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Accessory scrotum (AS) is rarely diagnosed antenatally, and its prenatal features remain unknown. Here, we report a case of a prenatally diagnosed accessory scrotum with perineal lipoma. A 33-year-old woman was referred to our hospital at 35 weeks of gestation to evaluate a mass in the fetal perineal region. Prenatal ultrasonography showed a 2.0 × 2.0 cm sized, echogenic, and circular mass located posterior to the left scrotum in a male fetus. Magnetic resonance imaging (MRI) showed a mass containing adipose tissue. A 6.5 cm elastic mass (AS and protruding lipoma) was observed in the perineal region, and surgical excision was performed at 8 months of age. Histological examination confirmed the diagnosis of AS with perineal lipoma, and there was no recurrence at follow-up. The typical prenatal presentation of AS was a circular perineal mass located posterior to the normal scrotum and was associated with perineal lipoma. The prenatal detection of AS was feasible with careful observation via ultrasonography, and prenatal MRI was useful in characterizing perineal tumors and evaluating associated anomalies.

Gestational choriocarcinoma is a malignant trophoblastic tumor arising from any gestational event, even with a long latency period, generally in the reproductive female. It is associated with a high level of beta-human chorionic gonadotropin. Its primary site is usually the uterus but not all patients have a detectable lesion in this site. Regression of the primary tumor after it has metastasized is not uncommon, and one-third of cases manifest as complications of metastatic disease. In this report we present an uncommon case of gestational choriocarcinoma with lung, liver and jejunal metastases at the time of diagnosis without evidence of pelvic disease, in 34-year-old woman. The main points of interest of our case were the development of the ovarian hyperstimulation syndrome with massive multicystic ovarian enlargement induced by high level of beta-human chorionic gonadotropin and the bleeding of jejunal and liver metastases, due to the high vascularity of the tumor tissue, a condition known as “Choriocarcinoma Syndrome”. We will focus on the radiological findings of metastases, bleeding complications and ovarian hyperstimulation syndrome.

Artificial intelligence (AI) is a general term that refers to the use of a machine to imitate intelligent behavior for performing complex tasks with minimal human intervention, such as machine learning; this technology is revolutionizing and reshaping medicine. AI has considerable potential to perfect health-care systems in areas such as diagnostics, risk analysis, health information administration, lifestyle supervision, and virtual health assistance. In terms of immunotherapy, AI has been applied to the prediction of immunotherapy responses based on immune signatures, medical imaging and histological analysis. These features could also be highly useful in the management of cancer immunotherapy given their ever-increasing performance in improving diagnostic accuracy, optimizing treatment planning, predicting outcomes of care and reducing human resource costs. In this review, we present the details of AI and the current progression and state of the art in employing AI for cancer immunotherapy. Furthermore, we discuss the challenges, opportunities and corresponding strategies in applying the technology for widespread clinical deployment. Finally, we summarize the impact of AI on cancer immunotherapy and provide our perspectives about underlying applications of AI in the future., Graphical abstract With the increasing of clinical data and advanced AI methodologies, AI-based technologies have the potential to increase the functional roles in cancer immunotherapy response.Image 1

Chiari 1 Malformation in children is defined as 6 mm or more caudal extension of cerebellar tonsils below the foramen magnum. It is one of the deformities in the spectrum of craniovertebral junction anomalies. We report an unusual case of newborn girl with hypoplasia of bassiocciput of the clivus and extension of brainstem into the oropharynx, in addition to extension of cerebellar tonsils below the foramen magnum. Right anterior arch and right posterior arch of C1 vertebra are absent. Dens of C2 vertebra is asymmetric. Laryngoscope showed a membrane covering the brainstem in the oropharynx. Endotracheal and orogastric tubes were placed. A ventriculo-peritoneal shunt was placed for hydrocephalus. The patient was discharged home at 4.5 months of age with home Hospice care. To the best of our knowledge, this has not been described in the literature. The case illustrates a rare defect in the clivus and unusual protrusion of brainstem into oropharynx.

Highlights • Gallbladder involvement by lymphoma is extremely rare, and only 68 cases have been reported in the English literature so far. • We experienced a case of diffuse large B-cell lymphoma (DLBCL) of the gallbladder arising 8 years after DLBCL of the right testis. • We compiled and analysed reported cases in terms of background, symptoms, imaging findings, and prognosis. • DLBCL was significantly more involved in other organs simultaneously or heterochronously in contrast of MALT lymphoma (p = 0.004). • Gallbladder lymphoma should be added to the differential diagnosis of gallbladder tumours., Introduction Gallbladder involvement in lymphoma is extremely rare, and only 68 cases have been reported in the English literature so far. We experienced a case of diffuse large B-cell lymphoma (DLBCL) of the gallbladder arising 8 years after DLBCL of the right testis. Presentation of case A 68-year-old man underwent orchiectomy for malignant lymphoma of the right testis pathologically diagnosed as DLBCL 8 years ago. Systemic surveillance incidentally revealed a gallbladder tumour, and elective resection of the gallbladder bed of the liver was performed under a preoperative diagnosis of gallbladder cancer. The histopathological examination revealed DLBCL. At re-evaluation 3 months after surgery, he was diagnosed as having DLBCL involving the stomach. There had been no recurrence for 39 months after chemotherapy and radiation, but he suffered from a poor general condition due to protein-losing enteropathy and died of infection. Discussion We compiled and analysed reported cases of malignant lymphomas involving the gallbladder in terms of background, symptoms, imaging findings, and prognosis. Compared to MALT lymphoma, DLBCL was significantly more involved in other organs simultaneously or heterochronously (p = 0.004). Conclusion Gallbladder lymphoma should be added to the differential diagnosis of gallbladder tumours, especially when clinical findings are not consistent with the typical course of gallbladder carcinoma and cholecystitis.

