PROPHYLACTIC SURGICAL REMOVAL OF ASYMPTOMATIC LARGE PEDUNCULATED HEPATIC FOCAL NODULAR HYPERPLASIA IN A DOG

Abstract

A Shetland sheepdog was referred to us for splenomegaly. Blood examination revealed elevated activities of hepatic enzymes. Computed tomography revealed a hypoattenuated splenic mass and a large hepatic mass (size: 97 × 81 × 31 mm) connected to the left lateral lobe by a pedicle and iso-attenuating to the normal hepatic parenchyma. Imaging findings of the liver mass were consistent with benign changes. Surgical resection and definitive diagnosis through histopathological assessment were performed. Intraoperatively, partial torsion of the pedicle was observed. A thoracoabdominal stapler was used for resecting the pedunculated liver mass. Diagnoses of splenic hematoma and pedunculated focal nodular hyperplasia of the liver were confirmed and surgical resection normalized the hepatic enzyme levels and eliminated the risk of rupture and torsion. This is the first report of a pedunculated focal nodular hyperplasia with a size of > 5 cm and good clinical outcome after surgical resection in a dog. In veterinary medicine, there is no definitive indication for the resection of pedunculated hepatic nodular hyperplasia. Even without imaging evidence of torsion or rupture of large pedunculated liver masses, it is important to consider prophylactic removal.

Profilaktična kirurška odstranitev asimptomatske velike pedunkularne žariščne nodularne hiperplazije jeter pri psu

Izvleček: Šetlandski ovčar je bil na kliniko napoten zaradi splenomegalije. Preiskava krvi je pokazala povišano aktivnost jetrnih encimov. Računalniška tomografija je razkrila hipoatenuirano maso vranice in veliko jetrno maso (velikost: 97 × 81 × 31 mm), ki je bila s pediklom povezana z levim stranskim lobusom in izoatenuirana z normalnim jetrnim parenhimom. Slikovni izvidi jetrne mase so bili skladni z benignimi spremembami. Opravljena je bila kirurška resekcija in s histopatološko preiskavo je bila postavljena dokončna diagnoza. Med posegom je bila opažena delna torzija pedikla. Za resekcijo jetrne mase je bil uporabljen torakoabdominalni spenjalnik. Diagnozi hematom vranice in pedunkularna žariščna nodularna hiperplazija jeter sta bili potrjeni, kirurška resekcija pa je normalizirala vrednosti jetrnih encimov ter odpravila tveganje za rupturo in torzijo. To je prvo poročilo o pedunkularni žariščni nodularni hiperplaziji z velikostjo > 5 cm in dobrim kliničnim izidom po kirurški resekciji pri psu. V veterinarski medicini ni zanesljive indikacije za resekcijo pedunkularne jetrne nodularne hiperplazije. Tudi brez slikovnih dokazov o torziji ali rupturi velikih pedunkularnih jetrnih mas je pomembno razmisliti o njihovi preventivni odstranitvi.

Ključne besede: pedunkularna jetrna masa; žariščna nodularna hiperplazija; pedunkularna žariščna nodularna hiperplazija