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Introducción: La cirugía laparoscópica desde su introducción en 1987 ha experimentado un enorme desarrollo. La cirugía hepática laparoscópica de los tumores hepáticos plantea diversas controversias: los cirujanos deben estar formados en cirugía hepática y cirugía laparoscópica, la técnica laparoscópica más adecuada no está bien definida (totalmente laparoscópica o asistida con la mano), el abordaje o disección de grandes vasos entraña riesgos importantes, los métodos de sección parenquimatosa están menos desarrollados que en la cirugía hepática abierta entre otros retos. A pesar de estos criterios existen situaciones en que la cirugía puede llevarse a cabo con seguridad, sobre todo en tumores benignos y malignos cuando las lesiones se localizan principalmente en segmentos anteriores del hígado. Objetivo: Presentar una paciente portadora de una lesión hepática intervenida quirúrgicamente por videolaparoscopía con buenos resultados y evolución excelente. Caso clínico: Paciente femenina de 42 años de edad; antecedentes de salud con presencia de dolor abdominal de tres meses de evolución en región de hipocondrio derecho y trastornos dispépticos esporádicos. Se confirmó imaginológicamente un tumor de 5 cm de diámetro en segmento III, de aspecto hemangiomatoso con componente mixto y sospecha de malignidad. Se realizó resección laparoscópica, el diagnóstico anatomopatológico fue nódulo regenerativo, tipo nódulo cirrótico con hemangioma cavernoso de localización periférica en hígado sano, sin evidencias de malignidad en los estudios realizados. Conclusiones: Las resecciones quirúrgicas de lesiones hepáticas abordables por vía laparoscópica son una opción terapéutica segura y muy válida en pacientes con indicaciones específicas(AU)

Introduction: Laparoscopic surgery, since its introduction in 1987, has undergone enormous development. Laparoscopic hepatic surgery of liver tumors raises several controversies: surgeons must be trained in hepatic surgery and laparoscopic surgery, the most appropriate laparoscopic technique is not well defined (totally laparoscopic or hand-assisted), the approach to or dissection of large vessels involves significant risks, the methods for parenchymal section are less developed than in open hepatic surgery, among other challenges. Despite these criterions, there are situations in which the surgery can be performed safely, above all in benign and malignant tumors when the lesions are located mainly in anterior segments of the liver. Objective: To present the case of a patient with a hepatic lesion and operated on by videolaparoscopy with good outcomes and excellent evolution. Clinical case: A 42-year-old female patient with a family history of disease presented abdominal pain of three months of evolution in the right hypochondrium and sporadic dyspeptic disorders. Imaging confirmed a tumor of 5 cm of diameter in segment III, with hemangiomatous aspect, mixed component and suspicion of malignancy. Laparoscopic resection was performed; the anatomopathological diagnosis was regenerative nodule, similar to a cirrhotic nodule with cavernous hemangioma of peripheral location in healthy liver, with no evidence of malignancy in the performed studies. Conclusions: Surgical resections of hepatic lesions that can be laparoscopically approached are a safe and very valid therapeutic option in patients with specific indications(AU)

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The increasing interest of tumors in wildlife is important for biodiversity conservation and for monitoring environmental agents and/or contaminants with potential impact on human health. Here we described the occurrence of hepatocellular carcinoma (HCC) in noncirrhotic liver of a free-ranging three-toed sloth (Bradypus variegatus) from the Atlantic Forest biome in Brazil. The HCC showed a moderate mononuclear inflammatory infiltrate within the tumor tissue but with no inflammation and fibrosis in the adjacent liver tissue. Upon immunohistochemistry, neoplastic cells were diffusely positive for HepPar-1 and glutamine-synthetase presenting an irregular and random immunostaining pattern; ß-catenin was positive in the cytoplasmic membrane of malignant hepatocytes; and cytokeratin 19 immunostaining was restricted to bile duct epithelial cells. The liver tissue was negative for HBV-like and HCV-like viruses assessed by molecular tests. The potential similarity of pathogenesis may reinforce the need for research on environmental and/or infectious agents associated with HCC that may contribute to the understanding of cancer in wildlife.