Highlights • Hepatic venous outflow obstruction (HVOO) is a rare complication of hepatectomy. • HVOO might occur irrespective of whether the left triangular ligament is divided. • The treatment for HVOO is repositioning and/or stenting into the hepatic vein., Introduction Hepatic venous outflow obstruction (HVOO) is a rare complication of hepatectomy. We report a case of HVOO caused by remnant liver migration into the subphrenic space after hepatectomy, which was successfully managed by repositioning of the remnant liver. Presentation of case A 55-year-old Japanese man was diagnosed with a liver tumor on ultrasound. Contrast-enhanced CT revealed early enhancement in the arterial phase, followed by a washout in the late phase. Preoperative diagnosis was hepatocellular carcinoma, and hand-assisted laparoscopic extended posterior sectionectomy was performed. On postoperative day 1, middle hepatic vein (MHV) flow was not detected on ultrasound, and the portal flow was hepatofugal. CT during arterial portography revealed absence of the portal flow to the medial and anterior sections, and remnant liver migration into the subphrenic space. Therefore, we suspected that HVOO was caused by the remnant liver migration and performed redo laparotomy to reposition the remnant liver with suturing of the falciform ligament to the anterior abdominal wall. Postoperatively, contrast-enhanced CT demonstrated that the remnant liver remained in the anatomical position, and the medial and anterior sections were well enhanced. Discussion HVOO might occur irrespective of whether the left triangular ligament is preserved. We believe that it is necessary to fix the remnant liver to the abdominal wall in cases with poor venous blood flow confirmed by intraoperative ultrasound. If kinking of the hepatic vein persists, stent insertion should be performed. Conclusion HVOO after hepatectomy is rare but potentially fatal, and prevention and countermeasures should be discussed.

Introduction Adenoma and intra-adenoma carcinoma of the gallbladder are relatively rare diseases, and the World Health Organization classification reports a frequency of 0.3% for gallbladder adenomas. Precise preoperative diagnosis of gallbladder cancer, especially in the early stages, is challenging. Herein, we report a case of pyloric adenomatous carcinoma of the gallbladder, diagnosed by laparoscopic cholecystectomy and pathology, along with a literature review. This case was reported in accordance with the SCARE 2020 Guideline (Ref). Presentation of case A 62-year-old woman was diagnosed with a 4-mm polypoid lesion in the gallbladder during a medical examination. The patient was followed-up by ultrasonography (US) once a year and was referred to our department because of an increase in size. Carcinoembryonic antigen and carbohydrate antigen 19-9 levels were within normal limits. Abdominal ultrasonography revealed a pedunculated polypoid lesion in the body of the gallbladder measuring 8 mm. Computed tomography demonstrated that the whole tumor was enhanced in the early phase without significant lymph node enlargement. Magnetic resonance cholangiopancreatography demonstrated a type Ip polypoid lesion located in the body of the gallbladder without pancreaticobiliary junctional abnormalities. Endoscopic ultrasound detected a superficial nodular-type Ip polypoid lesion in the gallbladder body with a parenchyma-like internal echogenic pattern. Discussion Based on these findings, the patient was diagnosed with gallbladder adenoma, and laparoscopic cholecystectomy was performed. Histopathological examination revealed the tumor was a papillary growth of atypical high columnar epithelial cells. The final diagnosis was pyloric adenoma with high-grade dysplasia and intra-adenoma carcinoma. The patient is currently undergoing outpatient follow-up without recurrence for 1 year. Conclusion Early gallbladder carcinoma with adenoma should be considered in patients with small gallbladder polypoid lesions. Considering the surgical stress of cholecystectomy and the malignant potential of gallbladder cancer, preceding surgery would be acceptable., Highlights • Incidental gallbladder cancer is rare and preoperative assessment of GBPL is important. • Considering the malignant potential of GBC, preceding surgery would be acceptable.

Highlights • Mesenteric cysts are rare but may cause symptoms or complications. • If so, surgical excision is considered the cornerstone of therapy. • Laparoscopic excision is feasible. • The types of mesenteric cyst are discussed though their aetiology is uncertain., Introduction The diagnosis and treatment of mesenteric cysts (MC) is a challenge due to rarity, lack of specific symptoms and variability in location and size. Mesenteric cysts are rare surgical entities that occur approximately in 1: 200,000–1: 350,000 hospitalizations. Presentation of case A 47-year-old female patient presented in August 2018 with occasional abdominal pains and an abdominal swelling palpable in the lower right quadrant. A CT scan with contrast enhancement confirmed a 11 cm mass with liquid content in the right iliac fossa, clearly separate from other intra-abdominal structures. The mass was completely excised laparoscopically. The patient was discharged on the third postoperative day. She was symptom-free at 30-day follow-up. Histology demonstrated a solitary non-pancreatic cyst of the mesentery with negative cytology for neoplastic cells. Discussion The origin of mesenteric cysts (MC) is uncertain. Imaging (by ultrasonography, CT, and MRI) can be diagnostic. Therapy for these cysts should be performed if they are symptomatic or cause complications. The treatment of choice is complete surgical excision. The advent of laparoscopy has allowed the excision of these cysts without laparotomy in the expert hands of surgeons with good experience in advanced laparoscopy. Laparoscopy is not a standard for the presence in the literature of only case reports. Conclusion MC are commonly asymptomatic and discovered incidentally. If symptomatic, surgical excision is considered the cornerstone intervention and laparoscopic resection is feasible, causing less pain, a shorter postoperative stay, and quicker recovery of the patient than open operation. Further studies with a higher level of evidence are needed.

Objective: To study the prevalence, etiology, and outcome of acute pancreatitis (AP) in kidney transplant and stage 5 chronic kidney disease (CKD) populations in comparison to a non-CKD cohort. Patients and Methods: Using the Nationwide Inpatient Sample database, we identified patients with acute pancreatitis as the primary discharge diagnosis, after which propensity scores were used to create 2 cohorts of patients: 1 with CKD (n=13,425) and 1 without CKD (n=13,425). The CKD group was subsequently subdivided into dialysis-independent stage 5 CKD (n=690), dialysis-dependent stage 5 CKD (n=11,415), and kidney transplant recipients (n=1320). Patients younger than 18 years old, those who received a kidney transplant during the incident admission, and pancreas transplant recipients were excluded. Results: The adjusted odds ratios (ORs) of AP were comparable between the no CKD, stage 5 CKD, and kidney transplant populations. Adjusted inpatient mortality was highest in patients with dialysis-dependent stage 5 CKD (OR, 2.72; 95% CI, 2.2-3.3; P

Objective: The aim of this study was to determine the inter- and intra-observer reliabilities of magnetic resonance imaging (MRI) for the diagnosis of lateral epicondylitis, to examine whether degree of common extensor tendon (CET) injury is related to other elbow abnormalities on MRI, and to investigate the correlation between elbow abnormalities on MRI and patients' symptoms. Methods: Fifty-one patients (32 women and 19 men; mean age: 50 years (range, 22–63)) with a diagnosis of lateral epicondylitis were included in the study. The average duration of symptoms was 2.3 years. MRI scoring system was used to grade the CET injuries and associated injuries in the elbow joint. Three independent radiologists retrospectively reviewed MRI images. Inter- and intra-observer reliabilities for diagnosing lateral epicondylitis were calculated using kappa statistics, and Spearman's rank correlation analysis was used to analyze relationships between degree of CET injury and the associated abnormalities of elbow joints. Statistical relations were considered significant for p values of

