BACKGROUND: Immunosuppression after kidney transplantation is associated with increased risk of malignancy, which has become the second most common cause of death among kidney transplant recipients. In this review, we report the incidence of malignancies after kidney transplantation in a single center and evaluate the incidence, characteristics, relationship to immunosuppressive drugs and discuss what clinicians must consider during a follow-up of patients after kidney transplantation. METHODS: Between May 1978 and September 2013, a total of 748 kidney transplant patients who were able to undergo a follow-up process through electronic medical records were enrolled in this retrospective cohort study to determine the potential incidence and types of malignancy that may occur after kidney transplantation and the associated impact on patients and graft survival. RESULTS: Among 748 patients, 63 cases of malignancy appeared in 54 patients (7.2%). Gastrointestinal cancer (12 cases, 19%) and post-transplant lymphoproliferative disorder (12 cases, 19%) were the two most common types of malignancy. The second most common type of malignancy was urinary tract malignancy in 10 patients. Two different types of malignancy were diagnosed in nine patients during our follow-up. The overall graft survival in malignancy patients was better, which may mean that malignancy did not affect the overall graft loss. CONCLUSIONS: Clinicians should be aware of the incidence of malignancy in transplant patients and perform routine examinations for early detection of malignancy.
Cause of Death ; Cohort Studies ; Electronic Health Records ; Follow-Up Studies ; Gastrointestinal Neoplasms ; Graft Survival ; Humans ; Immunosuppression ; Incidence* ; Kidney ; Kidney Transplantation* ; Lymphoproliferative Disorders ; Retrospective Studies ; Transplantation ; Transplants ; Urinary Tract

PURPOSE: Primary mammalian hepatocytes largely retain their liver-specific functions when they are freshly derived from donors. However, long-term cultures of functional hepatocytes are difficult to establish. To increase the longevity and maintain the differentiated functions of hepatocytes in primary culture, cells can be cultured in a sandwich configuration of collagen. In such a configuration, hepatocytes can be cultured for longer periods compared with cultures on single layers of collagen. However, research regarding mouse hepatocytes in sandwich culture is lacking. METHODS: Primary mouse hepatocytes were sandwiched between two layers of collagen to maintain the stability of their liver-specific functions. After gelation, 2 mL of hepatocyte culture medium was applied. RESULTS: After 24 hours, 5, 10 days of culture, the collagen gel sandwich maintained the cellular border and numbers of bile canaliculi more efficiently than a single collagen coating in both high and low density culture dishes. Reverse transcription-polymerase chain reaction analysis of alpha-1-antitrypsin (AAT), hepatocyte nuclear factor 4 alpha (HNF4A), alphafetoprotein, albumin, tryptophan oxygenase (TO), the tyrosine aminotransferase gene, glucose-6-phosphatase, glyceraldehyde-3-phosphate dehydrogenase for mouse primary hepatocytes cultured on collagen coated dishes and collagen gels showed superior hepatocyte-related gene expression in cells grown using the collagen gel sandwich culture system. AAT, HNF4A, albumin, TO were found to be expressed in mouse hepatocytes cultured on collagen gels for 5 and 10 days. In contrast, mouse hepatocytes grown on collagen-coated dishes did not express these genes after 5 and 10 days of culture. CONCLUSION: The collagen gel sandwich method is suitable for primary culture system of adult mouse hepatocytes.
Adult ; Animals ; Bile Canaliculi ; Collagen ; Gels ; Gene Expression ; Glucose-6-Phosphatase ; Hepatocyte Nuclear Factor 4 ; Hepatocytes ; Humans ; Longevity ; Mice ; Oxidoreductases ; Tissue Donors ; Tryptophan Oxygenase ; Tyrosine Transaminase

Despite improved perioperative management and surgical techniques, patients undergoing hepatobiliary and pancreatic (HBP) surgery often need to be transfused. Although disadvantages of transfusion and advantages of patient blood management (PBM) have been recognized, study results of the effects of PBM in HBP surgery are rare. The aim of this article was to review the current status of PBM in Korea in patients having HBP surgery. PBM in HBP surgery consists of increasing preoperative hemoglobin level, preoperative blood conservation, and preoperative autologous blood donation. The main intraoperative modalities used to conserve blood in recent studies were autologous techniques of acute normovolemic hemodilution and intraoperative cell salvage (Cell Saver®). In postoperative PBM, blood augmentation with erythropoietin and iron are also used depending on the postoperative hemoglobin level. Advances in surgical, anesthesiologic and pharmacologic strategies have contributed to a reduction of blood loss during HBP surgery in all patients.
Blood Donors ; Erythropoietin ; Hemodilution ; Humans ; Iron ; Korea

