Surgical experiences of Ectopic Liver and Accessory Liver Lobe casese

Lee, Kyung Bum; Min, Byung Wook; Hong, Jeong Hun; Song, Tae Jin; Suh, Sung Ock; Kim, Young Chul; Choi, Sang Yong

Abstract

PURPOSE: The case of ectopic liver and accessory liver lobe have been rarely reported. A hepatic rudiment appears in the ventral angle between the foregut and the yolk sac; pars hepatica and pars cystica. The close connection between them explains accessory lobe on the Gall bladder surface wall. And the displacement of migration of a portion of the pars hepatica explains the ectopic liver. Difference between ectopic liver and accessory liver lobe can be defined whether the connection with hepatic proper exists or not. But, the definite discrimination of the type is very difficult clinically. Recently, we experienced cases of ectopic liver and accessory liver. CASES: In one patient, 43-year-old woman was referred to our department with left upper quadrant abdominal pain. Abdominal sonogram revealed a mass below the diaphragm attached to the superior pole of the spleen. On the operation, tumor mass was reddish gray colored and measured 10 7 3 cm. There were no direct connections with the liver proper except fibrous tissue, and its blood supply was considered from the left diaphragm. The pathologic result proved hepatocellular carcinoma(HCC). In the other patient, a 68-year-old woman complained right upper quadrant abdominal pain and was diagnosed as chronic cholecystitis on sonogram. During the laparoscopic cholecystectomy, a small bean sized mass, appearing as liver tissue, attached GB body portion was detected. The Mass was measured 1.0 1.0 3.0 cm in size and glistening dark brown colored, smooth surfaced. Streaky stalk connected with liver proper was visible. Pathologic finding confirmed the mass as an accessory liver. Both patients discharged without complications. DISCUSSION: Although the clinical problems are rare in the ectopic liver, it has been reported that ectopic liver is prone to be a cancer and accessory liver can induce symptoms. The larger the size becomes, the more it can be Symptomatic. Surgical treatment should be considered whenever they are diagnosed. More investigations are nedeed to know their clinical importance on the basis of the case accumulation.