Highlights • Desmoid tumours are rare benign neoplasms with local invasion and recurrence. • A margin-free excision may be challenging for the surgeon. • If necessary, abdominal wall reconstruction can be required for rectus abdominis muscle tumours. • A multidisciplinary approach is necessary approaching this rare disease., Introduction Desmoid tumours are rare benign neoplasms with strong tendency to local invasion and recurrence. They usually rise from muscles and aponeurosis and could be challenging for medical treatment. We here report the case of a patient requiring the excision of part of the abdominal rectus muscle and an abdominal wall reconstruction. Presentation of case A 38 years old women referred to our institution complaining of a painful lump in the anterior abdominal wall. She underwent ultrasonography (US), magnetic resonance imaging (MRI) and a computed tomography (CT) biopsy who showed the presence of a desmoid tumour arising in the right abdominal rectus muscle. She underwent surgical excision of the mass and an abdominal wall reconstruction according to the posterior component separation technique, with a large polypropylene mesh reinforcement. The post-operative period was uneventful and at 6 months she shows no clinical nor radiological recurrence. Discussion Desmoid tumours are rare neoplasms rising in many anatomical spaces and requiring challenging decisions. A radical resection with free margins remains the principal determinant of outcome. Non-surgical approaches and adjuvant therapy may be useful for patients with unresectable lesions. Conclusion The optimal treatment strategy for desmoid tumours still remains unclear. A multidisciplinary approach is always the best strategy to establish the correct treatment.

Introduction Pleomorphic adenoma (PA) rarely originates in the mammary gland. This tumor is a benign mixed tumor and is commonly found in the salivary glands, but rarely shows findings similar to those of breast cancer. The tumor is misdiagnosed in 30–50% of the patients, including overdiagnosis of malignancy preoperatively, leading to unnecessary surgery for breast cancer. Case presentation The present patient was a 45-year-old woman who exhibited no subjective symptoms. She visited the Takahashi Breast and Gastroenterology Clinic for breast cancer screening. A mass measuring 1.5 cm was palpated in the E region of the left breast. Mammography (MMG) showed a tumor shadow in the left S region. There was a high-density area inside the tumor, suggesting bone or cartilage formation, and a diagnosis of category 3 on MMG was made. Ultrasonography (US) revealed a poorly demarcated tumor measuring 14.3 × 14.8 × 10.7 mm with relatively smooth margins and inhomogeneous high-echo content. Core needle biopsy (CNB) was performed, which led to the diagnosis of PA. The tumor showed proliferation of small cells forming glandular duct-like structures or anastomosed funicular structures. Moreover, the cells in the basilar portion were spindle shaped and transitioned to the stroma. Cartilaginous metaplasia, calcification, and ossification were observed in some areas. Intraductal papilloma was also observed in some areas. Conclusion PA may be diagnosed based on the histological findings of CNB. Thus, unnecessary surgery for breast cancer may be avoided., Highlights • Pleomorphic adenoma of the breast is extremely rare and a benign tumor that frequently occurs around the subareolar area. • Pleomorphic adenoma of the breast is often misdiagnosed as breast cancer and surgically treated as a malignant tumor. • Insufficient excision results in not only local recurrence, but also malignant conversion. • Pleomorphic adenoma of the breast may be dignosed on the histological findings of core needle biopsy. • Thus, unnecessary surgery for breast cancer may be avoided.

Objective: To evaluate the efficacy of silodosin therapy, as a new α-adrenergic receptor (α-AR) blocker, on the success rate of semi-rigid ureteroscopy (URS) for the management of large distal ureteric stones. Patients and methods: This prospective study recruited 127 adult patients with single distal ureteric stone of ≥1 cm. The patients were randomly allocated to two groups: the first group included 62 patients who received silodosin (8 mg) for 10 days before URS (Silodosin group), whilst the second group included 65 patients who received placebo, in the form of multivitamins, for 10 days before URS (Placebo group). All patients underwent URS and a pneumatic lithoclast was used for stone fragmentation. Results: The mean (SD) operative time was shorter in the Silodosin group compared with the Placebo group, at 41.61 (4.67) vs 46.85 (4.6) min, respectively. Furthermore, advancing the ureteroscope to access the stone failed in a statistically significant number of patients in the Placebo group compared with the Silodosin group (13 vs two, respectively). The complication rate was significantly higher in the Placebo group compared with the Silodosin group (20% vs 6.4%, P = 0.036). Additionally, the need for postoperative analgesia was significantly lower in the Silodosin group compared with the Placebo group (8.1% vs 26.2%, P = 0.009). Conclusion: Silodosin therapy prior to URS management of large distal ureteric stones seems to be associated with better advancing of the ureteroscope to access the stone, shorter procedure time, higher stone-free rate, lower incidence of complications, and lesser need for postoperative analgesia. Keywords: Silodosin, Ureteroscopy, Ureteric stones, Management

Background & Aims Despite limitations, platelet transfusion has been used to minimise bleeding risk in patients with thrombocytopaenia. Lusutrombopag is an oral, thrombopoietin receptor agonist approved for treatment of thrombocytopaenia associated with chronic liver disease in patients undergoing planned invasive procedures. This post-hoc analysis assessed the magnitude of platelet count change based on the integrated per-protocol population from 2 similar phase III multicentre, randomised, double-blind, placebo-controlled trials. Methods Adults with chronic liver disease-induced thrombocytopaenia and platelet count, Graphical abstract, Highlights • Thrombocytopaenia is common in patients with chronic liver disease. • Lusutrombopag increased platelet count ≥1.5-fold in most patients with chronic liver disease-induced thrombocytopaenia. • Lusutrombopag doubled platelet count in half of patients treated. • Lusutrombopag-induced platelet count increases (without platelet transfusion) lasted for 3 weeks.

