Barazza Gonzalo, Adler Douglas G, Factor Rachel E
Address: Department of Pathology, University of Utah, Salt Lake City, Utah, USA.
Department of Gastroenterology and Hepatology, University of Utah, Salt Lake City, Utah, USA.
Cytojournal. 2016 Dec 20;13:29. doi: 10.4103/1742-6413.196239. eCollection 2016.
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.
胃周肿物的鉴别诊断范围广泛，涵盖从良性到恶性的各种病变。在良性病变中，副肝叶和异位肝较为罕见，常为偶然发现。在此，我们报告一例恶性黑色素瘤患者，临床上怀疑其胃周有转移灶或胃肠道间质瘤，但最终经细针穿刺抽吸活检（FNA）诊断为良性异位肝。一名47岁男性于2015年5月在一家三级医院被诊断为头皮恶性黑色素瘤。通过计算机断层扫描成像发现，他在胃底附近、膈肌下方有一个2.6 cm的强化肿物。为排除转移，该患者接受了内镜检查，并由细胞病理学家在快速现场评估（ROSE）下进行了内镜超声引导下的FNA。使用了一种相对较新的FNA针（鲨鱼芯针），获取了有用的芯针活检材料。细胞病理学显示有扁平细胞片、单个细胞以及小簇多边形细胞。细胞质丰富，常有色素。细胞无明显异型性。涂片结果显示与肝细胞一致。细胞块显示有含门管区的肝实质小芯针碎片。精氨酸酶-1免疫组化证实这是肝组织。ROSE有助于与内镜医师沟通，表明该肿物既远离肝脏，也与肝脏不相连。这是首例通过FNA诊断胃周异位肝的文献报道。在胃周肿物的鉴别诊断中应考虑到这种情况。
