Perivascular epithelioid cell tumor (PEComa) is a rare tumor that originates from mesenchymal tissues. Cases of PEComa in the liver are extremely rare. The present study aimed to analyze the clinical features of PEComa in the liver and discuss its management. Here we report a 25-year-old female with multiple lesions of low density with poorly defined borders in the liver, as shown by a computed tomography (CT) scan. A partial hepatectomy was proceeded and PEComa was diagnosed by immunohistochemistry. No evidence of recurrence was observed during the one year follow-up. A total of 20 patients with hepatic PEComa, including one case from the present study and 19 cases that were reported in literature between June 2001 and December 2012, were reviewed and analyzed. The mean patient age was 43.4 years (range, 25–67 years) and the cases consisted of 18 female and two male patients. The tumor size ranged between 2.0×1.6 and 15.0×12.0 cm. Of the 20 patients, nine were asymptomatic and 11 had mild to significant complaints. Immunohistochemistry plays a key role in the diagnosis of PEComa. All the cases in this study were strongly positive for human melanoma black-45. A surgical resection is the gold standard for curative intent. All the patients underwent a surgical resection and none were administered perioperative chemotherapy or radiotherapy. In total, 13 of the 14 patients with follow-up information survived during the 8–36-month follow-up period and one patient succumbed due to recurrence two years after the surgery.
Many nonoperative methods are available to treat postoperative bile leakage. Non-surgical treatment may serve as the first choice for the treatment of bile leakage for its advantages in higher cure rate, convenience and safety in practice. It is important to choose the specific non-surgical method according to the volume, site of bile leakage and patient's condition.
Budd-Chiari syndrome (BCS) is defined as hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the inferior vena cava (IVC) and the right atrium, regardless of the cause of obstruction. We present two cases of acute iatrogenic BCS and our clinical management of these cases. The first case was a 43-year-old woman who developed acute BCS following the implantation of an IVC stent for the correction of stenosis in the IVC after hepatectomy for hepatolithiasis. The second case was a 61-year-old woman with complete obstruction of the outflow of hepatic veins during bilateral hepatectomy for hepatolithiasis. Acute iatrogenic BCS should be considered a rare complication following hepatectomy for hepatolithiasis. Awareness of potential hepatic outflow obstructions and timely management are critical to avoid poor outcomes when performing hepatectomy for hepatolithiasis.
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