Background Spontaneous or fine-needle aspiration biopsy (FNAB)-induced remission of primary hyperparathyroidism (PHPT) is an extremely rare and generally transient phenomenon. Methods A 40-year-old woman with a history of recurrent kidney stones was diagnosed with PHPT (serum calcium, 14.2 mg/dL; parathyroid hormone [PTH], 380 pg/mL). Ultrasonography and scintigraphy findings were consistent with a left enlarged parathyroid. Ultrasound-guided-FNAB cytology of the lesion did not confirm a parathyroid nature. However, levels of PTH within the needle-washing fluid were elevated. Results After few days, there was evidence of biochemical remission of the hypercalcemia (calcium, 8.1 mg/dL), and at subsequent follow-up visits, the enlarged parathyroid showed progressive shrinkage with eucalcemia and normalized PTH levels throughout 12 months of follow-up. Conclusions Rarely, remission of PHPT may occur after ultrasound-guided-FNAB performed on a hyperfunctioning parathyroid lesion.

Background & Aims Personalised risk prediction of the development of hepatocellular carcinoma (HCC) among patients with liver cirrhosis on potent antiviral therapy is important for targeted screening and individualised intervention. This study aimed to develop and validate a new model for risk prediction of HCC development based on deep learning, and to compare it with previously reported risk models. Methods A novel deep-learning-based model was developed from a cohort of 424 patients with HBV-related cirrhosis on entecavir therapy with 2 residual blocks, including 7 layers of a neural network, and it was validated using an independent external cohort (n = 316). The deep-learning-based model was compared to 6 previously reported models (platelet, age, and gender-hepatitis B score [PAGE-B], Chinese University HCC score [CU-HCC], HCC-Risk Estimating Score in CHB patients Under Entecavir [HCC-RESCUE], age, diabetes, race, etiology of cirrhosis, sex, and severity HCC score [ADRESS-HCC], modified PAGE-B score [mPAGE], and Toronto HCC risk index [THRI]) using Harrell's concordance (c)-index. Results During a median 5.2 yr of follow-up (inter-quartile range 2.8–6.9 yr), 86 patients (20.3%) developed HCC. The deep-learning-based model had a Harrell's c-index of 0.719 in the derivation cohort and 0.782 in the validation cohort. Goodness of fit was confirmed by the Hosmer-Lemeshow test (p >0.05). Moreover, this model in the validation cohort had the highest c-index among the 6 previously reported models: PAGE-B (0.570), CU-HCC (0.548), HCC-RESCUE (0.577), ADRESS-HCC (0.551), mPAGE (0.598), and THRI (0.587) (all p, Graphical abstract, Highlights • Personalised risk stratification of HCC among at-risk patients is important for surveillance. • Deep-learning-based HCC prediction model performed better than the previous models, which were based on conventional statistics. • Deep learning method can provide continuous probability results, not a binary result.

Highlights • High-Resolution 3D radial Dixon MRI allows for the creation of quantitative fat fraction images. • Lymph node fat fractions improves diagnostic performance of MRI to detect axillary lymph node metastases. • Lymph node fat fractions are a promising quantitative indicator of metastases in axillary lymph nodes., Purpose To assess diagnostic performance of fat fractions (FF) from high-resolution 3D radial Dixon MRI for differentiating metastatic and non-metastatic axillary lymph nodes in breast cancer patients. Method High-resolution 3D radial Dixon MRI was prospectively performed on 1.5 T in 70 biopsy-verified breast cancer patients. 35 patients were available for analysis with histopathologic and imaging data. FF images were calculated as fat / in-phase. Two radiologists measured lymph node FF and assessed morphological features in one ipsilateral and one contralateral lymph node in consensus. Diagnostic performance of lymph node FF and morphological criteria were compared using histopathology as reference. Results 22 patients had metastatic axillary lymph nodes. Mean lymph node FF were 0.20 ± 0.073, 0.31 ± 0.079, and 0.34 ± 0.15 (metastatic, non-metastatic ipsi- and non-metastatic contralateral lymph nodes, respectively). Metastatic lymph node FF were significantly lower than non-metastatic ipsi- (p

Background Choledochal cyst is an uncommon congenital biliary tract abnormality of unknown etiology. Its classical symptoms are jaundice, abdominal pain, and right upper quadrant mass. However, the disease may present with a vague and non-specific chronic abdominal discomfort. Delay in diagnosis and management may increase the risk of complications particularly the malignancy, which can directly affect the prognosis and outcome. Complete excision of the extra-hepatic duct, cholecystectomy, and Roux-en-Y hepaticojejeunostomy through the open surgical intervention or laparoscopic procedure is the mainstay of treatment. Case Presentation A 14-year-old male was presented to our hospital complaining of vague abdominal pain for 5 years. The radiologic imaging showed the features of a type IVa choledochal cyst. He underwent complete excision of the extra-hepatic duct, cholecystectomy, and Roux-en-Y hepaticojejeunostomy. Although the bile leakage occurred as a complication of the procedure, our team best managed the patient in the post-operative period until full recovery. Discussion The Choledochal cyst was first described by Vater, which is a congenital anomaly that sometimes may remain asymptomatic till adulthood. Surgical intervention is the mainstay of treatment. However, postoperative complications including bile leakage need a close follow-up of the patient. Conclusion Diagnostic delay (antenatal and postnatal) and non-specific symptoms will mask the real feature of the disease, especially in low-resource settings. Technical facilities and professional care of the patient may preclude complications., Highlights • The choledochal cyst is an uncommon congenital biliary tract anomaly. • Early diagnosis and management can directly affect the prognosis and outcome. • Low-resource settings and less symptomatic cases may lead to diagnostic delay. • Open surgery or laparoscopic intervention is the mainstay of treatment.

