The human liver contains specialized subsets of mononuclear phagocytes (MNPs) and T cells, but whether these have definitive features of tissue residence (long-term retention, lack of egress) and/or can be replenished from the circulation remains unclear. Here we addressed these questions using HLA-mismatched liver allografts to discriminate the liver-resident (donor) from the infiltrating (recipient) immune composition. Allografts were rapidly infiltrated by recipient leukocytes, which recapitulated the liver myeloid and lymphoid composition, and underwent partial reprogramming with acquisition of CD68/CD206 on MNPs and CD69/CD103 on T cells. The small residual pool of donor cells persisting in allografts for over a decade contained CX3CR1hi/CD163hi/CD206hi Kupffer cells (KCs) and CXCR3hi tissue-resident memory T cells (TRM). CD8+ TRM were found in the local lymph nodes but were not detected egressing into the hepatic vein. Our findings inform organ transplantation and hepatic immunotherapy, revealing remarkably long-lived populations of KCs and TRM in human liver, which can be additionally supplemented by their circulating counterparts.

Pancreatic allograft thrombosis (PAT) remains the leading cause of nonimmunologic graft failure. Here, we propose a new computed tomography (CT) grading system of PAT to identify risk factors for allograft loss and outline a management algorithm by retrospective review of consecutive pancreatic transplantations between 2009 and 2014. Triple‐phase CT scans were graded independently by 2 radiologists as grade 0, no thrombosis; grade 1, peripheral thrombosis; grade 2, intermediate non‐occlusive thrombosis; and grade 3, central occlusive thrombosis. Twenty‐four (23.3%) of 103 recipients were diagnosed with PAT (including grade 1). Three (2.9%) grafts were lost due to portal vein thrombosis. On multivariate analysis, pancreas after simultaneous pancreas–kidney transplantation/solitary pancreatic transplantation, acute rejection, and CT findings of peripancreatic edema and/or inflammatory change were significant risk factors for PAT. Retrospective review of CT scans revealed more grade 1 and 2 thromboses than were initially reported. There was no significant difference in graft or patient survival, postoperative stay, or morbidity of recipients with grade 1 or 2 thrombosis who were or were not anticoagulated. Our data suggest that therapeutic anticoagulation is not necessary for grade 1 and 2 arterial and grade 1 venous thrombosis. The proposed grading system can assist clinicians in decision‐making and provide standardized reporting for future studies.

Cigarette smoking increases the incidence and mortality of HCC. Further studies are needed to evaluate possible impact of quitting smoking on decreasing this risk.

Primary neuroendocrine tumours (NETs) of the gallbladder are rare. In the absence of any randomised controlled trials or prospective case series, we sought trends for clinical presentation and management based on 60 patients from published literature over the last 15 years, as well as three patients from our experience, and categorised them into various subgroups according to the WHO classification for NETs. Well-differentiated NETs have an indolent course and better prognosis. Poorly differentiated neuroendocrine carcinomas, which may be of large-cell or small-cell type and may coexist with other types of carcinoma, have a poor outcome. A variety of surgical and chemotherapeutic approaches have been adopted. Surgical excision appears to prolong life, with chemotherapy perhaps adding a marginal advantage.

The evidence suggests that there is a potential benefit in using phlebotonics in treating haemorrhoidal disease as well as a benefit in alleviating post-haemorrhoidectomy symptoms. Outcomes such as bleeding and overall symptom improvement show a statistically significant beneficial effect and there were few concerns regarding their overall safety from the evidence presented in the clinical trials.However methodological limitations were encountered. In order to enhance our conclusion further, more robust clinical trials which take into account these limitations will need to be performed in the future.

Laparoscopic cholecystectomy is now one of the most frequently performed abdominal surgical procedures in the world. The most common major complication is bile duct injury, which can have catastrophic repercussions for patients and it has been suggested that intraoperative cholangiography may reduce the rate of bile duct injury. Whether this procedure should be performed routinely is still an active subject of debate. We discuss the available evidence and likely implications for the future.