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Introducción: La historia de la cirugía del hígado abarca 28 siglos, lo que ha permitido su evolución desde considerar al hígado como un órgano intocable hasta realizar hepatectomías complejas y trasplante hepático. Esta investigación representa el balance de 10 años en la actividad de un grupo de cirugía hepatobiliar. Objetivo: Caracterizar el tratamiento quirúrgico de los tumores hepáticos sólidos en el Centro de Investigaciones Médico-Quirúrgicas entre los años 2009 y 2019. Métodos: Se realizó un estudio de tipo observacional, descriptivo, longitudinal y retrospectivo en el que se analizaron 129 pacientes que fueron tributarios de tratamiento quirúrgico. Resultados: Los tumores malignos representaron el 73 por ciento del total, dentro de este grupo se destacan los metastásicos con 50 casos. La morbilidad de esta cirugía fue del 13 por ciento y la mortalidad operatoria del 2 por ciento. La causa de muerte identificada fue el shock séptico por peritonitis generalizada. Conclusiones: Los tumores malignos fueron los más frecuentes. Se presentó una baja morbilidad encontrándose el derrame pleural como la complicación más usual. Existe una mortalidad acorde a los valores reportados para este tipo de cirugía(AU)

Introduction: The history of liver surgery covers twenty-eight centuries, which has allowed its evolution from considering the liver as an untouchable organ to performing complex hepatectomies and hepatic transplantation. This research describes the ten years' balance in the activity developed by a hepatobiliary surgery team. Objective: To characterize the surgical management of solid hepatic tumors in the Center for Medical-Surgical Research between 2009 and 2019. Methods: An observational, descriptive, longitudinal and retrospective study was carried out, for which 129 patients who underwent surgical treatment were analyzed. Results: Malignant tumors accounted for 73 percent of the total; within this group, metastatic tumors stand out, accounting for fifty cases. Morbidity of this surgery type was 13 percent, while operative mortality was 2 percent. The cause of death identified was septic shock due to generalized peritonitis. Conclusions: Malignant tumors were the most frequent. There was low morbidity, with pleural effusion as the most common complication. Mortality is consistent with the values reported for this type of surgery(AU)

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RESUMEN Los tumores fibrosos solitarios hepáticos, una neoplasia poco frecuente, son tumores benignos del tejido submesotelial, pero con un potencial maligno no definido. Suelen presentarse asintomáticos, pero pueden debutar como una masa abdominal palpable y con síntomas de plenitud. Por imágenes pueden ser confundidos con otros tumores y está indicado el tratamiento quirúrgico. Presentamos el caso de una paciente de 70 años resuelto por hepatectomía lateral izquierda, y realizamos una revisión bibliográfica del tema.

ABSTRACT Solitary fibrous tumors of the liver are uncommon benign tumors originating from the submesothelial tissue with non-well-defined malignant potential. Most cases present as asymptomatic, some cases show abdominal bloating and a palpable mass. They may mimic other tumors on imaging tests and surgery is indicated. We report a case of a 70-year-old female patient treated with left lateral liver resection with literature review of the condition.

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Cholangiocarcinomas are neoplasms originating from the biliary epithelium. This report describes the gross, microscopic, and immunohistochemical findings in a case of cholangiocarcinoma in an Australian goose (Cereopsisnovaehollandiae). The animal had cachexia and ascites. The liver and gallbladder had cystic masses that was diagnosed as acholangiocarcinoma.

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Cholangiocarcinomas are neoplasms originating from the biliary epithelium. This report describes the gross, microscopic, and immunohistochemical findings in a case of cholangiocarcinoma in an Australian goose (Cereopsisnovaehollandiae). The animal had cachexia and ascites. The liver and gallbladder had cystic masses that was diagnosed as acholangiocarcinoma.(AU)

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Two cases of hepatocellular carcinoma (HCC) in 2 female captive golden-headed lion tamarins (Leontopithecus chrysomelas) are described. HCC was diagnosed in both, with pulmonary metastasis in one of them. Neoplastic cells were positive for hepatocyte-specific antigen (HSA) by immunohistochemistry, confirming the diagnosis.