Objective: To review articles highlighting the effectiveness of conservative laparoscopic ureterolysis as a primary treatment option in patients with ureteric endometriosis and to report on a further three cases. Patients and methods: PubMed, EMBASE, Cochrane database were searched to identify articles reporting cases of laparoscopic management of ureteric endometriosis and, in particular management by ureterolysis. We further described three new cases of ureteric endometriosis managed at our institute. Results: The present study illustrates the significance of laparoscopic ureterolysis in the management of patients with ureteric endometriosis. In our cases, a systematic surgical approach was followed in order to perform complete but careful excision of the all visible endometriotic implants. During follow-up successful treatment was established by relief of hydroureteronephrosis by ultrasonographic evaluation. Conclusion: Considering the risk of loss of renal function and due to the nonspecific symptoms, a prompt clinical suspicion and thorough preoperative assessment can potentially help in the diagnosis. We conclude that laparoscopic ureterolysis is a minimally invasive technique with low complication and recurrence rates. It is a suitable option as a primary approach for selected patients with ureteric endometriosis, if done in a systematic step-by-step approach. Keywords: Ureteric endometriosis, Laparoscopic ureterolysis, Hydronephrosis

This study aimed to identify the characteristics of the vascular network in the superficial subcutaneous layer of the breast and to analyze differences between breasts with cancer and contralateral unaffected breasts using vessel branching points (VBPs) detected by three-dimensional photoacoustic imaging with a hemispherical detector array. In 22 patients with unilateral breast cancer, the average VBP counts to a depth of 7 mm below the skin surface were significantly greater in breasts with cancer than in the contralateral unaffected breasts (p

Despite being first described two thousand years ago, the varicocele remains a controversial multifaceted disease process with numerous biological consequences including infertility, hypogonadism, and chronic orchidalgia. The underlying mechanisms remain poorly understood and likely include hypoxia, oxidative stress, hyperthermia, anatomical aberrations, and genetics as primary components. Despite a high prevalence amongst asymptomatic fertile men, varicoceles paradoxically also represent the most common correctable cause for male infertility. In this systematic review we discuss the rich historical aspects of the varicocele and the contemporary data regarding its clinical manifestations. We performed a systematic literature review with the goal of comparing outcomes and complication rates of each of the major surgical approaches as they relate to infertility and pain. We performed a Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)-compliant systematic literature review for manuscripts focused on varicocele and its biological consequences. We identified 112 studies suitable for qualitative analysis and included 56 of these for quantitative analysis, with an emphasis on infertility and chronic pain outcomes. Taken together, the clinical work to date suggests that the highest fertility rates and the lowest complication rates are associated with the microsurgical subinguinal surgical approach to varicocelectomy. In all, 26–40% of patients undergoing varicocelectomy will successfully achieve short-term spontaneous pregnancy, and up to 90% of all patients undergoing varicocelectomy for pain will have improvement and/or resolution of their symptoms. Taken together, the data support an ongoing role for varicocelectomy in both of these clinical arenas. Keywords: Varicocele, Infertility, Orchidalgia, Hypogonadism, Pampiniform plexus

Highlights • Ultrasonography or CT guided biopsy is useful for diagnosis of liver tumors. • Some tumors were not detectable with any modality except only MRI. • 3D simulation liver imaging can be created with CT and MRI images. • Excisional biopsy using preoperative 3D simulation could provide a certain biopsy. • Present biopsy method is effective for tumors that cannot be detected by CT or US., Introduction The imaging diagnostics of liver tumor are difficult. There are no effective biopsy examinations for liver tumors that cannot be detected even by ultrasonography (US) and computed tomography (CT). We report a remarkably useful biopsy method for such tumors. Presentation of case A 67-year-old man with hepatitis C underwent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, and the images revealed multiple delayed enhanced masses that showed high signal intensity in the hepatobiliary phase. The possibility of malignancy could not be ruled out due to the trend towards increased size of the masses. Percutaneous liver biopsy was considered impossible because CT and US could not detect the masses. Laparoscopic liver biopsy with preoperative simulation using 3D imaging was performed. The 3D imaging provided accurate information of liver surface irregularities with cirrhosis change. The tumor location was confirmed, and adequate tumor excisional biopsy was performed. Histological assessment revealed the tumor to be a focal nodular hyperplasia-like nodule. Discussion and conclusions Laparoscopic liver biopsy has been widely used because of its safety and accuracy. It enables accurate resection of tumors that are undetectable with CT and US by employing preoperative 3D imaging while maintaining the less-invasiveness.

Highlights • An extremely rare early cystic duct carcinoma. • The protruding part was the cause of jaundice. • There is a significant interesting macro findings in the removed sample. • The only small part of the invasive part which reach fibro-muscular layer is revealed by the pathological findings., Introduction Cystic duct carcinoma is a rare disease, and only 33 cases reported worldwide have completely fulfilled the criteria first established by Farrar in 1951. Here we describe an extremely rare case of early cystic duct carcinoma that fulfilled the Farrar criteria, the papillary tumour protruding into the common bile duct, leading to obstructive jaundice. Case presentation A 76-year-old man visited a clinic with icteric conjunctivae, and was referred to our hospital for investigation of suspected obstructive jaundice. He was initially diagnosed as having a distal bile duct carcinoma on the basis of ultrasonography (US), endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiography (MRC), and underwent pancreatoduodenectomy with regional lymphadenectomy. Macroscopic examination showed that the stalk of the papillary tumour originated from the cystic duct, and that the protruding lesion was 50 mm in size. Histopathological examination revealed the tumour to be a papillary adenocarcinoma confined within the fibromuscular layer, with no evidence of lymph node metastasis. Therefore, the final diagnosis was early cystic duct carcinoma. Conclusion To our knowledge, this is the first case report of obstructive jaundice due to early carcinoma of the cystic duct protruding into the bile duct, with characteristics fulfilling the Farrar criteria.

Highlights • We present an rare case of complete spontaneous necrosis of HCC with gross PVTT. • Immune response was thought to be the main cause of total necrosis of our case. • Surgery should be considered for patients with suspected tumor necrosis., Introduction We report a rare case of complete spontaneous necrosis of a hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombosis (PVTT), as confirmed by resection. Case presentation A 64-year-old man was referred to our hospital for suspected HCC. Contrast-enhanced computed tomography (CECT) findings before admission revealed a 53-mm tumor in the posterior segment of the liver and were suspicious for PVTT in the right posterior PV. Both alpha-fetoprotein (AFP) and proteins induced by vitamin K absence or antagonist-II (PIVKA-II) were elevated at 17,562 ng/mL and 153 mAU/mL, respectively. We diagnosed the findings as HCC with PVTT. Seven days after the first CECT scan, we performed CECT volumetry, which revealed that the tumor had regressed to 30 mm, along with regression of the PVTT. We performed portal vein ligation (PVL), and 10 days later, CECT revealed that the tumor had shrunk to 20 mm. AFP and PIVKA-II levels were 643 ng/mL and 14 mAU/mL, respectively. We suspected spontaneous regression of the patient’s HCC, but performed a hepatectomy. Histopathology revealed a 22-mm tumor with a thin fibrous capsule and a tumor thrombus in the PV. Trabecular and pseudoglandular structures consisting of denucleated HCC epithelial cells made up both the tumor and thrombus, and the finding confirmed the spontaneous necrosis of HCC. Conclusions We present an extremely rare case of complete spontaneous necrosis of HCC with PVTT. When spontaneous necrosis is suspected, surgery should be considered because of the potential risk of residual viable cancer cells.

