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HighlightsPECOMA is a rare mesenchymal neoplasm which expresses both myogenic and melanocytic markers showing a variable course.Association of SLE with hepatic PECOMA is unknown.Surgical resection is the preferred therapy.

Foreign bodies in the bladder are rarely observed because of difficult access. These patients usually have a mental disorder, a background of intense sexual perversion, or inquisitiveness. A 48-year-old, deaf, and mentally retarded woman was referred to the nephrology clinic for severe anemia and impaired renal function. Imaging tests showed a mercury thermometer positioned in the bladder and a stone, 5 cm in diameter, around it. This had caused bilateral ureteral obstruction. The patient underwent an open cysteotomy. Obstructive uropathy is one of the causes of kidney failure; therefore, foreign bodies should be included in the differential diagnosis.

Background: Laparoscopic liver resection (LLR) has been reported as safe and effective approach to the management of hepatocarcinoma (HCC). However, in decompensated cirrhosis, studies of long-term outcome about tumor recurrence and patient survival in comparison with other standard treatments are limited. The aim of this study is to analyze the long term outcome of LLR versus transarterial chemoembolization (TACE) for treatment of HCC in Child B patients Methods: Patients treated with LLR at a single European center were compared with patients treated with TACE included in the ITA.LI.CA database (a national multicenter HCC database). Only patients with same characteristics and adequate follow up were extracted from the database. A propensity score analysis was made matching patients by: age, sex, etiology of liver disease, number of lesions and size of largest nodule Results: Since 2004 to 2016, 35 patients underwent LLR. Those treated with TACE, identified in the database, were 200. Median overall survival (OS) was not statistically different between groups. After propensity score analysis LLR provided significantly better 3(p=0,05), 5(p=0,04) year survival and OS (p=0,03) than TACE: 44,9months (95% CI:14,9-74,9) versus 18,2 (95% CI:8,4-30,1) respectively Conclusion: LLR provides significantly better long-term survival than TACE in superselected patients with Child B cirrhosis. Thus, due to its low invasiveness, LLR should be part of multimodal management of HCC even in presence of mild liver function impairment

Background: Perivascular epithelioid cell tumor (PEComa) is a rare type of mesenchymal tumor with heterogeneous clinical behavior. Liver PEComas are very rare. Methods: The case of a 47-year-old man with hepatic PEComa and a complicated postoperative course is reported. Results: The patient had a history of systemic lupus erythematosus (SLE) and developed epigastric pain. An abdominal CT showed a large (7 cm) heterogeneous mass on segments I/IV, in direct contact with the inferior vena cava and portal vein. Percutaneous liver biopsy showed PEComa and the patient underwent left hepatectomy. On post-op day 7, he became pyrexial, with significant elevation in transaminases and inflammatory markers. Imaging (CT/MRI) showed a hypodense area in segment VIII close to resection margin. Blood cultures were taken and broad spectrum iv antibiotics were administered. As he continue to be pyrexial with a clinical picture of sepsis he underwent a second laparotomy, where necrosis of segment VIII was found and it was resected. As he became again pyrexial (on day 7), a new CT abdo was done revealing concentric hepatic artery stenosis with hypodense areas on segment VI with sphenoid shape. Acute exacerbation of SLE with right hepatic artery partial thrombosis or vasculitis was considered to be the diagnosis. He was commenced on steroids and anticoagulants with good clinical response. Conclusion: Management of hepatic PEComas can be very challenging especially in patients with significant comorbidities.

Background: Squamous cell carcinoma of the pyriform sinus(SCCPS) is a rare tumour with poor prognosis due to delayed diagnosis. It usually metastasizes to the lymphatic region or nearby organs. Distant dissemination is uncommon. We report the case of a patient diagnosed with SCCPS and a single liver metastasis. Methods: A 63-year-old man diagnosed with SCCPS 3 years ago, stage IVa(T1N2b), treated with QT/RT and a complete response. A control CT showed a liver mass of 68x59x48mm located in segments V-VI. The biopsy demonstrated a liver metastasis of SCCPS. The patient received 6 cycles of QT, with partial response. We decided to perform a segmentectomy V-VI. The specimen was compatible with metastasis of SCCPS, poorly differentiated. At present free-disease after 8 months. Results: SCCPS is the most frequently tumour in hypopharynx(70%), with an incidence of 1750/year. It is usually found in patients with tobacco or ethanol abuse. Only a small percentage present with early stage(T1-T2)without nodal involvement or distant metastases. Those are rare, with an incidence of 5%. Most of these patients have stage III or IV disease at presentation and, when present, they commonly involve lung and mediastinum(53%), bone(15%), skin(7%), and CNS(3%). To the present, this is the first report describing a liver metastasis from SCCPS resected. Conclusion: SCCPS is a low-frequency tumour with poor prognosis which rarely metastasizes to distant organs. We report a liver metastasis from SCCPS which was successfully treated with surgery.