, Belgium, involving 323 operative specimens obtained from 200 patients with macroscopic picture. Statistical analysis showed lack of agreement between surgical and histopathologic diagnosis in almost a third of the cases (Cohen's kappa coefficient of 0.683 +/- 0.037, P < 0.001). We, therefore, propose the term "exudative lesions of Reinke's space" to include Reinke's edema, polyps and nodules. These lesions share common histologic features, which are located in the Reinke's space and whose macroscopic appearance is largely dependent upon the presence and duration of certain causative factors.

No abstract

Laparoscopic resection of Segment 1 is technically challenging and reports remain limited. In this video we demonstrate our experience and technique for laparoscopic Segment 1 resection in three different settings. Methods: 1) A 56 y-old man diagnosed with solitary Segment 1 liver metastasis from conventional renal cell carcinoma received laparoscopic isolated Segment 1 resection. 2) A 72 y-old man diagnosed with bilobar colorectal liver metastases was submitted to laparoscopic left lateral sectionectomy and simultaneous Segment 1, 7 and 8 wedge resections. 3) A 79 y-old man diagnosed with intrahepatic cholangiocarcinoma underwent a laparoscopic left hemihepatectomy with enbloc Segment 1 resection. Low CVP and careful dissection are essential for a safe and oncologically efficient resection. Results: For all three patients postoperative course was uneventful and R0 resection was confirmed on histological exam. Conclusions: Although challenging, laparoscopic management of lesions in Segment 1 can be completed safely and efficiently for malignant lesions. In this video we demonstrate the surgical techniques we developed and adopted in different clinical settings.

The emergence of contrast-enhanced ultrasound (CEUS) and microbubble (MB) platforms capable of delivering payloads to solid cancers has expanded the arena of targeted molecular therapies. Tumour vascular endothelial ligands are an integral component of this approach to target MBs to tumour vasculature. With its aggressive nature and lack of effective adjunctive treatments, we evaluated Perihilar Cholangiocarcinoma (PH-CCA) as a candidate for this approach. The expression and impact of a panel of vascular endothelial markers in PH-CCA was assessed and CD105 based MB targeting analysed in a preclinical model. Methods: CD31, CD105 and Vascular Endothelial Growth Factor Receptor-2 (VEGFR-2) expression was assessed by tumour Immunohistochemistry (IHC) using microvessel density (MVD) measurements in a cohort of 54 patients who underwent PH-CCA resection from 2000e2010. Invitro flow assays were conducted to quantify CD105-MB targeting on SVR endothelial cells. CD105-MB tumour binding in-vivo was analysed using CEUS in BALB/c nude mice bearing subcutaneous extra-hepatic CCA (TFK-1 and EGI-1) xenografts. Results: Median patient age was 57.6 years and median tumour size 65 mm. T2 tumours formed the majority (54%). Nodal metastases occurred in 54% cases. None of the endothelial markers were significantly associated with nodal/systemic metastases. Cox regression analysis identified tumour size >47 mm and CD105 MVD >31 as independent predictors of overall survival (p <0.0001 and 0.003 respectively). CD105 was however expressed by hepatic sinusoids. Flow assay data revealed significantly higher endothelial cell binding of CD105-MB compared to isotype control (p = 0.019). Targeted molecular imaging in human CCA xenografts showed higher tumour endothelial binding of CD105-MB compared to control MBs. Conclusions: CD105 holds promise as a prognostic endothelial marker in PH-CCA. Further validation of these pre-clinical CCA models using CD105-MB is underway towards potential translation into clinical application.

IPM). The liver parenchyma was divided by a combination of CUSAÒ;, Thunderbeat (OlympusÒ;) and LigasureÒ; keeping the transaction line as close as possible to the cystic neoplasm. Locking clips and vascular stapler were used to divide the RPPP and branches of RHV in contact with the neoplasm. Results: Operative time was 300 min. Blood loss was 150 ml and IPM was used twice. The patient did not develop any complication. Total hospital stay was five days. The histologic reports confirmed the preoperative diagnosis of BCA with ovarian stroma. Conclusions: The laparoscopic approach is a feasible and safe option to treat patients with large BCA in need for a radical resection even when the lesion is localized in the right posterior segments as far as the surgeon is skilled with advanced minimally invasive liver procedures.

Laparoscopic resection of Segment 1 is technically challenging and reports remain limited. In this video we demonstrate our experience and technique for laparoscopic Segment 1 resection in three different settings. Methods: 1) A 56 y-old man diagnosed with solitary Segment 1 liver metastasis from conventional renal cell carcinoma received laparoscopic isolated Segment 1 resection. 2) A 72 y-old man diagnosed with bilobar colorectal liver metastases was submitted to laparoscopic left lateral sectionectomy and simultaneous Segment 1, 7 and 8 wedge resections. 3) A 79 y-old man diagnosed with intrahepatic cholangiocarcinoma underwent a laparoscopic left hemihepatectomy with enbloc Segment 1 resection. Low CVP and careful dissection are essential for a safe and oncologically efficient resection. Results: For all three patients postoperative course was uneventful and R0 resection was confirmed on histological exam. Conclusions: Although challenging, laparoscopic management of lesions in Segment 1 can be completed safely and efficiently for malignant lesions. In this video we demonstrate the surgical techniques we developed and adopted in different clinical settings.