Highlights • A 64-year-old man underwent head and neck surgery for oral squamous cell carcinoma. • Multiple suture granulomas mimicking tumor recurrence developed in the radiation field. • The suture granulomas developed shortly after adjuvant chemoradiation therapy. • Suspect suture granulomas when nodules appear during postoperative radiotherapy. • Suture granulomas may show spontaneous resolution., Introduction Suture granuloma is a benign tumor that develops because of the presence of surgical suture materials. It commonly occurs several years after different types of surgeries. Here we report a case involving a 64-year-old man who underwent head and neck surgery for oral squamous cell carcinoma and developed multiple suture granulomas mimicking tumor recurrence in the radiation field just a few days after the completion of adjuvant chemoradiation therapy. Presentation of case The patient underwent surgery for lymph node metastasis in the neck at 6 months after the resection of primary oral squamous cell carcinoma. Fifteen days after the completion of adjuvant chemoradiation therapy at a total dose of 50 Gy, small nodules appeared in the radiation field, along the areas of the subcutaneous surgical sutures. Cancer recurrence was initially suspected, but histopathological analysis of a biopsy specimen confirmed foreign body granuloma. Discussion Chemoradiation therapy may enhance the immunoreaction of macrophages in the radiation field and promote the formation of granulation tissue in a short period of time. In addition, cisplatin, which was concurrently administered with radiation in our case, could have influenced the development of the suture granuloma. Conclusion In addition to tumor recurrence, suture granulomas should be considered a differential diagnosis for nodules occurring after surgery, even if they develop in the field of radiation.

Introduction and importance A lactating adenoma is a benign breast tumor occurring in young women during pregnancy or lactation. Its growth is usually slow but, occasionally, can become rapid, resulting in a giant mass. This case report outlines an example of the rapid growth of a lactating adenoma, which was surgically excised. In this case, malignancy could not be ruled out, and biopsy and surgical excision were considered. Case presentation We present the case of a 28-year-old woman referred to us owing to the presence of a left breast mass with progressive enlargement. She initially presented with a left breast mass of approximately 20-mm in size, which increased to an approximate size of 70 mm during pregnancy. The patient's mammogram showed an equal-density lobular mass in the left breast. Ultrasonography and magnetic resonance imaging revealed a circumscribed lobular mass with cystic regions in the upper lateral quadrant. The patient was diagnosed with adenosis using core needle biopsy. However, it did not shrink during follow-up, and resection was performed. Histologically, the proliferation of the cystic ducts containing eosinophilic secretions and dilated tubules consisting of cuboidal or hobnail-shaped cells were observed. Clinical discussion Lactating adenoma, phyllodes tumor, and breast cancer are essential differential diagnoses when the size of breast masses increases rapidly. Ultrasonography is the first choice to examine lactating adenomas. Echogenic bands and pseudocapsules are characteristics of lactating adenomas. Conclusion Surgical excision is a notable treatment option when a lactating adenoma exhibits rapid growth or increase in mass, as it could be malignant., Highlights • A lactating adenoma is a benign breast tumor. • It rarely grows rapidly resulting in a giant mass. • When this occurs, differentiation from malignancy is important. • If malignancy cannot be ruled out, surgical excision becomes a feasible alternative.

Objectives: To present the current state of the art in various robot-assisted microsurgical procedures in male infertility and review the latest literature, as the technology in infertility procedures has substantially developed since the incorporation of the Vinci® robotic platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA). Materials and methods: The search strategy in this review was conducted in accordance with Cochrane guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A search strategy was conducted in MEDLINE, PubMed and the Cochrane electronic databases (from 2000 to present) to identify studies that included both robotic and male infertility. Results: In all, 23 studies were found, 12 of which met our inclusion criteria. Articles were excluded if the study did not include both male infertility and robotics. Conclusions: Robotic assistance for microsurgical procedures in male infertility appears to be safe and feasible. It has several advantages including elimination of tremor, multi-view magnification, additional instrument arms, and enhanced dexterity with articulating instrument arms. It also has a short learning curve with a small skin incision. However, larger, prospective studies are needed to establish the clinical benefits over standard microsurgery. Keywords: Robotic testicular sperm extraction, Robotic varicocelectomy, Robotic vasectomy reversal, Robotic vasoepididymostomy (RAVE), Robotic vasovasostomy

Objective: To compare the outcomes of transurethral incision (TUI) and upper pole partial nephrectomy (PN) in patients with duplex system ureterocoele (DSU). Patients and methods: We retrospectively reviewed the medical charts of patients who presented with DSU in the first-year of life and were managed with either TUI or PN. Patientsâ demographics, ultrasonography examinations, voiding cystourethrogram studies, and dimercaptosuccinic acid scans were reviewed. Also, the postoperative vesico-ureteric reflux status and febrile urinary tract infection occurrences, and subsequent surgical interventions were identified. The outcomes for the DSU location (intravesical vs extravesical) were compared. Results: Between January 1995 and September 2015, 44 patients underwent TUI (31 patients) or PN (13). The TUI patients presented at a median age of 1.1Â months and were followed-up for a median of 47.4Â months, whilst those who underwent PN presented at a median age of 1.06Â months and were followed-up for a median of 44.23Â months. Postoperatively, in the TUI group, four of 15 units had improved renal function and 11 units had stable function. In the PN group, five of nine units had stable renal function and the remaining four had worsened function (PÂ =Â 0.019). Furthermore, 15 of the 31 patients (48%) in the TUI group required second interventions compared with one of 13 patients in the PN group (PÂ =Â 0.01). There was no significant difference between the outcomes of intravesical and extravesical DSUs after TUI and PN. Conclusion: This study shows significant renal function preservation with TUI compared to PN. However, secondary surgical interventions were higher with TUI. Keywords: Ureterocoele, Duplex system, Nephrectomy, Transurethral incision