A primary hepatic sarcoma is a rare tumor, that most frequently arises from hepatic connective tissue or vascular channels, and is usually located in the intrahepatic area. Pedunculated, or bulging, lesions have also been reported. We encountered a pedunculated primary hepatic leiomyosarcoma occurring in a 61-year-old woman. A giant exophytic hepatic mass measuring 15x10cm in size, was located in the left lateral segment of the liver, which was compressing the stomach. A left lateral segmentectomy was performed. Microscopically, the tumor was composed of spindle cells reactive to muscle specific actin. The mitotic figures were 5/10 high power fields indicating the tumor was malignant. No other primary sites were recognized from clinical studies.
Actins ; Connective Tissue ; Female ; Humans ; Leiomyosarcoma* ; Liver ; Mastectomy, Segmental ; Middle Aged ; Sarcoma ; Stomach

PURPOSE: This study was conducted to investigate the safety of laparoscopic cholecystectomy (LC) performed by surgical residents. METHODS: We reviewed the records of patients who underwent LC for chronic cholecystitis and gallbladder polyps between February 2010 and July 2012. All diagnoses were confirmed by biopsy. All procedures performed by surgical residents were conducted under the close supervision of an experienced laparoscopic surgeon. A standard four-port method was used, and we achieved the critical view of safety in almost all patients. RESULTS: Of 219 LC procedures, 136 were performed by an experienced laparoscopic surgeon, and 83 by surgical residents. There was no significant difference in postoperative hospital stay (1.1 vs. 1.2 days, p=0.337) or complication rates (3.7% vs. 2.4%, p=0.712) between groups. However, the patients operated on by surgical residents had significantly longer operation times (40.7 vs. 63.7 min, p<0.05). CONCLUSION: LC performed by inexperienced surgical residents under the supervision of an experienced surgeon is safe and feasible for chronic cholecystitis and gallbladder polyps. Major bile duct injury is strongly correlated with having performed fewer than 20 LC procedures, so surgical residents must secure the critical view of safety, and the supervising surgeon must confirm it before the cystic duct and cystic artery are ligated.
Arteries ; Bile Ducts ; Biopsy ; Cholecystectomy, Laparoscopic* ; Cholecystitis ; Cystic Duct ; Diagnosis ; Gallbladder ; Humans ; Learning Curve* ; Learning* ; Length of Stay ; Methods ; Organization and Administration ; Polyps

Mucoepidermoid carcinoma of the liver is a rare variant of cholangiocarcinoma which contains both mucus-secreting glandular cells and squamous cells mixed in nests. We diagnosed a case of mucoepidermoid carcinoma of the liver in a 69-year-old woman who visited hospital because of fever, chill, right flank pain for one week. On admission, she was not jaundiced. Under a provisional diagnosis of liver abscess, a pigtail catheter was inserted to the abscess cavity. One month after the admission, despite conservative treatment, the abscess cavity remained. For a curative treatment and possible hiden malignancy, right hepatectomy of the liver and excision of partial diaphragm were done. Microscopically, the tumor mass composed of solid and invasive nests of epidermoid and mucin-producing cells with desmoplastic stroma. Alcian blue, Periodic-Acid Schiff (PAS) stainings confirmed the presence of mucin in the cytoplasm of mucus-secreting cells. Electron micrographs showed the presence of tonofilaments and confirmed the squamous nature of the tumor cells. The tumor cells, intrahepatic bile ducts and ductules were consistently reactive with cytokeratin 7. Adjacent nonneoplastic liver cells were negative to cytokeratin 7. In the present case, the tumor was diagnosed as mucoepidermoid carcinoma, which was arisen from the intrahepatic bile duct.
Abscess ; Aged ; Alcian Blue ; Bile Ducts, Intrahepatic ; Carcinoma, Mucoepidermoid* ; Catheters ; Cholangiocarcinoma ; Cytoplasm ; Diagnosis ; Diaphragm ; Female ; Fever ; Flank Pain ; Hepatectomy ; Humans ; Intermediate Filaments ; Keratin-7 ; Liver Abscess* ; Liver* ; Mucins