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AIM: To study the antineoplastic efficacy of 10% aspirin intralesional injection on VX2 hepatic tumors in a rabbit model. METHODS: Thirty-two male rabbits (age: 6-9 wk; body weight: 1700-2500 g) were inoculated with VX2 hepatic tumor cells (10(4) cells/rabbit) via supra-umbilical median laparotomy. On day 4 post-implantation, when the tumors were about 1 cm in diameter, the rabbits were randomly divided into the following groups (n = 8 each group) to assess early (24 h) and late (7 d) antineoplastic effects of intratumoral injection of 10% bicarbonate aspirin solution (experimental groups) in comparison to intratumoral injection of physiological saline solution (control groups): group 1, 24 h control; group 2, 24 h experimental; group 3, 7 d control; group 4, 7 d experimental. The serum biochemistry profile (measurements of glycemia, alkaline phosphatase, gamma-glutamyl transferase, aspartate aminotransferase, and alanine aminotransferase) and body weight measurements were obtained for all animals at the following time points: D0, before tumor implant; D4, day of treatment; D5, day of sacrifice for groups 1 and 2; D11, day of sacrifice for groups 3 and 4. Gross assessments of the abdominal and thoracic cavities were carried out upon sacrifice. The resected liver tissues, including hepatic tumors, were qualitatively (general morphology, signs of necrosis) and quantitatively (tumor area) assessed by histopathological analysis. RESULTS: Gross examination showed no alterations, besides the left hepatic lobe tumors, had occurred in the thoracic and abdominal cavities of any animal at any time point evaluated. However, the features of the tumor foci were distinctive between the groups. Compared to the control groups, which showed normal unabated tumor progression, the aspirin-treated groups showed imprecise but limited tumor boundaries and a general red-white coloration (indicating hemorrhaging) at 24 h post-treatment, and development of yellow-white areas of a cicatricial aspect at 7 d after treatment. At all time points evaluated, all except one biochemical parameters tested within the reference range (P > 0.05); a significant increase was detected in the alkaline phosphatase level of the control group 3 on D11 (P < 0.05). At 24 h post-treatment, the aspirin-treated groups showed extensive coagulation necrosis accompanied by a remarkable absence of viable tumor foci; at 7 d after treatment, the tumors had completely disappeared in these animals and fibrous necrotic nodules had developed. In contrast, throughout the study course, the tumors of the control groups remained unchanged, showing tumor nodules without necrosis at the time point corresponding to 24 h post-treatment and increased amounts of tumor nodules at the time point corresponding to 7 d post-treatment. Quantitative analysis of the remaining tumor area revealed that the aspirin-treated groups had significantly smaller tumor foci at 24 h post-treatment (8.5% ± 0.7%) and at 7 d after treatment (11.0% ± 4.2%), compared to those in the control groups (24 h: 98.5% ± 1.5% and 7 d: 94.0% ± 2.7%; both, P < 0.005). CONCLUSION: Intralesional injection of a 10% aspirin solution causes destruction of VX2 hepatic tumors in rabbits without evidence of relapse at 7 d after treatment administration.