Objectives: To assess the safety and efficacy of bipolar plasmakinetic enucleation and resection of the prostate (PKERP) for the management of benign prostatic hyperplasia (BPH) in patients on oral anticoagulant (OAC) therapy and/or platelet aggregation inhibitors (PAIs). Patients and methods: In all, 91 patients were recruited and underwent PKERP whilst they were receiving PAIs (aspirin, 56 patients; clopidogrel, three; aspirin and clopidogrel, 11). In all, 15 patients were receiving an OAC drug perioperatively, whilst another six patients were on dual PAIs and OACs. The primary outcomes were the perioperative morbidity and mortality rates. The secondary outcomes were functional outcomes including maximum urinary flow rate (Qmax), International Prostate Symptoms Score (IPSS), and post-void residual urine volume (PVR). Results: The mean (SD) age of the patients was 65 (5.9) years, preoperative adenoma volume was 80.9 (30.4) mL, and the operative time was 67 (23) min. No patient developed serious perioperative cardiovascular complications. The mean (SD) duration of hospital stay was 1.79 (1) days and the postoperative catheterisation time was 1.14 (0.76) days. The mean (SD) haemoglobin drop was 0.74 (0.61) g/dL, blood transfusion rate was 2.2%, and the clot retention rate was 2.2%. The mean (SD) postoperative Qmax was 18.6 (4.37) mL/s as compared to 7.2 (3.2) mL/s preoperatively (Pâ¯

Objectives To evaluate factors contributing to bleeding after percutaneous nephrolithotomy (PCNL) and ways of managing this complication, as bleeding is a serious sequela that requires prompt management. Patients and methods The demographic and procedural data of 200 patients, who underwent unilateral PCNL during a 20-month period, were prospectively collected. Preoperative, operative, and postoperative details were recorded. The preoperative variables analysed included: age, sex, body mass index (BMI), the presence of hypertension, diabetes mellitus, serum creatinine, degree of hydronephrosis, previous ipsilateral open renal surgery, stone size and complexity. The operative variables analysed included: number of tracts, operative time, size of Amplatz sheath, type of anaesthesia, and complications such as calyceal and pelvic perforation. Results The variables of age, sex, BMI, diabetes, hypertension, and a preoperative creatinine level of >1.4 mg/dL had no significant effect on blood loss (all P > 0.05). However, the rate of bleeding was significantly higher (P ⩽ 0.05) in patients who had a history of previous open renal surgery, intraoperative pelvicalyceal perforations, and Guy’s Stone Score (GSS) grade 3 and 4 complex stones; however, absence of hydronephrosis, larger stone size, operative time (>83 min), more than one puncture, and size of the Amplatz sheath (26–30 F) did not maintain their significance in multivariate analysis. Conclusion According to our present results stone complexity (GSS grade 3 and 4), history of ipsilateral renal stone surgery, and occurrence of intraoperative pelvicalyceal perforation are alarming variables for post-PCNL bleeding.

Objective: To evaluate the efficacy and safety of immediate versus delayed shockwave lithotripsy (SWL) for inaccessible stones after uncomplicated percutaneous nephrolithotomy (PCNL). Patients and methods: Between December 2011 and June 2014, patients with residual inaccessible stones after uncomplicated PCNL were prospectively randomised into two treatment groups; Group I, immediate SWL and Group II, delayed SWL at 1 week after PCNL. Patients with residual stones of ⩾1.5 cm, a stone density of >1000 Hounsfield units and body mass index of >40 kg/m2 were excluded from the study. The following data were reported: patients’ demographics, stone characteristics after PCNL, hospital stay, perioperative complications, stent duration, and stone-free rate (SFR). Results: In all, 84 patients (51 males and 33 females) with mean (SD) age of 39 (8.5) years were included in the study. Group I included 44 patients, whilst Group II included 40 patients. There was no statistically significant difference amongst the groups for patients’ demographics, stone characteristics, and perioperative complications. The hospital stay was significantly shorter in Group I, at a mean (SD) of 34 (3.7) vs 45 (2.9) h (P

Objective: To investigate the relationship between low birth weight (LBW

Highlights • Partial splenectomy is an alternative to total splenectomy in β thalassemia intermedia. • Partial splenectomy provides the desired hematologic effects. • Partial splenectomy avoids the risks associated with total splenectomy. • Partial splenectomy preserves the integrity of the splenic function., Introduction Thalassemia is a common disease which treatment is often based on splenectomy. The risks associated with total splenectomy stimulated partial splenectomy as a potentially alternative therapy. Case presentation A 45 year-old female patient with long term follow-up for β thalassemia intermedia started to develop signs of hypersplenism and iron overload. A partial splenectomy was performed and was observed a marked hematologic improvement while preserving the desired splenic function. Discussion Partial splenectomy proved to provide a persistent decrease in hemolytic rate while preserving the integrity of splenic phagocytic function, presenting itself as an effective alternative to total splenectomy. After being subjected to partial splenectomy, our patient experienced a sustained control of hemolysis and showed no signs of hypersplenism or iron overload. No splenic regrowth or infectious complications were observed. The major drawbacks of partial splenectomy are the increased risk of intra- and postoperative bleeding, splenic remnant torsion and splenic regrowth. Conclusion Partial splenectomy is an alternative to total splenectomy for the treatment of adult β Thalassemia intermedia patients avoiding the risks associated with total splenectomy.

Highlights • We report an extremely rare case of breast metastasis from RCC. • Including the present case, only 23 cases of breast metastasis from RCC have been described in the literature. • It is important that the differential diagnosis of primary breast cancer and metastatic breast cancer be de determined by histological examination. • Minimally invasive surgery or nonsurgical ablation should be performed in accordance with the prognosis., Introduction The breast is a rare site for metastatic disease. We report a rare case of breast metastasis 9 years after nephrectomy for renal cell carcinoma (RCC) and include a review of the relevant literature. Presentation of case An 82-year-old woman who developed an RCC underwent left nephrectomy in 2005. In October 2014, computed tomography (CT) revealed a mass of approximately 1 cm in the lateral portion of the right breast. Breast ultrasonography (US) revealed a well-circumscribed, hypoechoic mass at the same site. Fine needle aspiration (FNA) was performed, but the sample was inadequate because it did not capture breast duct epithelial cells. In June 2015, follow-up US revealed enlargement of the mass, and core needle biopsy (CNB) was performed to confirm the diagnosis. Histological examination resulted in the diagnosis of breast metastasis from an RCC. The patient underwent surgery for partial mastectomy in November 2015. The patient was asymptomatic and free of detectable disease at 18-month follow-up. Discussion The diagnosis of breast metastasis by imaging examination is difficult, and the results of FNA examination are often inconclusive because of the absence of breast duct epithelial cells. Only 22 cases of breast metastasis from RCC have been described in the literature. In almost all the reported cases, lumpectomy or partial mastectomy was performed. Conclusion It is important that histological diagnosis be determined by CNB and by other methods if the patient has a history of malignancy, and minimally invasive therapy should be performed in accordance with the prognosis.