BACKGROUND/AIMS: The diagnosis and treatment of benign hepatic lesions remain controversal. The widespread availability of ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI), and their frequent application in evaluating abdominal pain, has resulted in more frequent discovery of incidental benign hepatic lesions. To address these points, the clinical data of patients with benign hepatic lesions treated with surgical resections at our hospital were reviewed retrospectively. METHODS: We reviewed the clinical records of thirty nine patients with benign hepatic lesions who had undergone hepatic resection from January, 1985 to August, 2002 at Hanyang University Hospital. RESULTS: There were 39 patients, whose mean age was 47.0 years. The ages ranged from 24~74 years. There were 14 male patients and 25 female patients. The ratio of male and female was 1:1.8. Major symptoms were right upper quadrant pain, mass, epigastric pain, and non-specific GI symptoms. 22 cases of anatomical resections (10 right lobectomy, 5 left lobectomy, 7 left lateral segmentectomy) and 17 non anatomical resections were done. There were no postoperative deaths in this series. Fourteen patients (35.9%) developed operative complications. All of them were minor complications. During the mean follow up time, symptomatic relief was achieved in patients out of patients who we could contact with opd follow up or telephone interview. Three patients died of massive pleural effusion 4 years after operation, myocardial infarction 14 months after operation, alcoholic liver cirrhosis and diabetes mellitus 33 months after operation. CONCLUSION: Hepatic resection in patients who had benign hepatic lesions in the liver was safe and effective treatment modality if patients were selected with suitable indications.
Abdominal Pain ; Diabetes Mellitus ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Interviews as Topic ; Liver ; Liver Cirrhosis, Alcoholic ; Magnetic Resonance Imaging ; Male ; Myocardial Infarction ; Pleural Effusion ; Retrospective Studies ; Ultrasonography

PURPOSE: Multiple primary cancers are not a rare disease. The clinicopathologic characteristics of a hepatocellular carcinoma with extrahepatic malignancies, have not been identified. To address these points, the clinical data of patients with a hepatocellular carcinoma, with extrahepatic malignancies, treated with surgical resections at our hospital, were retrospectively reviewed. METHODS: We reviewed the clinical records of ten hepatocellular carcinoma patients, with extrahepatic malignancies, who had undergone an operation between January, 1986 and December, 2002 at the Hanyang University Hospital. RESULTS: 10 patients were comprised of 9 males and 1 female, with a mean age of 58.6 years, ranging from 34 to 75. There were 9 stomach cancers and 1 rectal cancer extrahepatic malignancies associated with the hepatocellular carcinomas. Four of these were synchronous type and six were metachronous type. The treatments used for the HCCs were: 1 extended right lobectomy, 6 right lobectomies, 1 each of a TAE with RFTA, a segmentectomy with RFTA, and a segmentectomy. The operations for the extrahepatic malignancies included 1 low anterior resection, for the rectal cancer and 9 subtotal gastrectomies, for the stomach cancers. During the mean follow up time of 66.1 months, five patients survived and five died. CONCLUSION: Patients who have a hepatocellular carcinoma, associated with extrahepatic malignancies, have been treated with aggressive operations and combination therapies. Stomach cancer is the most common extrahepatic malignancy associated with a hepatocellular carcinoma.
Carcinoma, Hepatocellular* ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Male ; Mastectomy, Segmental ; Rare Diseases ; Rectal Neoplasms ; Retrospective Studies ; Stomach Neoplasms

Angiomyolipoma is a benign renal tumor composed of thick- walled blood vessels, smooth muscle cells, and adipose tissue. Despite the aggressive biological and histological features associated with angiomyolipoma, the lack of distant metastasis led us to conclude that angiomyolipoma is a benign neoplasm. Epithelioid angiomyolipoma is a recently described variant type of angiomyolipoma of the kidney. Diagnosis is usually made by histological method and immunohistochemical staining with HMB-45. Several reports suggested the presence of malignant epithelioid angiomyolipomas showing multiple metastases and local aggressiveness. We report a case of epithelioid angiomyolipoma with multiple metastases. Local recurrence and liver, bone and lung metastases developed 11 months after radical nephrectomy. Right hepatectomy and wedge resection of left lobe of the liver with radiation therapy were done.
Adipose Tissue ; Angiomyolipoma* ; Blood Vessels ; Diagnosis ; Hepatectomy ; Kidney ; Liver ; Lung ; Myocytes, Smooth Muscle ; Neoplasm Metastasis* ; Nephrectomy ; Recurrence

Adult polycystic liver disease (APLD) is an inherited, benign rare condition, often associated with polycystic kidney disease. Liver failure is unusual, but some patients may require therapy. Surgery appears to be more effective in relieving the symptoms of APLD for an extended period than nonsurgical therapies. We report on the successful surgical treatment of a case of APLD located in the left lobe of the liver.
Adult* ; Humans ; Liver Diseases* ; Liver Failure ; Liver* ; Polycystic Kidney Diseases