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Los sarcomas primarios de localización hepática constituyen fundamentalmente en el adulto un grupo de tumores excepcionales, cifrándose su incidencia según las series consultadas entre un 0.1-1%, de todos los tumores hepáticos malignos del adulto La edad media de presentación se podría situar entre la cuarta y quinta décadas, con edades extremas referidas en la bibliografía de 22 y 77 años. El síntoma más frecuente de los sarcomas hepáticos, independientemente del tipo histológico, es el dolor de pequeña a mediana intensidad en hemiabdomen superior, que se suele acompañar de otros síntomas inespecíficos, como pérdida ponderal, febrícula vespertina y astenia. Caso Clínico: Paciente masculino de 20 años, inicia EA en el mes de febrero de 2005, cuando presenta debilidad general y pérdida de peso progresiva cuantificada en 8 kg Desde inicio de marzo de 2005 evidencia palidez cutánea, hipertermia precedida de escalofríos, de predominio vespertino, dolor en epigastrio, opresivo, no irradiado, motivo por el cual consulta a facultativo en su localidad, donde es hospitalizado con la IDx. de Absceso Hepático. Permanece 30 días, recibiendo tto. Con antibióticos sin mejoría, ameritando transfundir por presentar Hb de 6 gr/dl, sin sitio evidente de sangrado Ecosonograma abdominal.: Hepatoesplenomegalia y LOE lóbulo hepático izquierdo Gastroscopia y colonoscopia Normal. Resonancia magnetica abdominal: Evidencia de hepatomegalia asociado a la presencia de lesión de apariencia tumoral en el lóbulo hepático izquierdo, con realce heterogéneo. La evolución no fue la de un absceso hepático y la imagen ecosonográfica es de comportamiento sólido, por lo que se solicita a cirugía laparoscopia diagnostica. Se descarta la posibilidad de toma percútanea guiada por eco en vista de alta posibilidad de sangrado. Se practica Hepatectomía Izquierda, Biopsia: Reporta Leiomiosarcoma Hepático. Luego de la cirugía el paciente evoluciona satisfactoriamente. Conclusión: a pesar de su infrecuencia, los sarcomas hepáticos deben tomarse en cuenta en el diagnóstico diferencial de tumores hepáticos sólidos en el adulto, en ausencia de cirrosis. El único tratamiento que permite expectativas de supervivencia es el quirúrgico, mediante hepatectomías regladas o "atípicas" con márgenes de seguridad e incluso en algunos casos trasplante hepático.

Primary sarcomas of hepatic location fundamentally constitute a group of exceptional tumors in the adult, amounting its incidence according to the series consulted between a 0,1-1%, of all the malignant hepatic tumors of the adult the average age of presentation could be located between the fourth and fifth decade, with referred extreme ages in the bibliography of 22 and 77 years. The most frequent symptom of hepatic sarcomas, independently of the histological type, is pain of small to medium intensity in superior hemiabdomen, that itÊs usually accompanied by other unspecific symptoms, like ponderal loss, vespertine febrícula and asthenia. Clinical Case: Male patient 20 years old, begins symptoms in february of 2005, presenting general weakness and progressive loss of weight quantified at 8 kg From the beginning of March of 2005 demonstrates cutaneous paleness, hyperthermia preceded of chills, of vespertine predominance, , opressive, not radiated, pain in the epigastric region, reason why he consults a facultative in his locality, where he is hospitalized with the diagnosis of hepatic abscess. He remains 30 days, receiving antibiotic treatment without improvement, needing a transfusion because of Hb levels of 6 gr.dl, without evident signs of bleeding. Abdominal Ultrasound: Hepatoesplenomegalia and SOL in left hepátic lobe Normal gastroscopy and colonoscopy. Abdominal magnetic resonance: Evidence of hepatomegalia associated to the presence of lesion of tumorlike appearance in the left hepatic lobe, with heterogenous enhancement. The evolution was not the one of an hepatic abscess and the ultrasound image is of solid behavior, reason why laparoscopic diagnostic surgery is suggested. The possibility of a guided ultrasound percutaneous sample is ruled out because of the high probability of bleeding .A left hepatectomy is done Biopsy: reports hepatic leiomiosarcoma. After surgery the patient evolves satisfactorily. Conclusion: In spite of its uncommoness, hepatic sarcomas must be taken into account in the differential diagnosis from solid hepatic tumors in the adult, in absence of cirrhosis. The only treatment that allows survival expectations is the surgical one, by means of regulated or atypical hepatectomy with safety margins and in some cases even hepatic transplants.