Highlights • Maintenance of adequate portal inflow is essential for the graft regeneration in adult LDLT. • Portal inflow steal may occur due to presence of huge spontaneous porto-systemic collaterals. • If the portal inflow to the liver graft is inadequate after adult LDLT, post-transplant impairment of the graft regeneration and eventually graft failure would occur. • A surgical procedure to increase the portal inflow is rarely necessary in adult LDLT. • We report a case of prophylactic surgical interruption of spontaneous huge porto-systemic collateral to prevent PFS during adult LDLT procedure., Introduction In adult living donor liver transplantation (LDLT), maintenance of adequate portal inflow is essential for the graft regeneration. Portal inflow steal (PFS) may occur due to presence of huge spontaneous porto-systemic collaterals. A surgical procedure to increase the portal inflow is rarely necessary in adult LDLT. Presentation A 52 years male patient with end-stage liver disease due to chronic hepatitis C virus infection. Preoperative portography showed marked attenuated portal vein and its two main branches, patent tortuous splenic vein, multiple splenic hilar collaterals, and large lieno-renal collateral. He received a right hemi-liver graft from his nephew. Exploration revealed markedly cirrhotic liver, moderate splenomegaly with multiple collaterals and large lieno-renal collateral. Upon dissection of the hepato-duodenal ligament, a well-developed portal vein could be identified with a small mural thrombus. The recipient portal vein stump was anastomosed, in end to end fashion, to the graft portal vein. Doppler US showed reduced portal vein flow, so ligation of the huge lieno-renal collateral that allows steal of the portal inflow. After ligation of the lieno-renal collateral, improvement of the portal vein flow was observed in Doppler US. Discussion There is no accepted algorithm for managing spontaneous lieno-renal shunts before, during, or after liver transplantation, and evidence for efficacy of treatments remains limited. We report a case of surgical interruption of spontaneous huge porto-systemic collateral to prevent PFS during adult LDLT. Conclusion Complete interruption of large collateral vessels might be needed as a part of adult LDLT procedure to avoid devastating postoperative PFS.

Objectives To identify factors predicting renal recovery in patients presenting with renal failure secondary to bilateral obstructing urolithiasis. Patients and methods Data from electronic records of consecutive adult patients presenting with bilateral obstructing urolithiasis between January 2007 and April 2011 were retrieved. Ultrasonography of the abdomen, and kidney, ureter, bladder (KUB study) X-ray or abdominal non-contrast computed tomography confirmed the diagnosis. Interventional radiologists placed bilateral nephrostomies. Definitive intervention was planned after reaching nadir creatinine. Renal recovery was defined as nadir creatinine of ⩽2 mg/dL. Results In all, 53 patients were assessed, 50 (94.3%) were male, and 18 (33.9%) were aged ⩽40 years. Renal recovery was achieved in 20 patients (37.7%). A symptom duration of ⩽25 days (P 16.5 mm (P = 0.001), and haemoglobin >9.85 g/dL (P

Objective To evaluate surgical outcome, complications, and patients satisfaction with the Tube® (Promedon, Cordoba, Argentina) malleable penile prosthesis in diabetic and non-diabetic patients with refractory erectile dysfunction (ED). Patients and methods The records of 128 eligible patients who received Tube malleable penile prostheses at our institute between September 2008 and October 2015 were reviewed. Results Of the 128 patients, who received Tube penile prostheses at our institute, 53 were diabetics and 75 were non-diabetics. Both groups of patients were comparable for mean age, education level, marital status, hospital stay, time to commencing sexual intercourse, and median follow-up. Complications included: inter-corporeal septal perforation (2.3%), glanular urethral injury (1.5%), acute urinary retention (3.9%), superficial wound infection (7%), penile discomfort (9.4%), and penile prostheses infection (5.5%). Moreover, 3.9% developed atrophy of the cavernosal tissue, 5.5% experienced bad cosmesis, 6.3% experienced ejaculatory disorders, and 2.3% developed bladder calculi. In all, 13 prostheses (9.4%) were removed, seven of them due to infection, three on the patients’ demand and three due to mechanical failure. The satisfaction rates with the prostheses were 77.3% and 79.4% in the diabetic and non-diabetic patients, respectively; with an overall satisfaction rate of 78.5%. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. Conclusion Tube malleable penile prostheses are associated with low complication and high satisfaction rates. There was no significant difference in the complication rate or prostheses infection between diabetic and non-diabetic patients. A prospective comparative study with a large number of patients is recommended.

Highlights • A hepatic schwannoma is extremely rare and difficult to diagnose preoperatively. • We attempted to gain the radiological feature of the hepatic schwannoma by reviewing case reports. • If the hepatic tumor is diagnosed as a schwannoma preoperatively, surgical resection is highly recommended., Introduction A hepatic schwannoma is extremely rare and difficult to diagnose preoperatively. Presentation of case We report the case of a 47-year-old male patient who was referred to our hospital for the close investigation of a hepatic tumor which had not been detected two years earlier. An enhanced computed tomography revealed a well-circumscribed and encapsulated tumor with a size of 50 mm which was adjacent to the inferior vena cava (IVC) and the right hepatic vein. The tumor was heterogeneously enhanced until the equilibrium phase. A magnetic resonance image showed a hypointense area on a T1-weighted image and a hyperintense area on a T2-weighted image. These findings differed from those of common malignant hepatic tumors, such as hepatocellular carcinoma and colorectal liver metastases. The tumor was most likely a mucus-producing tumor or a liquefactive degenerated adenocarcinoma. Although we could not confirm an exact diagnosis of the tumor, we performed a surgical resection in view of the possibility of malignancy. The patient underwent a limited liver resection with resection of the IVC. Histologically, the tumor was diagnosed as a benign schwannoma comprised of Antoni A and B areas. The nuclear palisading formation of the tumor showed Verocay bodies. Discussion 15 cases of hepatic schwannoma are reviewed to clarify the typical radiological features. The radiological findings of the present case were consistent with those of the hepatic schwannoma when considering retrospectively. Conclusion A precise preoperative diagnosis of hepatic schwannoma is difficult, and liver resection is recommended when a hepatic schwannoma is suspected.