A Rare Cause of a Liver Tumor Nodule

Chau, Ivy Yenwen; Chen, Yen Ying; Chau, Gar Yang

doi:10.1053/j.gastro.2020.10.005

Cited by 1 publication

(4 citation statements)

References 2 publications

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“… 11 Thirteen cases were diagnosed by the direct observation of an ulcer that perforated into the liver during surgery. 4 , 8 , 12 , 21 , 24 , 26 , 27 , 29 , 33 , 34 , 39 , 40 …”

Section: Resultsmentioning

confidence: 99%

“…In addition, one patient in the literature presented with a liver tumor at the site of perforation with an absence of hepatocytes at the gastric ulcer biopsy, which was further confirmed as a nodule of reactive inflammation with no sign of malignancy after surgery. 33 The in-house case was first diagnosed as malignancy (adenocarcinoma) in biopsy samples with the presence of atypia and cytoplasmic fat vacuoles that appeared to mimic signet ring cells but was later confirmed as a perforated duodenal ulcer that involved the liver ( Fig. 4 ).…”

Section: Resultsmentioning

confidence: 99%

“…Endoscopically, penetration into the liver could frequently appear as a polypoid or pseudotumoral mass that protruded from the central area of the ulcer bed. 8,9,13,14,21,24,[32][33][34][35][36] This feature, combined with the irregular ulcer ground and margin, the giant ulcer size (average size 5.1 cm for gastric ulcers and 2.4 cm for duodenal ulcers) and clinical features (weight loss and emaciation) always raised the potential for malignancy. However, as indicated by Padda et al, 24 an endoscopic biopsy had the potential risk of inducing active bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Under endoscope or during surgery, a large or giant ulcer (defined as the largest dimension of ≥3 cm for gastric ulcers 5 and 2 cm for duodenal ulcer 6 ) was described in 25 patients; A polypoid or pseudotumoral mass that protruded from the central area of the ulcer bed was mentioned frequently (in 11 cases 8,9,13,14,21,24,[32][33][34][35][36] ). Five ulcers had an irregular margin.…”

Section: Gross Manifestationsmentioning

confidence: 99%

See 3 more Smart Citations

Liver Involvement by Perforated Peptic Ulcer: A Systematic Review

Jiao¹,

Zhang²

2021

Journal of Clinical and Translational Pathology

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Background and Objective: Liver penetration by a confined perforation of peptic ulcer is a rare but severe event. Its clinical and pathological features are unclear. Methods: In total, 41 qualified English publications were identified using the PubMed database and one in-house case. Results: Among the 42 patients, 20 patients had liver involvement by a perforated duodenal ulcer and 22 by a gastric ulcer. Among the 23 cases of known ulcer histology, 2 ulcers were malignant and were adenocarcinomas in the gastric remnant and the remaining 21 ulcers were confirmed as histologically benign (for frequency of malignancy in duodenal versus gastric ulcers, p = 0.48). The presence of hepatocytes was the clue of diagnosis for 19 cases. The median ages of the patients were 64.5 years (95% Confidence Intervals [CI] 53.40-71.90) for duodenal ulcer and 65.5 years (95% CI: 59.23-70.95) for gastric ulcer, respectively. The male to female ratio was 1.5:1 for duodenal ulcers and 2:1 for gastric ulcers. Patients with liver involvement of a perforated gastric ulcer were more likely to have a larger ulcer (median largest dimension, 4.75 cm versus 2.5 cm, p = 0.014). Female patients with liver involvement of a gastric ulcer were older than male patients (median age 72 versus 60 years, p = 0.045). There were no differences in gender, region (Asia, Europe, America versus others), use of nonsteroidal anti-inflammatory drugs (n = 15), H. Pylori positivity (n = 10), possible history of peptic ulcer disease (n = 19) or mortality (n = 32) between duodenal and gastric ulcers. Conclusions: Careful histologic examination, clinicopathological correlation, and immunohistochemistry are critical to establish the diagnosis and avoid misdiagnosing liver involvement as malignancy.

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“… 11 Thirteen cases were diagnosed by the direct observation of an ulcer that perforated into the liver during surgery. 4 , 8 , 12 , 21 , 24 , 26 , 27 , 29 , 33 , 34 , 39 , 40 …”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%