In vivo (Athens, Greece) · 2022
Sebaceous Gland Ectopia of the Esophagus: A Challenging Clinical Diagnosis.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Semaan Alexander, Branchi Vittorio, Marowsky Anna-Lena, VON Websky Martin, Kupczyk Patrick, Enkirch Simon Jonas, Kukuk Guido, Bölke Edwin, Stoffels Burkhard, Kalff Jörg C, Schäfer Nico, Lingohr Philipp, Matthaei Hanno
Аннотация
BACKGROUND: Detection of asymptomatic focal liver lesions (FLL) is increasing because of a widespread use of modern radiologic imaging. Most of these lesions are benign, though malignancy often has to be ruled out, which is posing a diagnostic challenge.
AIM: To critically evaluate our treatment strategy in the context of recently published American College of Gastroenterology (ACG) guidelines.
PATIENTS AND METHODS: The medical records of patients who underwent surgery for asymptomatic, incidentally detected FLL from 2005-2012 were reviewed. Primary end-points were the congruence of suspected diagnosis and final pathology, as well as the identification of predictors of malignancy. A systematic review was undertaken to help define a standardized management.
RESULTS: Eighty patients, 37 male and 43 female with a mean age of 57 years (range=16-83) were included, harboring 39 (49%) malignant and 41 (51%) benign, asymptomatic hepatic lesions. Hepatocellular carcinoma (HCC) (n=24) represented most of malignant FLL, followed by cholangiocellular carcinoma (CCC) (n=10), whereas focal nodular hyperplasia (FNH) (n=19) and liver hemangioma (n=7) were the predominant benign entities. Fifty-one patients (64%) had a correct preoperative diagnosis, while patients with FNH were most commonly misdiagnosed (53%). We identified age (p<0.001) and male sex (p=0.013) as risk factors for malignancy in an asymptomatic FLL.
CONCLUSION: Despite recent technical advances of the modern radiology setting a correct preoperative diagnosis in an asymptomatic FLL remains challenging. Male gender and old age seem to correlate with malignancy. In the absence of biomarkers and evidence-based guidelines, a multidisciplinary approach in an experienced tertiary referral center is recommended for an optimized individual management.
AIM: To critically evaluate our treatment strategy in the context of recently published American College of Gastroenterology (ACG) guidelines.
PATIENTS AND METHODS: The medical records of patients who underwent surgery for asymptomatic, incidentally detected FLL from 2005-2012 were reviewed. Primary end-points were the congruence of suspected diagnosis and final pathology, as well as the identification of predictors of malignancy. A systematic review was undertaken to help define a standardized management.
RESULTS: Eighty patients, 37 male and 43 female with a mean age of 57 years (range=16-83) were included, harboring 39 (49%) malignant and 41 (51%) benign, asymptomatic hepatic lesions. Hepatocellular carcinoma (HCC) (n=24) represented most of malignant FLL, followed by cholangiocellular carcinoma (CCC) (n=10), whereas focal nodular hyperplasia (FNH) (n=19) and liver hemangioma (n=7) were the predominant benign entities. Fifty-one patients (64%) had a correct preoperative diagnosis, while patients with FNH were most commonly misdiagnosed (53%). We identified age (p<0.001) and male sex (p=0.013) as risk factors for malignancy in an asymptomatic FLL.
CONCLUSION: Despite recent technical advances of the modern radiology setting a correct preoperative diagnosis in an asymptomatic FLL remains challenging. Male gender and old age seem to correlate with malignancy. In the absence of biomarkers and evidence-based guidelines, a multidisciplinary approach in an experienced tertiary referral center is recommended for an optimized individual management.