Developmental abnormalities are rare in the liver. This study presents two case reports of ectopic liver. The first case was a 31-year-old male with clinical indication for laparoscopic appendectomy. Laparoscopy identified a perforated appendix and an unknown tumorous lesion in the ligamentum hepato umbilicalis. The patient underwent a laparoscopic appendectomy, intraoperative lavage of the peritoneal cavity, and extirpation of the lesion in the ligamentum hepato umbilicalis. Histopathological examination of the excised tumor revealed that it comprised liver tissue with fibrinous changes. The tumor was completely separate from the liver with no connection. It was classified as an ectopic liver. No further therapy was required. The second case was a 59-year-old male with a tumor on the upper pole of the spleen, incidentally diagnosed in an ultrasound examination. The biopsy raised suspicion of hepatocellular carcinoma. A positron emission tomography-computed tomography examination revealed accumulation of F-18 fluorodeoxyglucose only in the tumor. The patient underwent a splenectomy with a resection and reconstruction of diaphragm. After the hepatocellular carcinoma was confirmed, adjuvant therapy (sorafenib) was initialized. The operations and postoperative recoveries were uncomplicated in both cases. Despite the low incidence of ectopic liver and rare complications, it is necessary to maintain awareness of this possibility. The potential malignancy risk for ectopic liver tissue is the basis for radical surgical removal. Therapy for hepatocellular carcinoma in an ectopic liver follows the same guidelines as those followed for treating the "mother" liver.

Pavel Zonca Lubomir Martinek Peter Ihnat Department of Surgery University Hospital Ostrava 70852 Ostrava Czech Republic

See more in PubMed

Watanabe M, Matsura T, Takatori Y, Ueki K, Kobatake T, Hidaka M, Hirakawa H, Fukukmoto S, Shimada Y. Five cases of ectopic liver and a case of accessory lobe of the liver. Endoscopy. 1989;21:39–42. PubMed

Asada J, Onji S, Yamashita Y, Okada S, Morino M, Kanaoka M, Ohta Y. Ectopic liver observed by peritoneoscopy: report of a case. Gastroenterol Endosc. 1982;24:309–312.

Eiserth P. Beitrage zur Kenntnis der Nebenlebern. Virchows Arch A Pathol Anat Histopathol. 1940;307:307–313.

Collan Y, Hakkiluoto A, Hästbacka J. Ectopic liver. Ann Chir Gynaecol. 1978;67:27–29. PubMed

Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53:1020–1022. PubMed PMC

Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008;359:378–390. PubMed

Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, Luo R, Feng J, Ye S, Yang TS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10:25–34. PubMed

Sadler TW. Langman’s Essential Medical Embryology. Philadelphia: Lippincott Williams and Wilkins; 2004.

Curtis LE, Sheahan DG. Heterotopic tissues in the gallbladder. Arch Pathol. 1969;88:677–683. PubMed

Carrabetta S, Piombo A, Podestà R, Auriati L. Torsion and infarction of accessory liver lobe in young man. Surgery. 2009;145:448–449. PubMed

Koumanidou C, Nasi E, Koutrouveli E, Theophanopoulou M, Hilari S, Kakavakis K, Batakis N. Torsion of an accessory hepatic lobe in a child: ultrasound, computed tomographic, and magnetic resonance imaging findings. Pediatr Surg Int. 1998;13:526–527. PubMed

Elsayes HB, Elzein MA, Razik AM, Olude IO. Torsion of an ectopic liver in a young child. J Pediatr Surg. 2005;40:E55–E58. PubMed

Umehara M, Sugai M, Kudo D, Hakamada K, Sasaki M, Munakata H. Torsion of an accessory lobe of the liver in a child: report of a case. Surg Today. 2009;39:80–82. PubMed

Khan AM, Hundal R, Manzoor K, Dhuper S, Korsten MA. Accessory liver lobes: a diagnostic and therapeutic challenge of their torsions. Scand J Gastroenterol. 2006;41:125–130. PubMed

