Pedunculated hepatocellular carcinoma (P-HCC) is a rare subtype of HCC. P-HCC may occur in patients without underlying liver cirrhosis and can be present with negative serum tumor markers. With a growing worldwide incidence of nonalcoholic fatty liver disease, non-cirrhotic HCC will likely become more prevalent. We report a patient presenting to the hospital with nonspecific symptoms of weight loss, abdominal discomfort, and early satiety. Abdomen palpation found a large firm mass in the right middle abdomen. Computed tomography imaging showed a large right abdominal mass without evidence of liver attachment. The patient underwent a diagnostic laparotomy where a single 17 cm exophytic mass originating from the left liver lobe was found and resected. Clear margins were attained, and pathology demonstrated HCC. Early diagnosis of HCC is critical to achieving curative treatment, and physicians should keep P-HCC in mind when presented with a similar patient.
Our results indicate that intra-band pressure measurement is of little value for determining the amount of fluid that should be removed for treatment of band obstruction. We suggest the removal of fluid in volumes of 0.5 ml until symptoms are relieved. Only in complicated cases, such as in patients having recurrent obstructions, should additional modalities be employed for further management guidance.
Introduction and importance: Collision tumors refer to the phenomenon where two or more different and unrelated tumors occur in the same location of an organ and form a single lesion. We present the first case of renal collision tumors composed of clear cell carcinoma (ccRCC) and collecting duct carcinoma (CDC) treated with combined therapy of nivolumab and ipilimumab.Case presentation: An 89-year-old male presented to the emergency room with back pain. Imaging studies demonstrated a large tumor in the left kidney with renal vein thrombosis. After radical nephrectomy, the histopathological report showed collision tumors with ccRCC and CDC components. The patient was included in a treatment protocol based on nivolumab (220 mg) and ipilimumab (73 mg) every 21 days, however, obtaining no clinical responses after 5 cycles of treatments.Clinical Discussion: Immune checkpoint inhibitors have become a new standard of care for patients with advanced ccRCC. However, current literatures showed inconclusive evidence on the efficacy of immune checkpoint inhibitor for metastatic CDC. As collision tumors with ccRCC and CDC components were infrequently reported in the literature, we also discuss the histological and immunohistochemical findings, clinical outcomes, and a literature review on this type of renal collision tumors.
Conclusion:CDC is a rare and highly aggressive type of renal neoplasms, with limited treatment choices. More studies are needed to evaluate the efficacy of immune checkpoint inhibitors on CDC and its associated collision tumors.
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