An unexpected diagnosis of ectopic liver diagnosed by fine needle aspiration

Abstract

The differential diagnosis of perigastric masses is broad, ranging from benign to malignant entities. Among the benign entities, accessory liver lobes and ectopic liver are unusual and often incidentally discovered. Here, we report a patient with malignant melanoma who was clinically suspected to have a perigastric metastasis or a gastrointestinal stromal tumor but was ultimately diagnosed by fine needle aspiration (FNA) to have benign ectopic liver. A 47-year-old male was diagnosed with malignant melanoma of the scalp in May 2015 at a tertiary care hospital. He was found to have a 2.6 cm enhancing mass adjacent to the fundus of the stomach and below the diaphragm by computed tomography imaging. To exclude metastasis, the patient was referred to endoscopy, and an endoscopic ultrasound-guided FNA was performed with rapid on-site evaluation (ROSE) by a cytopathologist. A relatively new FNA needle (Shark Core) was used, which produced useful core biopsy material. Cytopathology demonstrated flat sheets, single cells, and small clusters of polygonal cells. There was abundant granular cytoplasm, often containing pigment. Cells lacked pleomorphism. The smear findings appeared consistent with hepatocytes. The cell block demonstrated small core fragments of hepatic parenchyma with portal tracts. Immunohistochemistry for arginase-1 confirmed that this was hepatic tissue. ROSE was useful for communicating with the endoscopist that the mass was both far from, and not connected to, the liver. This is the first documented account of perigastric ectopic liver diagnosed by FNA. This entity should be considered in the differential of perigastric masses.

Ectopic liver tissue in the fundus of the stomach: A case report

“…Currently, the most common site of incidental finding of EL is on the wall of the gallbladder [1,5]. Moreover, EL has also been identified in the thorax, lung, pancreas, umbilicus, adrenals, pylorus, inferior vena cava and within congenital abdominal wall anomalies [2,6,7].…”

Ectopic Liver Tissue in the Left Hypocondrium: A Case Report and a Literature Review

“…The majority of the intrathoracic ectopic or accessory liver lobes were connected to the orthotopic liver by means of a small pedicle that pierced the diaphragm or passed through a small hiatus (Chen et al). From intra abdominal sites the most frequent site where are found the majority of ectopic livers is the gallbladder (Tejada & Danielson;Arakawa et al;Sakarya et al, 2002;Acar et al, 2002;Catani et al, 2011;Martinez et al;Bal et al, 2015;Yahya et al, 2016;Karaca et al, 2016). Occasionally ectopic liver have been found in other organs like stomach (Huang et al, 2015, Barazza et al, 2016, in the upper pole of the spleen (Zonca et al, 2013), in the ligamentum hepato-umbilicalis (Lara-Díaz et al, 2011;Vaideeswar et al, 2011;Zonca et al), in the pancreas , kidney (Merve & Scheimberg 2014), left adrenal gland (Hashimoto et al, 1997) or have been found as intracaval floating mass (Morris et al, 2012;Rafiei et al, 2012).…”

Diagnostic utility of immunohistochemical analysis and Epstein–Barr virus‐encoded small RNAs in situ hybridisation of cell block sections obtained using fine‐needle aspiration in nasopharyngeal carcinoma with lymph node metastasis

“…Fine needle aspiration biopsy (FNAB) is a simple, rapid, indicative, and accurate method to diagnose tumours owing to its minimal invasiveness and safety; it allows for the observation of abnormal cytological changes in suspicious lesions . Over the past few years, several studies have confirmed the diagnostic utility of FNAB in cancer, and therefore, it is now widely used in clinical practice . Owing to innovative developments in FNA technology, we can now collect more cells to prepare cell blocks (CB) that can be used for cell smears and immunohistochemistry (IHC) staining analysis, which compensates for some of the shortcomings of simple smears in organisational structure and cell morphology.…”