Ladurner R, Brandacher G, Mark W, Iannetti C, Lottersberger C, Steurer W, Königsrainer A, Margreiter R. Complete hepatic ischemia due to torsion of a large accessory liver lobe: first case to require transplantation. Transpl Int. 2005;18:467–469. PubMed

Ito F, Ando H, Watanabe Y, Seo T, Murahashi O, Harada T, Kaneko K, Ishiguro Y. An accessory lobe of the liver disturbing closure of the umbilical ring. Pediatr Surg Int. 1999;15:394–396. PubMed

Tsai CC, Yen TC, Tzen KY. Pedunculated giant liver hemangioma mimicking a hypervascular gastric tumor on Tc-99m RBC SPECT. Clin Nucl Med. 1999;24:132–133. PubMed

Vilgrain V, Boulos L, Vullierme MP, Denys A, Terris B, Menu Y. Imaging of atypical hemangiomas of the liver with pathologic correlation. Radiographics. 2000;20:379–397. PubMed

Leone N, Saettone S, De Paolis P, Carucci P, Brunello F, De Angelis C, Menozzi G, Rizzetto M. Ectopic livers and related pathology: report of three cases of benign lesions. Dig Dis Sci. 2005;50:1818–1822. PubMed

Kubota K, Kita J, Rokkaku K, Iwasaki Y, Sawada T, Imura J, Fujimori T. Ectopic hepatocellular carcinoma arising from pancreas: a case report and review of the literature. World J Gastroenterol. 2007;13:4270–4273. PubMed PMC

Yano T, Ishikura H, Wada T, Kishimoto T, Kondo S, Katoh H, Yoshiki T. Hepatoid adenocarcinoma of the pancreas. Histopathology. 1999;35:90–92. PubMed

Paner GP, Thompson KS, Reyes CV. Hepatoid carcinoma of the pancreas. Cancer. 2000;88:1582–1589. PubMed

Liu CL, Fan ST, Lo CM, Tso WK, Poon RT, Lam CM, Wong J. Management of spontaneous rupture of hepatocellular carcinoma: single-center experience. J Clin Oncol. 2001;19:3725–3732. PubMed

Caygill CP, Gatenby PA. Ectopic liver and hepatocarcinogenesis. Eur J Gastroenterol Hepatol. 2004;16:727–729. PubMed

Arakawa M, Kimura Y, Sakata K, Kubo Y, Fukushima T, Okuda K. Propensity of ectopic liver to hepatocarcinogenesis: case reports and a review of the literature. Hepatology. 1999;29:57–61. PubMed

Shigemori M, Kondo M, Azechi H, Inoue F, Tamura J, Kobayashi H, Saiga T. A case of ectopic hepatocellular carcinoma in the jejunum. J Gastroenterol. 2006;41:913–918. PubMed

Cardona D, Grobmyer S, Crawford JM, Liu C. Hepatocellular carcinoma arising from ectopic liver tissue in the pancreas. Virchows Arch. 2007;450:225–229. PubMed

Leone N, De Paolis P, Carrera M, Carucci P, Musso A, David E, Brunello F, Fronda GR, Rizzetto M. Ectopic liver and hepatocarcinogenesis: report of three cases with four years’ follow-up. Eur J Gastroenterol Hepatol. 2004;16:731–735. PubMed

Seo UH, Lee HJ, Ryu WS, Kwak JM, Shin BK, Kim WB, Lee SI, Park SS, Choi JW, Kim SH, et al. Laparoscopic resection of a hepatocellular carcinoma arising from an ectopic liver. Surg Laparosc Endosc Percutan Tech. 2008;18:508–510. PubMed

Takayasu K, Itabashi M, Moriyama N. Case report: ectopic hepatocellular carcinoma arising from the left diaphragm. Clin Radiol. 1994;49:579–581. PubMed

Stattaus J, Kühl H, Forsting M. [Diagnosis of an accessory liver lobe established by magnetic resonance imaging-guided core biopsy] Z Gastroenterol. 2008;46:351–354. PubMed