title: Misdiagnosed or Incidentally Detected Hepatocellular Carcinoma in Explanted Livers: Lessons Learned.
abstract: BACKGROUND
  Misdiagnosed or incidentally detected hepatocellular carcinoma (HCC) in liver explant is an undesirable surprise that might pose a medical challenge in the post-transplant setting.
  
  
  METHODS
  From May 2001 to the end of December 2013, 463 and 137 liver transplants for adult and pediatric patients, respectively, were performed at our center. Ten cases were found to have misdiagnosed or incidental malignant lesions on pathological examination of the explant.
  
  
  RESULTS
  We considered 105 patients for LT because of presence of HCC; 102 patients were accurately diagnosed by pretransplant imaging and the other 3 patients were misdiagnosed as HCC and then found to have mixed HCC-cholangiocarcinoma (CC) (2.9% misdiagnosis rate). Seven more patients were found to have i-HCC in explanted livers. Therefore, 109 patients were transplanted for presence of HCC (6.5% of them diagnosed incidentally). The overall rate of incidental HCC (i-HCC) among all liver explants was 1.2%. In the adult group no subjects had HCC recurrence, while only 1 subject had HCC recurrence in the pediatric group. All mixed HCC-CC lesions were found in adult patients. Two patients died from recurrence of cholangiocarcinoma after liver transplant. The other patient is still surviving with no recurrence at 13-month follow-up.
  
  
  CONCLUSIONS
  Misdiagnosed or incidental malignancy is a rare but reported finding following liver transplantation. Their preoperative suspicion is quite challenging. A thorough explant pathology study is needed to diagnose this condition. It is evident that the outcome of this undesirable finding was judged mainly by tumor biology.
authors.affiliation: Department of Liver Transplantation and Hepatobiliary Surgery, Organ Transplant Center, King Faisal Specialist Hospital And Research Center, Riyadh, Saudi Arabia.
authors.forename: Mohamed Rabei
authors.initials: MR
authors.lastname: Abdelfattah
authors.affiliation: Department of Liver Transplantation and Hepatobiliary Surgery, Organ Transplant Center, King Faisal Specialist Hospital And Research Center, Riyadh, Saudi Arabia.
authors.forename: Faisal
authors.initials: F
authors.lastname: Abaalkhail
authors.affiliation: Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
authors.forename: Hadeel
authors.initials: H
authors.lastname: Al-Manea
mesh_terms: D000293:Adolescent; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D018281:Cholangiocarcinoma / Q000473:pathology*; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D033162:Incidental Findings; D007223:Infant; D008099:Liver / Q000473:pathology*; D008113:Liver Neoplasms / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D014019:Tissue Donors; D055815:Young Adult