AIMTo analyse the range of histopathology detected in the largest published United Kingdom series of cholecystectomy specimens and to evaluate the rational for selective histopathological analysis.METHODSIncidental gallbladder malignancy is rare in the United Kingdom with recent literature supporting selective histological assessment of gallbladders after routine cholecystectomy. All cholecystectomy gallbladder specimens examined by the histopathology department at our hospital during a five year period between March 2008 and March 2013 were retrospectively analysed. Further data was collected on all specimens demonstrating carcinoma, dysplasia and polypoid growths.RESULTSThe study included 4027 patients. The majority (97%) of specimens exhibited gallstone or cholecystitis related disease. Polyps were demonstrated in 44 (1.09%), the majority of which were cholesterol based (41/44). Dysplasia, ranging from low to multifocal high-grade was demonstrated in 55 (1.37%). Incidental primary gallbladder adenocarcinoma was detected in 6 specimens (0.15%, 5 female and 1 male), and a single gallbladder revealed carcinoma in situ (0.02%). This large single centre study demonstrated a full range of gallbladder disease from cholecystectomy specimens, including more than 1% neoplastic histology and two cases of macroscopically occult gallbladder malignancies.CONCLUSIONRoutine histological evaluation of all elective and emergency cholecystectomies is justified in a United Kingdom population as selective analysis has potential to miss potentially curable life threatening pathology.

A case of isolated splenic metastasis from carcinoma of the breast in a 54 year old woman, two years after treatment for breast carcinoma, is presented. There was no involvement of other organs like liver, bone, lungs, etc. The patient underwent splenectomy and recovered without any complications. This case is being reported because of the rarity of the lesion. Breast carcinoma with visceral metastasis to liver, bones, lungs, etc is common. Secondary metastasis in spleen, on the other hand, is a rare entity. Though it may occur along with other visceral metastasis, isolated involvement of spleen has not yet been reported. CASE REPORTA 54 year old woman presented with left hypochondrial pain and mild fever of one month's duration. She was known to have asthma and hypertension, and she had been operated on for carcinoma of the breast (tumour, node, and metastasis staging: T 2 N 1 M 0 ) by modified radical mastectomy two years earlier. The histopathological examination showed infiltrating duct carcinoma with three metastatic lymph nodes. Other possible sites of spread revealed no metastasis. There was no family history of breast cancer. The patient received chemotherapy (cyclophosphamide, methotrexate, and 5-fluorouracil; six cycles) and was on tamoxifen. Over the previous two years she had not had any significant illness.On physical examination, the patient was pale but moderately nourished. Abdominal examination revealed a mass 5 cm below the left costal margin, moving with respiration, directed towards right iliac fossa (splenomegaly). The liver was not palpable. There was no other palpable mass or ascites. Vaginal and rectal examinations were normal. The mastectomy bed, contralateral breast, and both axilla were normal. Haematological analysis showed anaemia and leucocytosis. Biochemical parameters including liver function tests and renal function tests were within normal limits. An ultrasonogram of the abdomen showed splenomegaly with a large cystic lesion in the spleen. Computed tomography of the abdomen and pelvis revealed an enlarged spleen containing a well circumscribed solitary hypodense area. The liver, retroperitoneum, and pelvis were normal. Computed tomography of the chest was normal. A splenic abscess or metastatic lesion to the spleen were considered. As there were no other lesions, the patient was prepared for laparotomy and splenectomy.Peroperatively the spleen was enlarged with an irregular surface and numerous adhesions. Few lymph nodes were present in the splenic hilum. The liver, bowels, and other viscera were normal; there was no ascites. Splenectomy was done and the postoperative period was uneventful. The patient was followed up for six months, with ultrasound scan of the abdomen, and there was no persistence or recurrent disease.The spleen was 12 × 11 × 8 cm, weighing 500 g, with an irregular surface. Cut section showed fleshy growth with extensive necrosis, 10 cm in diameter, with a rim of splenic tissue all around. Microscopic examination showed sheets and nests of cells having eosinoph...